John Fetterman sponsored a bill from the hospital. Here’s what he can and can’t do in the Senate during treatment.

WASHINGTON — When a bipartisan group of senators from Pennsylvania and Ohio reached across their border to introduce a rail safety bill last week, Sen. John Fetterman joined them.

Despite remaining hospitalized while undergoing treatment for depression, Fetterman cosponsored a plan with Sens. Bob Casey (D., Pa.), Sherrod Brown (D., Ohio), J.D. Vance (R., Ohio), and others to try to avert future crises like the one unfolding after a Norfolk Southern train derailed in East Palestine, Ohio.

Fetterman’s office says it’s one example of how the freshman Democrat is staying engaged with his job.

Fetterman isn’t on his phone much since he checked into Walter Reed National Military Medical Center on Feb. 15, less than two months into his tenure.

Instead, one of two top aides — chief-of-staff Adam Jentleson or senior adviser Bobby Maggio — visits Fetterman at the hospital most mornings and briefs him for around an hour. They bring updates from Capitol Hill and ask for input on thorny questions, Jentelson said in an interview.

“The legislative process doesn’t really require a senator’s physical presence. It requires their intellectual engagement, and he’s in a place where he’s able to offer that,” Jentleson said.

When it came to the rail safety bill, for example, Jentleson said Fetterman asked about what unions for rail workers wanted. The issue not only affects a large swath of the senator’s constituents, it resonates with his pledge to stand up for “forgotten communities.”

“He was very tuned into the issue,” Jentleson said.

Meanwhile, aides in Pennsylvania have opened offices across the state, hired staff to reach out to constituent groups, and set up operations for constituent services.

In the face of intense scrutiny on his recovery, and questions about his long-term health after a stroke in May, Fetterman’s team points to the early activity to argue that he’s still able to fulfill key aspects of his new job. He can’t vote in the narrowly divided Senate, and help the Democratic agenda, until he physically returns to do so. But his aides hope that’s not far away: Jentleson said Fetterman’s absence is likely to last weeks but, “I don’t think we will be measuring this in terms of months.”

On Monday Jentleson tweeted photos of himself consulting with Fetterman at the hospital, adding, “John is well on his way to recovery and wanted me to say how grateful he is for all the well wishes. He’s laser focused on PA & will be back soon.”

Yet some longtime Senate aides say workarounds can only go so far.

“OK, you signed onto a bill. But what are you doing to make it into a law?” asked Matt Beynon, a Republican operative who once worked for Sen. Rick Santorum (R., Pa.).

Staffers can help negotiate a bill or draft a news release. They handle nearly all constituent services. But Beynon, who expressed sympathy for Fetterman’s health problems and wished him well, said that on tough issues, personal interaction is one of a senator’s most powerful tools. Only a senator can corral a colleague or a Cabinet secretary who’s on the fence.

“ ‘I’ve got something that’s really important to my state, can I talk to you about it? Can we get a cup of coffee together? Can I walk back to your office with you?’ That matters,” Beynon said. “Him not being there, it’s one less voice for something that he says he cares about.”

The not-so-secret reality of Congress is that a significant amount of work is handled by aides, who negotiate with other staffers, funnel information to their bosses, and rely on the elected officials for the toughest decisions. That’s especially true in the Senate, where the staffs are larger.

“They do 80% of the work,” said Wendy Schiller, a Brown University political scientist who has closely studied the Senate.

A number of senators have missed far more time than Fetterman — some close to a year — due to strokes or other ailments. And aides have done most of the lifting for some older senators who have declined while in office.

» READ MORE: John Fetterman wanted a quiet start in the Senate. His health has upended that.

“The United States Senate is a very user-friendly institution,” said Ross Baker, a Rutgers University professor who has also studied the chamber. “Accommodations are typically made for senators who are undergoing therapy of one kind or another.”

In Jentleson, Fetterman has a veteran staffer who has worked at the highest levels in the Senate, including for the late Democratic Majority Leader Harry Reid, of Nevada. Maggio was Fetterman’s chief-of-staff in Harrisburg, when Fetterman was lieutenant governor, and is familiar with the senator’s policy views.

“The staff tees up the big questions and the big issues for the boss, gets their feedback, and then goes back and executes based on their feedback,” Jentleson said. “Major decisions do not get made without his awareness and input.”

There are also few major legislative decisions at the moment, with Democrats holding a narrow Senate majority and facing a GOP-controlled House that would likely oppose most ideas Democrats pass anyway. The Senate has spent almost all its time on confirmation votes, mostly on noncontroversial nominees who have enough support to advance even without Fetterman. (He hasn’t voted since Feb. 15).

And Fetterman and Pennsylvania may also benefit from the fact that he has a number of allies pulling in the same direction, Schiller said. Casey is a fellow Democrat and so is the new governor, Josh Shapiro, and they’re both aligned with the White House.

