Faith, hands and technology: spiritual and physical therapy in the age of COVID-19
Mary Louise Aims stares at the ceiling from a nest of wire attached to thermometers, blood pressure gauges and heart rate monitors. The only instrument in her Penn State Heart and Vascular Institute hospital room that tracks her emotions is the expression on her face, and the current reading says she’s had better days.
Several floors up in the Telehealth Resources Center at Penn State Health Milton S. Hershey Medical Center, Darlene Miller Cooley, one of the hospital’s chaplains, aches for Aims. If only she could reach into her computer screen where she’s watching a camera view of the heart patient and hug her. She wants to hold her hand and give her arm the reassuring squeeze she’s sure Aims needs.
“For most of us human touch is very, very healing,” Miller Cooley explains. The axiom is just as true for Miller Cooley as it is for Aims. Empathy is basic equipment for the job of a spiritual counselor.
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Instead, both women must connect with microphones and two-dimensional images on screens. To talk, they use a program called Caregility. Penn State Health purchased Caregility several years ago for its growing telehealth service. Recent events have increased its importance.
To slow the spread of COVID-19, therapists at the Milton S. Hershey Medical Center, to whom touch and close contact have become second nature, are staying clear of patients’ rooms and finding new ways to heal body, speech and spirit. Some use Caregility. Some use paper signs. Others work directly with health care workers in personal protective equipment (PPE) who act as the therapists’ hands. The systems they’re perfecting could enhance their jobs beyond COVID-19, they say.
But can they replace physical contact?
Virtual hugs
Before Miller Cooley fires up her camera, she removes the surgical mask she’s wearing and applies lipstick. She wants Aims to see her smile.
She presses a button. Inside Aims’ room, a bell rings, letting Aims know someone wants to talk with her online.
An overhead view of Aims’ room flashes on Miller Cooley’s screen. A nurse is hovering by the bed.
“Good morning Mary Louise,” Miller Cooley says. “How are you this morning? I’m wonderful!”
The two talk for a few minutes. Miller Cooley asks about Aims’ husband and children. They discuss religious faith and how Aims is feeling.
Miller Cooley has been using Caregility for a little over a week. “It’s just wonderful,” she said. “It gives me that face-to-face contact … and I can offer them a virtual hug.”
The old-fashioned way
Some therapy sessions for COVID-19 patients at Hershey Medical Center are still completed in person. Therapists don mountains of PPE. Just after Miller Cooley ministers to Aims, Physical Therapist Heather Hahn puts on a face shield, surgical mask, protective smock and rubber gloves. She slides back the door to a negative-pressure room and ducks inside for a session with a COVID-19 patient. This patient doesn’t speak, which complicates her ability to share what hurts with Hahn, who already has to raise her voice to be heard through all her gear and the noise of the room.
Gently, Hahn and a nurse help the woman bend her knees and flex her ankles. The woman grimaces as she flexes her right foot. Hahn and her partner coax the woman to stand up from her hospital bed and sit in a chair. They applaud each minor movement like it’s a Super Bowl victory.
When Hahn, who usually works in the Medical Intensive Care Unit, treats people with COVID-19 on a given day, she either works with them exclusively or stacks her coronavirus caseload at the end of her shift to prevent spreading the disease. She sees between two and five COVID-19 patients per day.
Other than the garb, Hahn says, and all the essential-but-intractable rules governing sterilization, COVID-19 patients are just like any other. “They’re weak. They’re deconditioned,” she said. “They just need care and therapy and recovery and rehab.”
Going virtual
As patients’ symptoms worsen and the virus withers their ability to speak or move on their own, they usually meet with someone like Hahn. When a patient is first admitted, if they can still communicate and move without assistance, they are more likely to meet with members of the telehealth therapy team via Caregility.
Occupational Therapist Amanda Frank uses a toothbrush while working virtually with a patient in the COVID unit.
Speech, occupational and physical therapists all treat patients using telehealth to help preserve the supplies of PPE and prevent the spread of the virus. The jobs require close proximity, and hands on arms, feet and faces.
Caregility, they say, has been a godsend for patients and therapists alike, but it’s not without limitations. Acoustics are a challenge. Speech-Language Pathologist Laura Nairns says the noise in negative-pressure rooms (areas designed to keep pathogens from filtering out) can make hearing patients whose vocal cords are recovering from weeks of disuse during intubation difficult.
Occupational Therapist Zahira Paul and Physical Therapist Carolyn Haggerty also say acoustical limitations must be overcome. Many COVID-19 patients are older and have hearing problems. It’s hard enough teaching someone to stand, walk, put on their clothes and eat again – how do you do it when you can’t hear one another?
At Penn State Health St. Joseph Medical Center, Physical Therapist Beverly Hamm developed a poster to communicate with a COVID-19 patient who has hearing and visual impairments and couldn’t use telehealth technology. The poster reminded the patient to perform exercises like knee bending and leg raises while confined to bed. It was simple but worked so well, the staff is putting similar posters in other rooms, said Lisa Zwierzyna, the hospital’s physical therapy manager.
“The therapy staff has really stepped up to get creative and give these new ideas a try,” she said, “even though, as therapists, it is not at all what we’re used to.”
A two-person operation
At Hershey Medical Center, telehealth therapy has largely evolved into a two-person operation. Using Caregility, the therapist communicates with the patient. Inside the patient’s room, another health care worker dressed in full PPE fills the missing physical gaps to help patients stand, communicate and heal.
Physical Therapist Heather Hahn works with a patient in a Hershey COVID-19 unit.
Trust between therapist and nurse is key. “The nursing staff has been paramount,” Haggerty said. “We wouldn’t be able to do any of this without the sacrifices they are making so that other allied health staff don’t have to. It’s a really supportive group of nurses who work closely with us.”
Therapists say using the system has required them to focus on one element of their care at a time. Rather than running down a list of requirements in one session, they might focus on one movement, given the limitation. What they’ve learned might be useful when the pandemic ends, enabling them to offer more and better care at home.
“It has been an amazing resource for us to have at this time,” Nairns said. “It’s also an amazing resource for patients.”
However, Nairns and other therapists say there’s no substitute for doing their jobs in person.
Faith plays a role
Miller Cooley also would rather visit Aims in person, but Caregility offers her the next best thing. Aims asks the chaplain to pray with her, and Miller Cooley obliges.
“Lord … wrap your loving arms around Mary Louise,” she prays, “and give her comfort and give her peace. Allow her to know that you’ve sent these doctors and nurses just for her, Lord.”
The internet connection is saving both women.
Aims has been hospitalized for congestive heart failure. Given her immune system’s vulnerability, protecting her from COVID-19 is high on everyone’s mind.
Miller Cooley has sarcoidosis, an inflammatory disease that has caused her lungs to be riddled with scar tissue. As much as she’d like to visit patients, she has been warned that her condition causes her to be more susceptible to the virus’ life-threatening effects.
Miller Cooley hasn’t let sarcoidosis stop her, and telehealth has allowed her to continue administering care. But she believes that more than technology and Hershey Medical Center’s foresight are allowing her to continue to deliver comfort.
“I feel my faith has protected me,” she said.
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