A final request

“Do you have any ice cream?” My new patient Mrs. V., had nodded her head yes when I asked her if she wanted a massage, but clearly she had another form of comfort on her mind. I looked over on her tray and saw, among many items of untouched food, an open cup of melted chocolate ice cream. “It’s melted,” I replied. “Is that okay?” She nodded again, and I went to retrieve her treat.

Before I left her bedside to get the ice cream, I took a look at her wristband to make sure I was with the right patient. When the nurse gave me the referral, she told me that she was surprised that the patient was still alive: yet here was Mrs. V., not only alive, but asking me for ice cream.

In end-stage disease, many patients enter a final phase that we refer to in hospice as “actively dying.” In this state, we see common signs of imminent death: peripheral circulation slows, leading to discoloration of the hands and feet (known as “mottling”); breath becomes irregular, then shallow; the eyes become glassy and unfocused; the patient loses consciousness.

Actively dying patients do not usually eat or drink. The body no longer wants nutrition or hydration as it prepares to shut down; this is a natural component of the dying process. I was concerned that, even though she was asking for ice cream, perhaps her body would reject any attempt to feed her. But who was I to deny a dying woman what could be her last request? I picked up the spoon, dipped it into the melted ice cream, and brought it to her mouth.

Her lips parted, and closed around the spoon as she took in the ice cream. Then the corners of her mouth began to curl upward into a teeny smile. “Is that good?” I asked. Again she nodded. I gave her another spoonful, and then another. “Is chocolate the only flavor you have?” she asked. I looked again at her food tray and saw no other ice cream options, but spotted some vanilla pudding. When I offered her this option, she requested that I mix them together.

I dipped the spoon first into the custard, then into the ice cream. Again came the smile. A few bites later and she’d had enough. I put away the food and began to massage her left hand, then moved up to gently place my hands on her head. She drifted off into sleep and my work was done.

Mrs. V. died twelve hours later.

Meditation for Hospice, and for Everyone Else

I recently collected a couple of meditation CDs that someone had left in the family room at one of our hospice inpatient units, presumably for patient and family use. I was working on collecting suitable guided meditation audio for this express purpose, so I wanted to listen to what we already had on-site.

Imagine my surprise when I heard the following words:

In order for you to overcome your illness, cancer, it is important for you to express your emotions. Trapped negative emotions create stress in your body, and suppress your immune system…Picture your body now completely free of cancer, and in perfect health…your immune system is alive and radiant and brimming with life…your immune system is strong and powerful…letting your mind completely relax as you get more and more used to the idea of your body being completely free of cancer and your immune system powerfully strong.

Needless to say, I did not return this CD to our hospice after I listened to it.

Thankfully I happened upon Meditation Oasis, a project of Mary and Richard Maddux. They distribute free guided meditation podcasts on a variety of topics. As I began listening to assess their suitability for hospice, I came across meditations on deep rest, coping with pain, processing grief, and flowing with change. I heard no claims of healing the body or curing disease, just suggestions for coping with difficult emotions within a framework of acceptance.

When I contacted Mary for permission to burn the podcasts onto CDs to distribute to our patients and families, she told me that she used to be a hospice social worker. Ah, yes, I thought. That makes perfect sense.

Although many of these meditations are hospice-appropriate, most of them are on general topics suitable for anyone who is looking for help with stress relief.  Just click on the link above, or search on iTunes.

Crossing over into Reiki territory

It’s official: I have been “attuned” as a Reiki practitioner. And I am still torn between wanting to believe and wanting not to believe.

My teachers at Memorial Sloane-Kettering, Wendy and Michelle, described the introductory Reiki course as an “initiation.” There was a small amount of lecturing, where they gave the history of Reiki as they practice it, but most of the class revolved around four initiation ceremonies.

We sat in a circle and meditated quietly while Wendy and Michelle went around to each participant, placing their hands on our heads, shoulders, and finally taking our hands. It was very ritualized (and weird in that respect) but also extremely relaxing and powerful.

