Oh, Say, Can You See?

Like many Jewish children who grew up in Brooklyn, I was encouraged to learn how to play an instrument. When one of my uncles (the musician in the family) started giving my sister piano lessons, I demonstrated a knack for sitting at the piano and playing what I heard. But in those days, the ability to play by ear, transpose music from one key to another, and have the dexterity to navigate a keyboard at an early age was only viewed from a musical perspective. As a child, I loved playing piano. Until I discovered a different kind of keyboard.

In an era when boys were told that they should never learn how to type (that was strictly “girl stuff”) I rapidly accelerated to a speed of 70 words per minute on a manual typewriter. Later, when I ran the office for a YMCA sailing camp, the program director – a burly football coach who envied my typing ability– always used to tease me. But one day he said something which stuck in my mind forever. “Just remember that whenever you get into trouble, those fat little fingers of yours are going to save your life.”

Having graduated from college in an era when students were urged to “get a liberal arts education because it means you can do absolutely anything” (except get a job), my typing skills were always welcomed by temp agencies. Those fat little fingers led me on adventures in banking, air freight, manufacturing and accounting. In 1974, when I answered an ad for a fast typist, I found myself learning medical terminologyunder the keen eye of a former medical editor who also belonged to a local witch’s coven. It was a pretty good match: I thought I could learn some new words to use while playing Scrabble. Rosie liked the idea of having a wise-ass ex-New Yorker on the premises.

So, with my fat little fingers as my strongest professional credentials, I was given a chance to develop and hone a new skill.

Over the ensuing years I worked in hospitals, transcribed for court reporters, and developed a career as a freelance arts critic. Once, when I dropped by St. Luke’s Hospital to say hello to the people I used to work with, Maria (a crazy old Mexican transcriptionist) looked up and said “Oh, hi, George. I was just thinking of you. Come andtake a look at what I typed.” I peered down at the report in her typewriter and read “The patient had a noticeable case of anal wink.”

Things kept going well until 1990 when I tried to launch an opera magazine. Everything that could go wrong did. Suddenly, I found myself head over heels in debt, without any income, and terrified of becoming homeless. California’s economy was in the toilet, jobs were scarce, and after 15 years of writing about opera, I had no idea what I might be qualified to do. When a gym buddy reassuringly said “Don’t worry, a door will open,” I was so terrified and depressed that I wanted to punch his lights out. But he was right.

Two weeks later, when a door opened, I was lucky enough to recognize the moment and seize it. I picked up the Sunday classifieds and started to read the“Help Wanted” ads from A to Z. The last time I had done this was in 1970 in Providence, Rhode Island (when jobs involving typing or secretarial skills paid slave wages and were listed under “Help Wanted – Female”). Although the gender classifications had since disappeared, the job leads were still pretty dismal. Until I came to a listing for medical transcriptionists.

I kept coming back to that ad time and again until I finally remembered that some 16 years ago (in what seemed like another lifetime), I had learned how to do medical transcription. Could I do it again? Could I work my way out of my depressed state and California’sdepressed economy? Could I continue to work from home?

I was lucky. Oh, was I ever lucky. The woman who interviewed me started to explain how computers were impacting the field of medical transcription -- which fascinated me. When I told her about my career as an opera critic, she started to talk about her passion for playing the viola. I didn’t do poorly on her test for aspiring MTs but, because Janet had designed the test herself, she saw that some crucial errors I had made (spelling a word “parametal” instead of “pyramidal”) could be rectified. Because she had faith in my intelligence and my ability to learn (and was eager to have someone with whom she could talk about classical music), she gave me a chance. Once again my fat little fingers had saved the day.

And so, while Desert Storm raged on in the Middle East, I sat in a suburban office and kept transcribing until management felt confident that I could start telecommuting. I introduced a friend’s lover to medical transcription, agreed to mentor him, and when he tested for Janet, she hired him as well.

In 1992, Tom and I launched our own company. Exactly seven years later, fate came knocking on my door. In January of 1999, I received a phone call from a woman who had been referred to me by another transcription service. This woman used to do medical transcription work but had been away from it for about 16 years. She knew her computer very well and was willing to purchase any software she needed to work with us. All of Marsha’s answers were very upbeat and positive. All she wanted was a chance to get back into medical transcription. It all sounded very promising. And then she said the magic words. “There’s one thing I have to tell you – I’m blind.”

Her statement was simple, honest, and could put any business owner to the test. But once again, I was lucky. Throughout my years as an opera fan I had been friends with a woman who was legally blind but attended more performances than most people who were fully sighted. A close friend who had been like a second mother to me when I lived in Providence was losing her sight because of macular degeneration. I had traded e-mails several years prior with a woman named Rose in Phoenix,who was a blind medical transcriptionist. And my friend, Judith Marshall, had told me about her experiences in Boston teaching blind medical transcription students as part of a program run by the Commonwealth of Massachusetts.

Sometimes fate allows you to choose your challenges and a unique one had just fallen into my lap. I could take it or leave it. I knew that blind people could transcribe. The real question was whether, as a small business owner, I could spend the time it would take to mentor a blind transcriptionist who (a) would be working as an independent contractor, and (b) telecommuting from her home. When I called Judith Marshall to ask her for some input, we discussed the pros and cons of thesituation. “All that the blind are really asking for is a chance – the same as everyone else,” she stressed. “Just give them a chance.”

That I could do. After all, where would I have ended up if Janet Photinos hadn’t given me a chance? So I called Marsha back and we agreed on the following set of rules.

