Wednesday, April 1, 2009

Not An April Fool's Joke

Camptown Ladies by Kara Walker (Camptown Ladies, paper cut by Kara Walker)

Hi, y'all. I've been fasting in terms of news and analysis, not just the dreadful network coverage, but also from even many progressive blogs. It seems like almost everybody is scared and instead of calmly admitting that, letting the fear work its way out, and using humor/kindness/connection to keep our spirits up, folks are trying to think their way out of a grim situation. The problem is, being scared shitless doesn't lend itself to clear thought. I know the Hollywood version is that a hero somehow magically knows what to do under pressure, the exact right button to push, and this is the example we're supposed to emulate. But most Hollywood heroes are morons in every other part of their lives, blocks of wood with two facial expressions in their toolbox, and I simply don't buy the myth that they have intelligence on reserve somewhere.

Further, too many of the people yammering away at us are the very ones whose belief system created the mess we're in, and I'm not going to trust their solutions. They want the system not to fail, but it has already failed. Epic Fail. I wish we'd all just stop tuning in to them. I'm sick to death of reading progressive blogs reporting on the drek coming from the liars and manipulators whom they damned well know are such -- it's not enough to know, you also need to stop giving them any attention whatsoever. No reinforcement at all.

What I already understand is enough to help me chart a new course:

(1) The system of growth at all costs has failed. Sustainability is now upon us.
(2) There was never as much money as they pretended there was in order to keep making profits from manipulating money. It ain't coming back.
(3) If we stop being the world's consumers, we have to come up with another reason why we are valuable. I vote for integrity, pluralism, and human liberation, how's that sound?
(4) If we give up the addictions of consumption and overstimulated attention spans, we have to choose recovery and work it instead of the Dubya method.

Obama is not FDR. He's doing some things well, others less well, and comparing him to Dubya is pointless because I have a used tampon which could do a better job than Dubya did. Obama and the folks he's choosing as administrators of his vision are not going to come up with a new way of doing things. He was crystal clear about that all along. He will find practical ways to keep things as they are, more functional but essentially unrevised. The good part of his methodology is that it will keep folks from starving and dying, a trend the Bush administration absolutely was not going to ever intervene to stop. This will buy some time for real visionaries to create and implement change. That's us, the Peanut Gallery. So don't get caught up in the minutiae of this period -- stoke your coals for the long haul and the big dreams.

Now, of course, it's important I own where I stand personally. I live knee-deep in the floodwaters. I have no more physical slack, most days, than you could find in a Nyquil dispensing cup. My health issues have taken a turn for the worse over the last month, making my daily burden -- oh, hell, I can't even describe it. You don't want to know. Just trust me, it's enough to have shut me up for a while.

I don't write if what I'm producing doesn't raise the energy in some way.

But, like John Lennon, I try to always admit when it's getting better, and I'm getting better. Emotionally and spiritually, at least. So here's my voice again, with a few things to share.

LOLCat Dance like nobody's watching

One of my struggles this past month is that my cat Dinah got suddenly ill, to such an extent that she vanished and would not come when I called her. I had no money or means of getting help for her/us for a few days, and I went a little nuts over it. Finally folks stepped in with funds, and at the same time she recovered from whatever it was. She's completely back to normal. Still, it's altered our relationship, at least my end of it. I now admit to myself how emotionally dependent I am on her companionship. She's the only living thing I see, week in and week out.

Night before last Dinah did her disappearing act again. I was eating my version of lunch, which is around 10 p.m., and I noticed she wasn't showing up to check out my plate. She won't eat human food but she always like to look over my menu and give me a critical glance. I realized I hadn't seen her for an hour. I began calling her, and she didn't respond or come, which she almost always does -- curiosity rules her personality. I tried not to panic, gave it an hour in case she was deep in sleep, and went back to work.

When she hadn't shown up in a hour, I began calling, then searching for her. Unfortunately, there are several places she can hide where I cannot get to her. I guess she was in one of them and in a Greta Garbo mood. She didn't appear again for eight hours, during which time I pretty much melted down, decided she had died of a sudden heart attack or something like that and I wouldn't be able to locate her body until it began deteriorating. No sleep or work was possible. She eventually came, after a long bout of calling on my part, looking like "What is your problem?" I slobbered all over her (metaphorically speaking, of course) and she allowed me to rave on about how much I needed her. Since then, she has adopted a new habit, climbing onto the back of my rolling office chair as I type and sitting in state, looking over my shoulder. I actually love the proximity, although it means I can't shift position in my chair and after 15 minutes or so, that becomes painful. Whatever. Even if she's fucking with me, I'm too attached to her to care.

Postcard from Stella Marrs (Postcard from'>Stella Marrs)

A year ago, the national transcription company I work for part-time (which is consistently rated the best in the country, with a commitment to never outsource their work overseas), finally gave in to industry pressure and began allowing their hospital clients to use speech recognition software [SRS] as part of the transcription process. The way it works is that some physicians dictate their medical reports into the software, which then "transcribes" it and that version comes to us, the transcriptionist. Theoretically, we listen, correct the errors, and the software "learns" how that particular physician deviates in their speech pattern, making the transcription increasingly more accurate. For this we received a cut in pay on any report sent through that software. We had no choice in the matter.

