Holding Hands During a Pandemic

By Emily Wehrwein, MS, OTR/L

Practicing as an outpatient occupational therapist during the pandemic has instilled an additional appreciation for a therapist’s work and is changing the ways in which I interact with my patients.

Admittedly, I had early concerns about my ability to perform job duties in the age of the modern pandemic. What is essential? We don’t provide food, water, or antibiotics. I trust that our therapists give great home programs to ensure our patients’ progress. Will our patients be okay without us for a little while?

A mental pros and cons list was on a constant loop in my mind as the second half of March rocked our world. Waves of gratitude for my ability to work and fear of the unknown and our community’s safety oscillated continuously. 

In late March, I was humbly reminded of a therapist’s impact when I was greeted by tears from one of my patients amid rumors that outpatient clinics may close. Though fearful, anxious, and in physical pain, my patient expressed a deep gratitude toward our work that I will not soon forget. She said through tears, “I am so thankful that you are staying open. I need this. I can’t do this on my own yet”. This patient experienced multiple years filled with numerous surgeries and many periods of being out of work due to any injury sustained on the job. This course of therapy and this specific recovery was that last stepping stone for her much awaited return to work. She had come too close to achieving her goals and getting her life back to stop now. Supporting this woman’s livelihood was, in all essence,  essential. We sanitized, masked up, and kept working so that she could stay on track.

As masks became standard, and the pandemic worsened,  I could no longer see my patients’ facial expressions. Suddenly, it’s August. We have been wearing masks in our clinics for months. Many of my patients from March and April have returned to their pre-injury lives and have been discharged from my care. I have since come to the realization that I have only seen restricted facial expressions and emotions from the majority of my current patients. We all need to wear masks to prevent viral spread, but I realize how much I relied on my patients’ facial expressions to determine how their therapy sessions were going.

This directly impacts my relations with patients, as my care is profoundly guided by each individual’s response to treatment. As a hand and upper extremity therapist, I often sit face to face with patients and am quite literally holding their hands through the recovery process. I continuously scan facial expressions to tailor my intervention to a patient’s needs. Pain. Relief. Fear. Appreciation. Skepticism. Optimism. A patient conveys so much through these ‘now-masked’ expressions. They impact the intensity of manual work I provide to release soft tissue restriction after a wrist fracture. They tell me how much scar mobilization is tolerable in a day’s work. They cue me into their confidence level for their ability to perform post-operative exercises independently. Expressions and emotion keep me on the same page as my patients and help develop our therapeutic relationship.

Encouragement. Empathy. Understanding. Motivation. These are the emotions that I am trying to radiate from beneath my mask. A pandemic, combined with physical pain and dysfunction, is an unfortunate reality for many. The physicality of hands and arms are allowing people to work-from home, take up new hobbies, stay active, and try seemingly countless new recipes. I am here to keep people’s arms well so that they can participate in desired occupations and find some sense of normalcy in this uncertain and ever-changing space.  

I am learning new ways to interact with my patients and to care for them. After all, starting an hour long therapy session with the question, “How was your weekend?!” just doesn’t elicit the same response right now. I am becoming increasingly aware of a person’s overall body language. The subtleties of a raised eyebrow or a sudden postural adjustment tell me most of a story. Though I miss encouraging patients with a toothy smile, I am finding new ways to cue patients to effectively describe what they’re experiencing. Multifaceted interaction is our way forward.

Through the cycling of the pandemic, I am proud to be an essential worker and to help people in upper extremity rehabilitation. I am looking forward to times in which I can openly smile at my patients again. Until then, I can be found holding people’s hands, incessantly cleaning off equipment, defogging my glasses, and smiling with my eyes.