Interview with Justin Stehr OTR/L, CHT, WCC, CEAS, CPAM

Personal Journey

What inspired you to become a caregiver?

I was in operations management before. I was working with a pool company and we sold wholesale pool equipment, materials, chemicals and so I would manage inventory, hazmat, and drivers—things like that. So, you know, very operations-based.

I met my wife at church. She’s an occupational therapist as well and she was talking a lot about her work with patients that are primarily post-stroke, post-brain injury. At that point, I already had a Bachelor’s degree and I was thinking I kind of wanted to change fields to something a little more meaningful instead of just like, crunching numbers and working inventory. So, I went back to school, got my Master’s, and decided to pursue this line of work initially. Five years before becoming an occupational therapist I cut my forearm on a saw, requiring flexor tendon surgery and hand therapy, and while that didn’t directly inspire me, I’m sure as I learned about it and kind of had more and more of an interest in certain things that’s kind of what hemmed me to be a hand therapist.

Can you describe a defining moment in your caregiving journey that reinforced your passion for this work?

I would say my own personal experience, and then I shared one link to a patient story. That’s probably one that comes to mind because, you know I worked with them for a very long time and we did a whole story about it. So, that was really cool, being able to see something that, you know she was initially told that the arm is going to be amputated, and is not salvageable. You know, she ended up moving from Michigan to Nashville basically for surgery and therapy and everything else. So, she relocated and now she has a functional arm. It’s not perfect, but she’s able to have her independence and is happy, and doing a lot of stuff like playing volleyball with her daughter and having a good time.

What is the most rewarding aspect of being a hand therapist for you?

In my particular setting, I’m very fortunate. A lot of hand therapists work in a place where they don’t get to see two or three patients at a time. They’re very much: you got to see fourteen, fifteen patients in a day, and it can be overwhelming and maybe not as rewarding because it’s more routine work over and over again. Where, here, I’m within a clinic so most of my patients are post traumas and they have no idea what’s going to happen or what the future is. A lot of times they don’t even know they’re going to see me, like, “What do you mean I’m going to see a therapist? My arm was just repaired, reconstructed.”

Working in a post-operative trauma clinic with patients puts me in an environment where people don’t expect a therapist to so immediately after their injury. I get to help them out of a plaster splint and into something removable to improve their comfort. Many of my patients are extensively injured and need an extended acute rehab experience where they spend weeks in therapy. Instead, their injuries are often managed as an outpatient despite having significant functional deficits in their hands.

You know, I get to be able to help them transition from seeing the doctor and the nurses, and go, “Ok, so here’s this new splint that you can remove, you can wash, you can do everything you’ll need to be able to do.” So, I’m the one that gets to be able to come in and give them some of that independence back. As minor as it seems, it can be very helpful for these patients in this acute time frame.

Care Recipient

Who do you care for, and what is their condition or situation when they arrive to you?

We’re writing a paper right now and we’re presenting to the Canadian National Percussion Society next year on our paper. It’s “The Biomechanics of Drumming,” so like, a lot of times the musician, in respect to drumming at least, we looked at posture, and the elbow and the shoulder. For me, you know we’re focusing on the actual grip portion of it that’s not very well covered. So, I look at more of the actual grip portion, and the wrist. There are a lot of elements in grip that are not very well covered so, in this paper, we go over that. You know, being in Nashville, we definitely see our fair share of musicians. There might be guitarists, percussionists, drummers, pianists, or whatever it might be. It’s a newer program so we’re starting to build up and it’s been nice to learn about that on-the-go as we build up our practice, and it’s been fun!

Do you primarily see musicians, being in Nashville, or do your patients span all over the spectrum?

I would say 95% of my patients are post-trauma. So, most of my patients that are sitting right here, they just had a hand or upper extremity injury very recently, you know they’re coming here to see their doctor after their first surgery and get everything down. A lot of those patients just happen to be musicians who live here. Or, you know, they maybe have a repetitive injury because of their vocational practice, whatever that might be. People often think I’m going to be treating the Grade-A celebrities. One or two may have come through here, but the majority of the musicians that need help are just the average person working Broadway or whatever it might be. You never know, a lot of times we don’t even realize they’re musicians, they come in for therapy and they see the guitar sitting right here by my desk and the drumsticks and go, “Hey, oh by the way, I play this or that,” and it kind of turns into that whether they think about it or not.