Interestingly, the folks selling the hospitals this software strongly advised only the clearest dictators be allowed to use it at the beginning. I've been through this before with other companies, and could easily predict how it would go. Electronic medical records, for instance, typically demand 10-15 minutes of entry and review time from a physician for each patient seen. However, dictating that same report will take no more than 3 minutes of her/his time. Even the most tech-crazy young doctor quickly figured out they could not possibly keep up the patient load most of them have (about four patients per hour in a typical day) and also use the EMR system. It's far cheaper to pay a transcriptionist to create the record than use 10 minutes of physician time. But by the point the hospitals figure this out, the software company has cashed their check and moved on to the next sucker I mean customer.

Electronic medical records are far more accessible, which can and does lead to improved patient care -- if the physician uses them competently. But they also remove any hope of patient privacy. Trust me, I know. Don't tell your doctor anything you don't want to be publicly available, not if they're using EMR.

Speech recognition software is also doubly labor-intensive. The physician saves no time, her/his dictation requirement is the same. But the complete and utter garbled crap that arrives over the wire to me as a supposed draft legal medical document is a hazard to good care everywhere. I gave the effort of training the software an honest try, and at the one year mark, when even the slowest and clearest-voiced dictators are still resulting in "review for errors" reports which are virtually unreadable -- I decided it ain't working. In a medical report, the placement of a decimal point on a lab test or medicine dosage, for instance, is critical to well-being. Do doctors dictate "zero point two five micrograms"? No, not even the best of them. They say, in a rush, "two-five mikes". They use CVA for both costovertebral angle and cardiovascular accident. Peroneal means a different part of the body than perineal (VERY different part of the body). And so on. Me, with my human brain and decades of experience, automatically translate this into what they mean to say. I care very much about the absolute accuracy and usefulness of the records I product, because it is human health and well-being on the other end.

Factor into this the reality that a growing percentage of good doctors in this country are not native English speakers, or have regional American accents which the allegedly "smart" software seems utterly unable to comprehend, plus the fact that most physicians dictate on the go in very noisy environments (where background speech is picked up by the software and inserted as random words into the transcribed report), and the number of physicians who will ever be good candidates for SRS plummets.

So, I've stopped even trying to correct the first drafts I get. I start from scratch, transcribing what I hear, and it goes much, much faster than if I hop from word to word cleaning up the mess. The hospital plan, of course, is that eventually they can just use the software and phase out a transcription service. Well, lots of luck with that. As long as patients can sue for malpractice, the accuracy of medical records will be a profitable concern, and there is no machine that can replace what I do. Until that lesson is learned, all these expensive purchases and trials will come out of hospital budgets and get passed on to you.

Two tangents I want to follow from the above: First, last night I typed a medical report on someone famous who is a personal hero of mine. I'll tell you it was a woman, since you'd probably guess that much, but nothing else that might identify her. I wanted to look at the entirety of her medical record, but did not until during the course of typing her report, I could not ascertain the name of a particular physician from her past and had to go dig anyhow. I read her original History and Physical, which was revelatory. She has major health issues that must affect every detail of her personal life, and I had no idea. I view her very differently now, with heightened respect. I'll never meet her personally, but I've still invaded her privacy, don't you think? I console myself with a promise that I'll never, ever tell anyone else what I learned.

This is the second time this has occurred in my career. The other instance, it was a major actress who that year came up for an Academy Award. The movie she was about to begin filming had a health clause which might have kept her from the Oscar-contending role if they had learned of the condition which was being secretly treated (and which was the topic of the report I typed). I kept that secret, too, and I've never read about her health issue out there in the gossip trade.

Another reason why SRS is being tried out by transcription companies, in addition to demand from clients who are determined to learn the hard way, is that it is becoming increasingly difficult for them to find competent people to work as transcriptionists. It's not only that the ability to transcribe is a particular language ability which is akin to simultaneous translation -- you can learn it, but if you don't have some sort of innate ability, you'll never be really proficient. Those of us who have the ability can transcribe, editing as we go, without actually retaining most of what is passing through our brains. We can carry on a conversation, listen to radio or TV, or (in my case) write poetry and fiction in our heads as we transcribe.

But, as I said, it's not just the particular ability of transcription, it's also finding folks who can spell anything that comes along without looking it up or relying on a spellchecker, who know grammar and syntax backwards and forwards, and who have keen listening skills. These are all human abilities which are atrophying in our current culture. I hear that most grade schools are no longer teaching handwriting because kids use keyboards so much, which I think is absolutely ludicrous -- why not stop teaching kids how to walk, I mean, we have Segways, don't we? Or stop teaching basic math because we have calculators. The fact is, not only do these basic skills make us independent of electronics and petroleum-based technology whose days are numbered, they also help develop our brains in ways we can ill afford to lose. As a writer, I use keyboards for certain kinds of composition but not others. No single technique is best for any kind of activity, haven't we learned that by now? It's more of the dumbing down, lowest common denominator culture of conservatism, which understands that stupid, incurious consumers are the ideal citizens under their version of government.

Photo of crescent moon over water

Still, I promised to raise the energy, and fresh examples all around us. Folks are putting in gardens and deciding to eat better rather than "diet". Iceland elected an out lesbian to lead their country. (I wish dykes and blacks didn't always get their first breaks when things have gone to shit and it's questionable whether anyone can fix the mess we're handed, but a first is a first.) New Mexico repealed the death penalty. Religiosity in America is being slowly replaced by generic spirituality. The State of Missouri understands the real threat to our personal security is the right-wing among us, not those brown people from (fill in the blank). The Texas State Board of Education managed to keep some significant Creationist language out of our science education standards. I bet you have examples of how the floodwaters are receding as well, perhaps literally if you live in Fargo. Jump in and dare to believe. See you around.