Forty-six years later, I found myself reviewing movies for cigarette money, teaching World Literature on minimum wage and Indochinese refugees’ survival English, and silkscreening T-shirts to make more ends meet. With a Bachelor of Arts in Philosophy, minor in English, I got into dozens of other “staying alive” jobs after college, all of them not remotely related to saving life or limb. What happened? I don’t know. LIFE, most likely.

As history would have it, I don’t have to die and be reincarnated as a bona fide Dr. Manny MD. I can have a foot in Medicine via the allied medical professions. In 1996, the U.S. Congress passed the Health Information Portability and Accountability Act (HIPAA), which required all practicing doctors in the U.S. to convert all medical records into electronic form, for purposes of health management and insurance accessibility. What all this meant for people like me (a Filipino living in the Philippines) is that I can have a job here listening to overseas doctors dictate patient medical reports to cellphone-size voice recorders (sent as voice files to me via internet) and I type what I hear in predetermined format templates and get paid per line minus transcription errors. Kind of like a medical secretary without having to get up to make coffee or lie on the phone for your boss.

First, the bad news

But aren’t there enough Americans living in America who can do this job? Apparently not. You have to have a doctor’s vocabulary to transcribe medical reports, and you have to have a grammarian’s professional command of English to edit people who not only have the power of life and death over you and your blood relatives but also routinely murder the English language with impunity. Americans who have the former are already doctors and nurses, and retired nurses are the frontline deployment for medical transcription because they already talk the talk and can do the work at home with just an online computer, a headset, and a foot pedal (no more duty rounds and dressing downs from arrogant residents and earnest interns and still be in the healthcare business). Americans with excellent command of English are either already employed in media, teaching in school, or are in transcription either as legal secretaries (less specialist jargon) or more likely in entertainment transcription (English subtitles for English-language movies).

Like call centers, medical transcription had to be outsourced simply because qualified Americans sniff at the low salary and the American health care system simply can’t afford to pay transcriptionists what is justly due them, which they say is a figure approaching two-thirds of the salary of a certified nurse. Thus, the similar trade route medical transcription has taken with call centers. Which brings us both the good news and the bad.

First, the bad news: As with call centers, India had its end in transcription earlier than the Philippines, which means they set the service rates and therefore called the shots early on. In peso terms, an entry-level Filipino transcriptionist is lucky to enter the local job market at a depressing P7,000/month starting salary. The equivalent in Hindu rupee was obviously competitive in India, and in US dollar terms, less than a fourth of what an American transcriptionist makes within US borders.

In the Philippines, P7,000 is, of course, below minimum wage, and therefore, technically illegal. There are, however, many economically adaptive ways around this labor black hole about which, currently, we are doing ourselves a favor by looking the other way. Most of these “creative ways” are hopefully temporary, but certainly all are intended to keep the Philippines in the game while our economic managers look for ways to find competitive edge for Philippine-based medical transcription.

Moreover, the competition is waaay formidable: India has economies of scale; its intellectual and scientific tradition is British, and the English language was, of course, invented in England, not America. Our semifacetious “American-like” accent may put us ahead over India in call center services, but we have no such advantage in medical transcription, where medical knowledge and written English grammar are the rules of the game. A routine supplier of Nobel-caliber authors to the world stage, India boasts of roughly 500 Hindu medical transcriptionists for every Filipino MT of comparable skills. Which means that, in the Philippines at present, it is more frequently observed that a newly graduated medical transcriptionist has to undergo months-long OJT (on-the-job training) where he/she transcribes actual voice files, often for more than eight hours a day, and either get nothing or receive a daily P100 bus fare and snacks allowance. Six months to two years of this would look good in the resume. Like nursing, a Filipino citizen of sound mind and body studies medical transcription because of the prospect of working abroad, preferably in the US, where demand is highest and salary is best.

The good news

And now the good news: Medical Transcription is a LIFESAVER. That is, it saved MY life. I’ve done it all and I’ve seen it all in order to forget about wanting to become a doctor, and for decades this attitude of settling down with the next best thing always required a cigarette. And no substitute was ever good enough to quit smoking for. That is, until Medical Transcription. And only on the second month of the six-month course (AB Philosophy is “non-medical,” which takes six months to clobber with medical terminology; nurses do it in four, doctors in three or shorter).

On Month One, we were introduced to the arcane world of medical language, as well as medical transcription English and professional issues. While based on standard American English, medical transcription is written English (or more precisely, printed) with a principally scientific vocabulary. Recent rulings include the dropping of possessive apostrophe S in diseases and syndromes qualified by proper nouns. Down’s syndrome (chromosome 21 trisomy, or mongolism) will still be dictated as such, but will now be routinely transcribed as Down syndrome (an apostrophe and the letter S are 2 keyboard characters that help inflate line count, driving costs up).