• She would come to my office for an interview, the same as any other potential subcontractor.

• We would discuss the situation in person so that we could each get a feel for each other.

• If she were to work for our company as an independent contractor, she would have to be responsible for any and all maintenance work on her computer, even if it meant hiring a computer consultant to install programs and configure things for her.

• We would both agree that any criticisms or corrections were not to be interpreted as having any kind of personal meaning.

• If at any time I used language that was insensitive or inappropriate to working with a blind person, she would let me know in no uncertain terms.

Thus, we set out on a new adventure. After Marsha arrived via taxi with her seeing eye dog, I explained how some of the newer electronic tools (Stedman’s Medical & Pharmaceutical Spellchecker, Electronic Medical Dictionary and the electronic version of the Quick Look Drug Index) could be invaluable instruments to help her in her work. When I asked about her prior employment, I discovered that we had worked for the same company. When I learned that she, too, had been trained by Janet Photinos, the decision to work with a blind MT became much easier for me. If this woman’s work was good enough for Janet, it would probably be good enough for me.

Marsha then explained how blind people work with a program called “Jaws for Windows,” which reads everything on the screen to them (from text in a document to drop-down menus and button choices) using a process that is the exact opposite of voice recognition. Instead of converting voice to text, Jaws converts text to voice and plays it back to the listener. I demonstrated how our macros and templates worked (trying to explain what she could not see)and then asked how I could prepare a manual for her that would help her get used to our software.

That’s where we ran into our first challenge. Certain pieces of software pose specific challenges to the blind. AOL’s interface, for example, is strongly oriented to pointing and clicking on graphic images. While its drop-down menus may have keyboard commands, its mail functions do not. In a similar vein, the dialog boxes created by our macros in WordPerfect for Windows do not contain keyboard commands which uniquely identify each field in a dialog box. What seemed like an instant roadblock was simply solved by giving Marsha samples of each dialog box and identifying what went into each field in the exact order in which she would encounter the fields.

As we started working together, most of our problems revolved around file management and keyboard command issues. I quickly earned that, when working with the blind, you have to be extremely precise when giving directions. However, a blind person’s visual handicap may be compensated for by an acutely heightened sense of hearing. The blind often get used to certain voices much more easily than those who are sighted. They work very well from vocal input.

Because their lifestyle must depend on memorizing a lot of detail (where things are, where they were left), blind people may work better with certain types of computer programs that depend on specific commands. If a process is logical and repetitive, they adapt to it very well. As a result, medical terminology is not always a major problem. However, the correct spelling of local streets (a blind person would never have seen the street sign) and the spelling of certain names may take a little extra work.

During our tech support phone calls, I got used to the cacophony of Marsha’s expletives and grunts of frustration combined with Jaws for Windows quacking away in the background. When trying to solve a problem over the phone, I quickly learned how futile it was to say “right click with your mouse” or “double click on that” because what would be easy for a sighted person to do didn’t translate to how a blind person interacts with her computer. Dragging and dropping files was best accomplished by having Marsha go to a DOS prompt while I dictated DOS commands over the phone. Because I didn’t know the keyboard commands necessary for certain Windows-based tasks, there were many moments when I was the one struggling with a handicap.

Of course there were some unforeseen problems. There was a period of time when Marsha would hit a sequence of keystrokes that caused an unintentional block indentations. Certain things that a sighted person would automatically fix (false indentations, orphaned paragraphs, split signature blocks) were invisible to her and will always require proofing. When her computer became infected with the Melissa virus, there was nothing I could do except wait for a computer consultant to arrive on the scene and get her up and running again. But her basic transcription skills were never at issue.

As a business owner I learned a lot from this experience. Obviously, the learning curve for a blind MT starting to work for a new business is substantially longer than for someone who is sighted. I also had to make sure that any accounts I asked Marsha to work on required little in the way of specialized formatting. But when dictation piled up, she demonstrated that she could be a real work horse, churning out as much as (or more than) other subcontractors. I don’t know how long it took her to do the work. Nor do I want to know. All I know is that I was able to provide her with work and she was able to deliver it to me on time. After a 90-day learning period, she is routinely transcribing about 700 minutes of recorded dictation per month on a quality assurance level that is equal to your average sighted medical transcriptionist.

There is no doubt in my mind that because I live in San Francisco – where diversity is celebrated and there are many programs to help the handicapped – my decision to take a chance on a blind medical transcriptionist was made easier. The decision was helped by the fact that I knew some people who were blind and had heard about medical transcriptionists who are blind. I was much more predisposed to working with Marsha because, at that time, I was also involved in a collaborative effort between the Golden Gate Business Association and San Francisco’s Positive Resource Center (which helps people with HIV re-enter the workplace).

As a business owner, I was slightly more educated about working with a disabled person who is battling a physical handicap. And, as I mentionedat the beginning of this article, there was a curious element of fate and “personal payback time” involved in my decision. But, when I attended the Medical Transcription Industry Alliance’s conference in April, I noticed something very peculiar. In one session after another, business owners bemoaned the lack of qualified transcriptionists. Yet none of the MTSOs I queried (representing companies much larger than my own) were looking to the blind community as a possible source of qualified labor.

There’s no question that the mentoring required to bring a blind transcriptioniston line is more intense and personal than it might be for a sighted MT. But if the blind person’s skills are strong, there is less likelihood that she will go employer-hopping. When all is said and done, the challenge is not restricted to accommodating a worker who might be blind. The burden of proof may lie with an MTSO who is blind to a qualified handicapped worker’s potential.