Every day working as a CART provider and captioner is an adventure. Not only do we have to prepare for the unexpected in terms of the material that we will be hearing, but we also have to deal with the technology component, everything from modems and encoders, to streaming text over the Internet.

We are oftentimes asked to CART or caption what seems to be the impossible: the foreign speaker whose words are unintelligible, the professor speaking at 300 words per minute, or an outdoor event where the acoustics are poor. We strive to do our best under all of these circumstances. And despite the obstacles, these CART events generally turn into very rewarding experiences. We meet some wonderful people, and even become their friends and “part of the family” in many cases.

Working in the medical arena can be both challenging and rewarding. I have been working in the hospital setting for over a year now. I have only spoken to the administration, nurses and doctors over the phone and through email, never meeting them in person. I have never met the patients that I work with. Yet, I feel that they all trust me. The administration trusts that I will be there at the scheduled time and that I will CART to the best of my ability. The patient trusts that I will write what is being said accurately and that I will consider everything confidential. The majority of these patients have never used CART, certainly never in the doctor/patient setting, instead relying on the doctor or nurse to write important information on a notepad. “Most of us rely on a combination of the physician’s note writing proficiency and willingness, our ability to read lips, perhaps a sign language interpreter, a friend or spouse to accompany us to the appointment and remember enough of what the doctor said to share it with us later. It’s all scary stuff,” (Michie O’Day, NF2 patient).

Recently I had occasion to remotely CART a doctor’s appointment for a man I will refer to as “John” (not his real name). John has a severe hearing loss caused by neurofibromatosis. I received the assignment to work with John on a Thursday. I was contacted by the doctor at the scheduled time and remotely CART’d the appointment. At one point, when the doctor left the room, I chitchatted with John. He was curious how I got started CARTing in the medical field. I explained to him that for the past three years I had been “going to” medical school with a student who had a hearing loss. CART was a foreign technology to John, but he found it was very useful, especially in the medical setting. Every human being should receive quality healthcare. A component of quality healthcare is effective communication.

“Next to providing a germ-free environment, I can think of nothing more important for any patient than good communication with the medical team while in the hospital or doctor’s office.” (Michie O’Day, NF2 patient).

I didn’t know if I would hear from John again. A few days after the appointment, though, I received an email from John’s girlfriend, Annie. They found my email address on our website. She asked if I could CART a funeral. She didn’t say whose funeral it was. I told her it could be done as long as there was an Internet connection and a way for me to hear what was being said. I then received an email from John. John said that his mother passed away the day after his doctor’s appointment. I remember him lovingly talking about his mother during the appointment. Because, you see, his mother also had neurofibromatosis. My heart was broken for this man I did not know. I also wanted to help him participate in his mother’s funeral. John told me that there was one obstacle, though: The funeral was going to be outside. We brainstormed through email and decided to just try to see if it would work.

The following day, John and his girlfriend arrived at the gravesite. John, using his Treo, hooked up the data connection cable to his laptop. He connected to the Internet! They then used her Sidekick and tested the audio component. It was perfect. We tested it out several different times by connecting and reconnecting to the Internet. We were all excited that this was going to work. John was going to arrive at the site an hour early to get set up. But because of family obligations, John wasn’t able to arrive an hour early. He had 20 minutes. One thing we didn’t take into account was the sun shining down on the computer. John connected to the Internet, and we were ready to go. Then I lost John. I had audio, though, and spoke to Annie. She said he was having a computer problem. I told her to keep the line open and when he was ready he could just reconnect. I never saw John again on the computer. I tried to figure out what was happening, at the same time writing the funeral. After the funeral was over, John emailed me and said that it was “operator error.” Because the sun was so bright, John was mistyping on the keyboard; he just couldn’t see. I was so disappointed that I wasn’t able to help him participate in this most precious event.

In the end, though, John was given a copy of the pastor’s sermon immediately after the funeral, and I was able to transcribe and email the remainder of the funeral proceedings to him.

I learned a tough lesson that day: As a CART provider, we have to be prepared for everything. And in the future I won’t forget the sun component when working outside. This event also proved to me that we can CART anywhere, as long as we have a good Internet connection, good audio signal…and a little shade.

The CART profession – (Communication Access Realtime Translation) also known as captioning – brings new experiences, new knowledge, and new friends.

Today I had the privilege of working with a gentleman who apparently was in an accident of some kind. He is in ICU on a ventilator. This gentleman has a condition known as Neurofibromatosis 2. Many people with NF2 end up losing their hearing because tumors develop around their acoustic nerves. I have provided communication access remotely for many patients each time they meet with a doctor or healthcare professional.

This particular CART job, though, had more of an impact on me than most of my CART jobs. This gentleman was clear across the country lying in a hospital bed on a ventilator and I was able to use my skill to help him communicate with his caregivers and his family, instantaneously.

The hospital has developed a system called the IPOP and COW: IV Phone on a Pole and CART on Wheels. They wheel the speaker phone that is mounted on an IV pole into the room and place it next to the patient. I know this information about the equipment not because any of the staff told me but because this gentleman’s young son commented on the acronyms, thinking it was a funny use of letters.

The hospital staff phones the CART provider and we listen to the conversation and simultaneously stream the text back to the computer they have placed in front of the patient. In this instance, when the patient needed to speak, they took him off the ventilator for a brief period so he could talk. It was difficult not to get emotional when the patient said that through the night he felt he was dying because he couldn’t breathe. And when the doctors told him that he may be on the ventilator for the rest of his life, I just about fell apart. I feel as if I know him even though I’ve never met him.

The family and staff call me by my first name and often ask how I am doing. I am a part of the team to help someone recover. It is so rewarding to know that CART providers can use the skill, knowledge and technology that we possess to help someone wherever he or she may be; that we can be an integral part of someone’s recovery and to be there to help someone communicate, to hear his son say “Daddy, can’t wait for you to get home,” and for that son to hear daddy say “Daddy’s gonna be okay and be home soon.”

Written by:
Denise Hinxman, Owner of Captions Unlimited in Reno, Nevada