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^A Transcriptionist's Tale Irena Rusenas As a medical transcriptionist I became intrigued by the voices of dictating doctors; hundreds of doctors confessing thousands of sins against the body through my ears to my fingers. During the night shift tales of innumerable transgressions flowed on a stream of voices through a human conduit onto appropriate Mother of Mercy Metropolitan Hospital forms: abortions, amputations, chest pains, heartaches, hernias, back aches, carcinomas, mastectomies, vasectomies , hysterectomies. More patients in an evening, it sometimes seemed, than one physician might follow through a month. Most words for the medical record are identical from one patient to the next (heart, regular rate and rhythm; chest, clear to auscultation and percussion). They are chanted like a litany. And like a litany of patient bodies, let us heal them, broken bones, let us heal them, bleeding ulcers, let us heal them, breaking hearts, let us heal them, removable parts, let us take them, they lull the listener into a semi-hypnotic state. A state in which I sometimes felt myself an extra presence in the examining room bearing witness as the doctor questioned, tested, palpated . While words slipped like rosary beads past practiced fingers to create the H&P, Op, Path, D/C reports, the transcribing station would contain the patient, his family, nurse, pathologist, phlebotomist, diagnostic equipment, resident, as well as the turns of medical mind of the dictating doctor. We were all gathered in a cubbyhole of time: the patient, doctor, myself, the past, the prognosis. The cubicle became a nexus and the whole universe associated with each illness, its onset, presentation, diagnosis , hummed through me by way of the voice. Transcriptionists are blind in that they seldom see the doctor or the patient. Among the standard forms and multi-syllable language, the voice is the only real sensory variable. And in the way a blind person becomes aware of odors and motions and textures we who see don't seem to need to notice, I became acutely aware of nuances: pitch, pauses, changes in volume, in cadence of the healer's voice. After hours it became like a current carrying directly to the physician's mind, and when it Literature and Medicine 11, no. 1 (Spring 1992) 84-85 © 1992 by The Johns Hopkins University Press Fiction and Poetry 85 hesitated, rephrased, rose in pitch it was through tributaries of alternative thought we travelled. The invisible troubador told more than cushioned ear plugs could transfer to the typewriter. Truths are generally spoken quietly and clearly—a candid observation has its own music, the words themselves suffice; faith hardly needs grace notes or fortissimo. I know the words I shout (or whisper) are usually not the words I mean to be saying. But it's easier to shout, "Why don't you take the garbage out for a change!" than to say, "You work all the time and I'm hurt and afraid that maybe you don't like me well enough to spend time together anymore." Anyway , that's what I mean about hearing more on the tape than showed up in the legal document of each body's burdens. A certain counterpoint to the Gregorian hymns seemed to emerge. Not from staccato statements, crisp, direct: lower right quadrant pain, high white count, prep for appendectomy. These were a siren route from thought to page to chart; speed, intensity, emergency communicated, obvious, appropriate. It was the searching voice, usually in younger residents still being incorporated into the choir of current medical practice that led me to wonder if there weren't tunes that the standard hymn of medicine couldn't adequately transpose for everyone seeking treatment . Perhaps the voice faltered when it had no score according to its training to plainly cant what seemed a cause and appropriate course for some complaints. A complete history and physical, like a medical résumé, a corpus vitae, describes the story of a life. With practice, in the rhythm of the voice, as the shape of the body appears on paper, the spirit breathes in the story of the flesh. ...

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