How has your relationship with your patients influenced your approach to being a caregiver?

Being a hand therapist often leads to significant time spent face-to-face across a table where stories are shared. I often learn a lot about the daily activities and events that seem minor but provide valuable clues into their function that I can incorporate into therapy that day.

It’s really taught me to be patient. I’m not the most patient person, and a lot of my patients here come in in a post-operative dressing, so a lot of times they’ve got dried blood and the dressing is stuck to it, or they’re in a lot of pain. Luckily, I’m right here with our nursing team, our doctors, and our advanced practice providers, so it’s very much a team effort. So, it can take time for all of us to work together and do each of our parts slowly, and just be patient and work with them. Being patient with our patients. I think that’s the main thing, you know, slowing down and realizing that in this early stage, there can be some changes made, but it’s actually going to be pretty slow because of all of the things going on.

Challenges & Support

What are some of the biggest challenges you face as a caregiver?

The burnout can be hard. It’s very easy to want to do everything for a patient, especially if the patient is someone who’s receptive and willing to do the work, or they’re just a good patient, easy to get along with. Then it’s like you really want to go above and beyond, and sometimes you have to kind of stop yourself and go, “Ok, I’ve got to work with the next one now,” and kind of pace yourself. I think a lot of therapists go in with the expectation of doing 120% for every patient, but sometimes that’s not realistic. You’ve got to be able to balance that a little bit more.

Do you feel supported in your role? Where do you find your support network?

I’m very fortunate. A lot of therapists don’t get to be in a clinic like this where they get the support of the entire team. I have three doctors I work with very closely, all in the same clinic. All three are hand surgeons and plastic surgeons. And then, all three of their nurses, three advanced practice providers, a nurse practitioner, a surgical tech, and a couple of nurses who help out with this team. So, it’s very collaborative. I’m kind of right here in the middle. We all meet every morning, and then when patients come in, we all are working together on them, so there’s a lot of collaboration. That’s not the norm. I’ve worked in other clinics where it’s very much, “You do your thing and the doctors do theirs.” But here, we all work together, and that’s been really, really helpful and has helped me grow.

Advice & Resources

What advice would you give to someone new to caregiving or considering entering the field?

Make sure you enjoy doing this. Make sure it’s something you really enjoy doing, because, if you go into therapy just thinking that it’s going to be a good job that pays the bills or offers stability, you’re not going to last. You’re going to burn out.

Make sure it’s something you enjoy and then don’t be afraid to ask questions. Find mentors and people that are doing the work that you’re doing and see how you can learn from them.

Are there any resources, tools, or organizations that you’ve found particularly helpful?

Yeah, absolutely. For me, I’m a certified hand therapist. So, I went to an orthopedic program, and that gave me a great foundation. But I would say the best one was joining the American Society of Hand Therapists. I think they’re a fantastic resource. They have a mentorship program, they have a new grad program, they have a student program, they have tons of materials that you can use to study, but also get involved and learn. That was a really great one.

There’s also a group called the Performing Arts Medicine Association (PAMA). That’s a newer one that I’ve gotten involved with in the last two years, and that one’s really interesting because it’s specific to working with artists. So, it might be music, dance, circus arts, Broadway, all kinds of things like that. It’s very interdisciplinary: it’s doctors, therapists, mental health professionals, physical therapists, occupational therapists, athletic trainers, and they all come together. That’s one that we’ve been trying to be more involved in and grow from.

Looking Forward

What are your hopes for the future of caregiving?

I hope that there’s more awareness about the mental health aspect of caregiving. That applies to both the caregiver and the patient. I think people think that being a therapist is all physical, but there’s so much mental and emotional burden that’s taken on from the patient’s side and ours. I hope that’s something that becomes more widely addressed and supported in the field.

What changes would you like to see in the way caregivers are trained, recognized, or supported?

I’d like to see more support in terms of mentorship and training early on. A lot of therapists come out of school and feel really overwhelmed, and they get thrown into settings where they don’t have a lot of support. I think there should be more structured mentorship programs, more continuing education that’s accessible and not super expensive, and more emphasis on interprofessional collaboration.

Closing

Is there anything else you’d like to share about your experience or insights as a caregiver?

I’m grateful for the opportunity to do what I do. I get to work with people on some of the hardest days of their lives, and hopefully, help make things a little bit easier. That’s a privilege, and I don’t take it lightly.