The date March 2,
2020 looms large in my mind. That is the date of the last occupational therapy
mental health group I led, and I have proof: The date is still written on the
dry-erase board in the rehab gym.
Since March and
the onset of COVID-19, so many changes have occurred at Levindale Hebrew
Geriatric Center and Hospital in Baltimore, where I work as an OT (occupational
therapist). Occupational therapists treat people who are recovering from
illness or injury, focusing on ADL (activities of daily living)/IADL
(instrumental activities of daily living) as well as cognition and
psychological function. I mostly work on the four inpatient Brain Health units,
with patients diagnosed with dementia and/or mental illness. I also cover on
acute rehab, sub-acute rehab, and the “Households” (similar to assisted living)
as needed.
* * *
And so the changes
began. I first had to complete two computerized competencies (one was two hours
long) to better understand COVID-19 and an in-person demonstration of
donning/doffing PPE (personal protective equipment) correctly.
Here is my typical
day during COVID-19: Upon arriving to work, I don a surgical mask while in my
car and grab my PPE bag (including my N95 “duck” masks and goggles, clean brown
bag and used brown bag). Before I enter the hospital, I apply hand sanitizer. I
then have my temperature checked, sign my name on a clipboard, and don goggles
and a yellow gown (when that was part of the protocol) before entering the unit.
I sanitize a workstation computer and chair with Clorox wipes before and after
use, and send an updated shift report to everyone in rehab and recreational
therapy. I then check the most recent vital signs and labs on the computer for
all my scheduled patients; this is vital, as some lab values, temperature, and
blood pressure changes can be indicators of COVID-19.
In “normal” times,
I would then bring my patients, one at a time, to the rehab gym. And so would
the other therapists. In COVID-19 times, we are allowed to have just one or two
patients at a time in the gym to reduce risk of exposure. And we can only bring
a patient to the gym after they have been in Levindale for 14 days and tested
negative for COVID. These days, for the most part, my fellow therapists and I
treat our patients on the unit pod.
After loading a
cart with a box of gloves and a container of Clorox wipes, I add essential
equipment, including therabars (exercise bars of varying weights), an arm bike
and timer, a large bouncing ball, a rainbow arc (colored rings on a
semicircular bar), clothespins, patterned puzzles, pegs and a pegboard,
cognitive screens, home safety assessments, and a folder containing mental
health and coping skills handouts. It’s pretty much the entire gym on one cart,
full of physical, cognitive, and psychological treatment modalities, depending
each patient’s specific therapy goals. This is the reason we now refer to
ourselves as “Rehab-on-the-Go.”
* * *
Treating patients
on the unit during COVID-19 has its challenges and triumphs. I’ve learned how
to make mask-wearing appealing to my patients. Here’s my speech: “Good morning.
Did you get a mask? I’ll get you one. It will protect both you and me.” I often
apply the mask on patients, as they may not understand its proper wear and
place it over their eyes, on their head, or only over their mouth. I often
readjust their mask during the therapy session or remove their mask when they
try to drink from their cup of water while still wearing the mask. I also make
sure each patient is positioned six feet away from another patient, on opposite
sides of the square tables. Between treating patients, I wipe off all equipment
with Clorox wipes. I try to remember to also wipe the table.
Since March, both
therapy and the hospital have implemented certain systems. The therapist who
plans our daily schedules tries to keep each therapist on one floor (two units)
in order to reduce risks of exposure. Our scheduler will indicate the order in
which to see patients: first, patients at least 14 days since admission to the
hospital; second: patients with less than 14 days since admission, referred to
as PUI (person under investigation); and last, patients who are COVID-
positive.
As for the four
brain-health units, one unit on each floor is designated for new admissions and
patients with less than 14 days from admission. If needed, one unit is reserved
for patients who are COVID-positive. When there are only one or two cases,
patients who are COVID- positive must stay in their rooms with a sitter at
their door and isolation signs posted.
Deborah Graves, president
of Levindale, does a wonderful job of keeping all staff informed. She emails
daily updates providing current COVID information with respect to the hospital,
Lifebridge Health, and Maryland.
* * *
To counter the
stressful environment that COVID has engendered, I try to find a bright side
for both my patients and myself. An example: since I failed the fit test for a
regular N95 mask (it covered my eyes), I was approved to wear an N95 mask
nicknamed the “duck mask” for its wide and narrow shape. One of my patients,
whenever I entered his room for treatment, would burst out laughing and say,
“You look like a duck!” I would laugh along with him in agreement.
I absolutely
appreciated the health-care worker perks: free Starbucks coffee during certain
months; free Krispy Kreme donuts (sometimes two dozen!); a Dunkin’ Donut
caravan brought to Levindale; fresh produce from the Renbaum family; and
delicious, pre-packed meals provided by Suburban Orthodox Toras Chaim (from the
Knish shop), Pearlstone Retreat and Conference Center, and Beth Tfiloh, among
others.
Due to the recent
uptick in COVID cases in Maryland, no visitors are allowed at Levindale. That
means Facetime and phone calls are more important than ever. Families are so
appreciative to receive a phone call with an update on their loved one’s
therapy progress and then a conversation with the patient. I have had scheduled
treatment sessions with a patient, along with physical therapy, which the family
can view on Facetime. For the most part, this works well, depending on the
level of dementia and comprehension of the patient. For example, one patient
kept saying her daughter’s name when hearing her voice but could not understand
that her daughter could see her on video.
Before the
pandemic, I never realized the responsibility that comes along with being an
essential worker. Because I work closely with the elderly in the hospital, I
have seen how highly contagious COVID-19 is. I place great value on keeping my
patients, myself, my family and my community safe. I wear a mask both inside
and outside, whenever I am around others. When I leave work, I come straight
home, wipe off my belongings and take a shower. I put my N95 masks under a UV
light (for disinfection), as I need to reuse them. I stay away from large
gatherings. When asked, I have advised others on how to keep COVID-safe as well.
If I see COVID restrictions that may put others at risk not being followed, I
point them out in a respectful manner. Sometimes people listen; sometimes they
don’t. And I try to keep a positive attitude: counting my blessings, getting
vaccinated, and connecting over the phone with friends and family or through one-on-one
socially distanced visits. And, more than ever, I daven to Hashem for
appreciation of life and hope for a bright future.
This article is
dedicated in the memory of Rebbetzin Dr. Aviva Weisbord, a mental health
advocate and pillar of the Baltimore community.
