Written by CEO Catherine Siegler
After 30 years of providing communication access with CART captioning (as compared to a foreign language or sign language), it never ceases to amaze me how I need to adapt my service for each unique environment. I feel that sharing will help others doing similar work navigate through an ever-changing system of healthcare provision. In retrospect, I think all the staff that communicated using this service appreciated how much more efficient it was than pen and paper.
Yesterday I captioned for a patient in the pre-op intake stage. Not even 12 hours later, a short text message with an emoji smile reached me, thanking me for being there. As the song goes, “A smile is my reward.”
Pre-admission is a large room with a lineup like a bank. The “tellers” ask questions and take information in a not-so-quiet, open reception area, chairs hugging walls, patients and loved ones seated is introspective subdued early-morning stupor, or is it silent gripping fear of the unknown that lies ahead?
I venture that for a patient with hearing loss, this is fraught with all manner of difficulties, not to mention the danger of misinformation both ways.
When I arrived, I explained that I was going to be CART captioning for a patient with hearing loss. The well-meaning nurse/receptionist said that she would call the patient. I reminded her that the patient cannot hear. At last night’s FLEX meeting, the idea of handing a buzzer to such a person would be an excellent way to provide anonymity and alert the patient s/he is being paged.
A captioning interpreter is distinct from an ASL or foreign language service provider because of the equipment setup considerations.
Interpreters must take charge of their requirements for their service to be useful. In consideration of equipment set-up, I asked how much time will the initial process take? If it’s a matter of a couple of minutes, and given that the patient has reasonably good eyesight, I quickly turned on my shorthand machine with a large viewing screen, I boldfaced and all-capped the display so my client could easily read what was being asked. A tall tripod can be very useful if there is no chair for the captioner to sit on. Ideally the machine should have an articulating screen so it can be turned in their direction. As it is, it’s facing me. Over the years, I mentioned its usefulness to the shorthand machine manufacture. However, CART is a small market. The machines are mostly used by court reporters and broadcast captioners.
At the hospital, given the noise level and limited space allocation, I requested a quiet room for the intake interview. The nurse practitioner very helpfully suggested her private office. She ushered me in and I quickly set up all my equipment, including a router to screen-share captioning between the patient’s iPad and my computer. Public WiFi in hospitals is generally sketchy, so best not to rely on it.
It was a good decision to request privacy, because the questions were quite detailed and The interview lasted about half an hour.
The next process was to Pack up and go into the pre-op area where the patient was shown her bed in a curtained cubicle. Again I didn’t know how long this process would take, so I waited for the patient to undress and sort out her belongings.
Once the cubicle curtain was withdrawn and the patient was in her bed, I proceeded to scooch into a tiny space beside her bed. I spied a power source, and with my extension cord and a chair, I set up everything I needed to provide text captioning. A captioner’s portable table and tripod are essential as the computer needs to be safe and visible. It can also be a second viewing screen for family and health care providers. Once the iPad was connected, it rested on the patient’s belly so she could view it as the line of personnel arrived. First, the intake nurse established that the protocols had been followed such as “do you have an implant?” and “when did you last eat?” Then the staff in charge of personal belongings arrived, followed by the anaestheologist, then the surgeon, then another nurse practitioner who prepped the patient.
It was important for me to obtain at least their first name and their role so that I could define it in my job dictionary. That made it much easier for the patient to know who each new person was.
When all of that was over, I then packed my belongings, and with a gentle smile wished my client good luck. I left, full of sadness for her, yet grateful that so many years ago I found this most satisfying work. Mitigating communication access is my reward.