What I was born to do

Medical transcription was my calling. Why did I leave it?

I followed a boyfriend to Iowa City the moment I graduated from college. He already had an apartment and a stack of reading for his graduate program in film theory. I had a degree in cultural anthropology, a collection of vintage lamps, and idealism. I was certain everyone would be clamoring to hire someone with an undergraduate degree in cultural anthropology and that my new life as an NGO hero/writer/actress would take off like a goldfinch, Iowa’s state bird.

Photo by Joshua J. Cotten on Unsplash

Fast forward a few months and my search for a job was flatlining, so I signed up with a temp agency. Would I like a three-month assignment in the gastroenterology department of the big hospital as a medical transcriptionist? Yes. Of course I would. Did I know medical terminology? No. But I was runner up in my second grade district spelling bee.

Not according to plan, according to Doris

This was not the job I'd hoped for. I wanted to be a writer or an actress or a nongovernmental organization hero feeding the world. But, funny thing about those goals: I hadn’t yet learned that you have to work your way up, that you can’t just start out amazing. This was the early 1990s. It wasn't like it is now, when kids have resumes a mile long before they even graduate. I didn't know a single person who'd done an internship. To my shock, rejection letter after letter piled up. So I took the gig.

On my first day, I met Doris, my supervisor. She pointed out my new home: a tiny table with a terminal in the corner. A green cursor was flashing on the black screen.

"And this is the tank!” she said.

She was practically beaming at this toaster oven-sized machine made of beige metal, with knobs and buttons, and it had a small screen showing a blinking number. That, she said, was the number of doctors’ dictations waiting to be transcribed. Next to the tank was a pair of headphones, and beneath, two foot pedals, one to slow and one to speed the sound of a doctor’s voice.

Medical transcription today…and yesterday

Today, doctors type up patient notes on computers right in front of you, or a professional "scribe" takes notes about the procedure right in the room, so the doctor doesn't have to recall what was done after the heat of the moment.

But back then, in the mid-90’s, here’s how it worked: after every visit with a patient, doctors called a phone number and read or just riffed notes about the visit or procedure. My job was to transcribe each dictation, put a printed copy in the doctor’s mail slot for proofreading, correct the draft, and place the final in a mail slot for someone to file in the patient’s medical record. No electronic medical systems here. No AI. Just human to tank to human.

Week 1: This is doctor blob-itty-blob

My first week, I mastered the mechanics of the tank and the basics of the job. I arrived early with my coffee mug. I said hello to Doris. I noticed the immovability of her fluffy brown helmet of hair. I turned on my computer, pulled up a blank dictation template on my computer, put on my headphones, positioned the foot pedals, pressed play, and typed what I heard, word for word.

A typical dictation lasted several minutes. It all depended on the complexity of the procedure, and the doctor’s style. They sounded something like this:

“This is doctor blob-bitty-blob. It’s 8 p.m. Monday, August 13. Forty-four-year-old male presenting with a spear of dried mango lodged in esophagus and distended abdomen. Endoscope was inserted and advanced towards the duodenum. Duodenoscopy confirmed a 3 centimeter subepithelial tumor at the Vater’s papilla. The scope ret-. Let me start that over. A flexible sigmoidoscopy was initiated at 8:30 am. Upon rounding the, the, the, the distal esophagus, ulcerative colitis was appreciated. OK that's it.”

Now imagine it in an Israeli accent, or a Russian accent. Imagine a fast talker. Or a short hander. Flexible sigmoidoscopy? Flex sig. Esophagogastroduodenoscopy? EGD.

Several times during the first couple of days, I gave up. I paused the tank, pulled off my headphones. I had never heard most of the medical terms, so I took my best stab at the spelling. But it was taxing. Doris red-lined lots of drafts.

Week 2: This is perfect!

Then, after a couple of days, something just clicked. A code cracked.

I didn’t need the slow-down pedal.

My fingers flew in perfect cadence with the doctor’s voice, as if we spoke the same strange language. I could see the words in my head as I heard them. My dictation copies quickly came back with hardly a correction. One doctor wrote “I can’t believe it! This is perfect!” followed by several exclamation points. Plus, I was fast. I guess they’d had some bad experiences with transcriptionists before.

Photo by Marcus Urbenz on Unsplash

Here was the magic for me: It had been a while since something had come easily to me, since I'd won such easy praise. It felt good.

Doris did not seem delighted. She had been at the job for more than 10 years and wasn’t nearly as fast as I was. She suddenly found more time to instruct me.

That bugged me, but what annoyed me more was anything that got between me and the tank. Doris was that thing. I’d be typing along, my fingers like flames on the keyboard, and Doris would straddle her office chair and foot-paddle herself over to chat. She had a lot to say, mostly about church pancake breakfasts.

After only six months in Iowa City, my 10-point master plan for being an adult was not working out. Number one, a job that involved changing the world eluded me. Number five, love - ugh. My boyfriend had begun to criticize nearly every move I made. He watched me washing the dishes one day and clutched his pearls over how I put them in the rack with suds still slipping down the back. He observed how much cheese I ate and noted the risk of high cholesterol. I started staying out later at the bar. He went to bed early.

Time to face the truth

Then my three-month temp contract came to an end, and the gastroenterology department offered me a permanent job. I had applied for dozens of other jobs—and nothing. I had auditioned for exactly one play and not been cast. I had taken a short story class for no credit, for which I wrote exactly one story that no one in class liked. I remember asking the adjunct whether I should keep going. Instead of giving me the pep talk I expected, he simply said either you keep trying or you don't.

As I mentioned, at 22, I didn't like the idea of having to practice.

But it just so happened that I was a phenomenal medical transcriptionist. I nailed every beautiful gastrointestinal word without a dictionary, words too beautiful for what they described.

And then it hit me: Lord, what if I were born to be a medical transcriptionist? What if this is the answer to everything that has ever and will ever ail me?

I had to make a decision. Stick with what comes easily or try for what you really love, even if it’s harder.

What if I were still emptying that tank?

I’m here to tell you that part of me wishes I had taken that full time job. There’s a kind of satisfaction in completing your work, of emptying that tank, every day, and going home, a kind of medicine in it for the existential crisis roiling just under the surface. There’s something to be said for doing something you’re damn good at, even if it’s not what you thought you’d be doing. These days, at my corporate job, I never get it right the first time. Nothing goes from human to tank to human to inbox to sign off to file cabinet. Finito.

Today I understand the value of working hard. Of practicing your craft. Of having a job that doesn’t come too easily is a good thing. How else do you grow if you don’t fail? Couldn’t I see that emptying that tank was actually draining my own?

But every time I see a long and and barely pronounceable medical term, I think, what if? Doris would be long gone by now, and I’d have that place to myself.