The preceding are the salads days of Med Trans, when on any given day in the first month the worst error you could make was spell OPHTHALMOLOGY with the first “H” missing. The nuances got steadily grim as the weeks ground on, which was when I realized I was taking less and less cigarette breaks to give more and more time to chasing some obscure medical term in the workbook, in Steadman’s Medical dictionary, or in last-resort, Google. “Dorsal endorachius” consumed three hours of fruitless search in the net, and that’s because there’s no such animal. I asked a physical therapist classmate to listen to the dictation and he said it’s “dorsal interosseous,” a muscle on the back of the hand. When doctors describe an anatomical part as “exquisitely tender,” they’re not being romantic. Exquisitely tender means it’s so painful a breeze could set off a throbbing pain attack.

Social issues

In the third month of Medical Transcription, under the specialty module of Obstetrics and Gynecology, I learned that in treating pregnant women, the mother’s life comes first, not the fetus. Even in overwhelmingly Christian Philippines, there is no ethical dilemma among Filipino doctors as to whose life they will save when it comes right down to it: The mother’s life is paramount, and therefore the fetus will be aborted if the continuation of the pregnancy threatens her life. And because abortion is illegal in the Philippines, what Filipino women do is induce it elsewhere then go to the hospital bleeding and in dire need of D&C and massive doses of antibiotics.

We actually discussed these big, Social Issues stuff in class, a “measly” six-month course in Medical Transcription. I bet Caregiver courses don’t even stray anywhere near these topics. Does it help one become a better medical transcriptionist? You bet your bottom dollar/euro/yuan it does. The realities of the pharmaceutical demand-and-supply process opened our eyes to the coldness, the uncaring, money-grubbing side of Western medicine from which, therefore, our understanding of class, category, MOA (mode of action), generic and trade names of drugs, was derived. Ponstan costs twice as much as mefenamic acid, but both are pharmacologically identical. In med trans, capitalize P in Ponstan, but mefenamic acid is always lower case.

In medical transcription, we don’t have visual cues from which to glean meaning and intention into the words and phrases we hear and type on the keyboard. Midwestern and southern accents, while no day at the beach, are not exactly the bane of the Filipino transcriptionist’s career. Well, at least not for me. All our laboratory practice files were obviously American, or originated from American hospitals, but with a wisdom becoming of a maturing industry, the curriculum designer of my school (MTC Academy) made sure the American health care system is realistically represented in the entire corpus of transcription training by including voice files of doctors from the Midwest, an Arab-American, a female Chinese-American, a male doctor with a distinctly Hindu intonation, several generic American academic English, and an “old school” type of country gentleman doctor (with a deep resonant baritone) who insists on using “decubitus ulcers” for a condition younger doctors have since called bedsores.

A ‘doable’ future

And so why am I peddling Medical Transcription with quasi-religious fervor to you? Let me tell you about my other classmates in my batch first (our batch name: Power Rangers) because in their shoes I occasionally weighed myself and found me relatively wanting.

Marie is in her early 40s, married with kids, younger than me, but tougher and more battle-weary-looking. She has never worked in an office before, despite a college degree, a quick wit and ability to multitask. Her husband is on dialysis, once a week, after his kidneys failed years ago. One session costs thousands, and what little the family business could spare after the kids’ schooling and housekeeping goes directly into his dialysis.

Marie needs a job, but she has never filled out an application in her life, much less write an application letter. She hasn’t a clue how to sell herself. But ask her anything about dialysis and she’ll rattle off every single first-hand little detail about the whole process, beginning with the itchiness, the darkening of the skin, the elevated blood pressure, the irritability. The dialysis machine, too. The model, the features, the price, the amount of time. And we haven’t even talked about the strict diet yet. I majored in Philosophy, but minored in English, so who else was better than me to sit in front of Marie, in awe, to take notes and help her compose an application letter? Target jobs: Med Rep for renal failure chemotherapy line, sales agent for dialysis machines, medical secretary for renal specialists and, of course, medical transcriptionist with first-hand log hours in dialysis.

Jenny is my age, and like Marie, she is married with kids. Unlike Marie, however, it’s not her husband who is ill but her younger sister, Tina, who is in stage IV of a lung cancer that metastasized 10 years ago from an osteosarcoma on her right leg. When our batch started in March, Tina was already bedridden, on oxygen and sedated 18 hours a day. By June, Tina was admitted in the hospital and Jenny was now regularly sharing with us Tina’s CT scans, x-rays results and lab data. Tina lost her battle with cancer in September, one month before our med trans graduation. In her funeral I first met her, at rest at last, and when I gazed at her peaceful slumber, her life flashed before my eyes in x-ray films, pages of medical reports, lab test results, CT scan printouts, a death certificate, and a hospital bill that totaled nearly P600,000.

There are other stories in my batch which are just as interesting, as maddening, and ultimately as inspiring to me as a healthcare professional wannabe. Along the six-month course, my batchmates and I learned to share these stories with less sighs of resignation and more confidence in an informed future. The tools we acquired in medical transcription made telling these personal histories a little less unbearable, the future a little more “doable,” as if from now on we’ll have a clue or two what to do in case something like it happens again.

Short of working as an autopsy assistant, Medical Transcription showed me more clearly the purpose of my dreams. Beyond making a living in the healthcare profession, Medical Transcription opened a window that showed me how wide open the field of medical science is to anyone who wants to make a difference. And if it takes gatecrashing through the back entrance for me to get in and make my contribution, so be it.