And with President Joe Biden eyeing reelection, Schiller added, Pennsylvania will never lack for attention, given the president’s personal and political ties to the state. (Biden has endorsed the rail safety bill, and he’s returning to Philadelphia Thursday to unveil his budget proposal.)

The rail bill, though, was a relatively light lift. Led by Ohio’s Brown, it had bipartisan support and was a somewhat obvious step for Pennsylvania lawmakers, given the number of residents affected.

Fetterman legislative assistant Madeleine Marr joined staff meetings with Norfolk Southern, the Federal Railroad Administration, the Environmental Protection Agency, the Centers for Disease Control and Prevention, and other relevant parties as the bill was crafted and delivered information to Jentleson, which he then took to the senator.

“There are obviously some aspects that are unusual, but fundamentally it’s not a whole lot different than how it would have transpired if John was in the office,” Jentleson said.

Theo Merkel, who was legislative director for Sen. Pat Toomey, the Pennsylvania Republican whom Fetterman replaced, said aides can handle many matters where a senator’s positions are clear. But in a situation like the one in East Palestine, direct action from a senator can make a difference, such as pushing a Cabinet member, like Transportation Secretary Pete Buttigieg, for specific steps.

“He’s got an experienced staff that will be able to handle much of it, [and] the Senate isn’t doing a tremendous amount right now,” Merkel said. “But there is no substitute for member engagement when it comes to persuading committee chairs, regulators, and ultimately in the most important cases, the president of the United States to take action.”

Even seemingly routine nominations can give senators a chance to exert themselves. For example, Phil Washington, the nominee to lead the Federal Aviation Administration, is facing a tight vote. If Fetterman was able to meet with Washington, he might be able to extract pledges of help for Pennsylvania’s airports. But he’s unable to do so right now.

Other senators have missed time, but they were already well established in their jobs. Sen. Tim Johnson (D., S.D.) was out for about nine months after a brain hemorrhage. Sen. Mark Kirk (R., Ill.) suffered a stroke and was away for nearly a year.

Fetterman, however, is just two months into his time as a senator and was still learning how to navigate his new role. His personal fame also means he’s facing much more public scrutiny as he tries to get well.

Looking ahead, Fetterman aides know the senator’s influence could be important when lobbying colleagues and committee chairs to get Pennsylvania priorities inserted into the upcoming Farm Bill that sets agricultural policy.

“We’re trying to think through ways for him to be involved even if he has to do that remotely,” Jentleson said.

One of the most important aspects of a senator’s work happens far from Washington, and the public eye. Senators handle reams of requests from constituents, from help navigating the federal bureaucracy to aid with passports and visas to recommendations for students applying to the service academies.

That work is almost entirely staff driven, even under normal circumstances, but has taken on perhaps added importance because the senator himself can’t hold events around the state.

His team has hired 17 aides in state, with more to come, including regional directors to reach out to constituents and take meetings with individuals or organizations, said Joe Pierce, Fetterman’s state director, based in Philadelphia.

» READ MORE: From the top of the political world to a basement office: How John Fetterman will fit in the U.S. Senate

Pierce also added a coordinator to both reach out to Latino communities and help address their service requests.

Meanwhile, they’re opening offices to establish a physical presence. Each Pennsylvania senator is allocated 8,000 square feet of office space (the amount varies by the size of each state), and can decide how to split it up. Instead of a few large offices, Fetterman is aiming for smaller offices spread among a wide variety of communities, Pierce said.

They’ve opened offices in Philly, Pittsburgh, Erie, and Harrisburg, with a Wilkes-Barre site to come in April. In Philadelphia, Fetterman’s team is using Toomey’s old offices at Second and Chestnut Streets, but they plan to move to the William J. Green Jr. Federal Building at Seventh and Arch Streets, where they’ll be more central and closer to a wider variety of public transportation options, Pierce said. (Moving a Senate office, though, can take 18 to 24 months).

They have plans for other offices in Johnstown, State College, Bethlehem, and possibly others, Pierce said.

After recently finalizing their software to handle constituent requests, they already had 3,000 waiting in their inbox. (Most have already been routed to the proper places, and many were simply well wishes, Pierce said.) Their constituent services director, Kathi Caber, is a veteran of Casey’s office who handled such matters for a decade.

All these steps would fall to aides, whether Fetterman was hospitalized or not, Pierce said. But the staff is acutely aware of the spotlight, and the pressure of making sure the new senator’s presence is felt. Pierce described a bond among aides forged by the office’s early adversity.

“It’s a big national story, and everybody’s looking at us like, ‘How are you going to handle it?’ ” Pierce said. “And everybody’s stepped up.”