The end of the class was devoted to hands-on practice time. We paired up and gave each other Reiki, both in a chair and on a massage table. We were also assigned “homework” that is required for moving on to Level 2. Unlike with massage therapy, Reiki practice is centered around self-treatment. So our homework involves integrating Reiki practice into our daily self-care routines.

What kind of Reiki student am I at this point? Curious, to be sure. And still skeptical. I have done some self-treatment sessions and have found them to be pretty relaxing. I’ve also tried it out a little bit on a couple of my clients.  Sometimes I “feel” the Reiki and sometimes I don’t.

In the week before my initiation I received a Reiki session from one of my colleagues. Her hands felt very hot. The session was short, only 1/2 hour, and it felt like it went by very fast. I didn’t feel any obvious flow of energy like I have during acupuncture treatments, but I did feel a weird sensation like I was floating at one point. And at the end, I was completely exhausted.

A few weeks after the initiation I received a “hands-off” chair Reiki session from another colleague. I could feel the heat generated by her hands but I was distracted by the sounds of her swallowing and by the smell of her perfume. I am so accustomed to massage therapy, to being touched, that the hands-off approach didn’t really click with me.  The experience was similar to the one I had when a Reflexologist worked only on my feet for an hour.  The rest of my body was cranky and felt neglected.

I was unsure of what to expect before I went to the Reiki training. Part of me anticipated some kind of seismic shift in my consciousness and that part of me is a little bit disappointed. The rest of me, though, feels like my experience was adequately challenging and enlightening and I don’t really need a “thunderbolt” experience.

For many years I have been aware of energy in hands-on bodywork but I have not made much of a conscious effort to work with it. I am hoping that, by continuing to experiment with Reiki, I can develop a useful framework for tapping into the energetic connection that exists between people.

Gearing up to start Reiki training

Shortly after my previous post on Reiki, where I cited scientific studies that give credibility to massage therapy, a new study about Reiki came out in the Journal of the American College of Cardiology. This study took place at Yale Medical Center and found improved outcomes for patients who had received Reiki treatment within three days after suffering a heart attack.

This kind of research intrigues me and makes me want to learn more. I’ve been doing a great deal of reading on the topic in preparation for my Level 1 Reiki training in early November. However, I am having trouble accepting two basic principles: “attunement” and “distance Reiki.”

“Attunement” refers to a kind of initiation ritual wherein an advanced teacher (known as a “Master”) somehow activates a person’s ability to tap into Reiki energy, which is claimed to be a universal life force flowing through everyone. One of my colleagues, who has attained Master-level training and told me she needed to learn more about how to do attunements, agreed with my interpretation that it was like “flipping a switch.” Not having had my own switch flipped yet, I’m not really convinced. I’ll be sure to follow up with a report on my “attunement” after November 5.

“Distance Reiki” is something that happens during training for Reiki Level 2. As I understand it, practitioners are supposed to be able to send Reiki healing energy to those who are not present. This is where, as I mentioned in my last post, Reiki begins to seem suspiciously like religion. I received this impression quite strongly from looking at an internet message board where people were posting distance Reiki requests. Many of them were heartbreaking and desperate, just as prayer requests can be when presented at church or through support groups. But when I got to the post where someone asked for people to send Reiki to her lost kitten, I thought, “seriously?” I love my pets as much as the next person, and I’ve even had a cat jump out my window and run away, but I certainly wouldn’t expect strangers to care, or to attempt to intervene in some cosmic way.

And so “Confessions of a Reiki Sceptic” continues. I’ll be receiving a Reiki treatment in a couple of weeks as a prerequisite for my course, and I’ll post my observations here then.

Self-Care for Caregivers

Several years ago I attended a seminar on self-care for caregivers.  The workshop was led by an Ayurvedic practitioner and yoga teacher named Scott. He began the day with a guided body scan and breathing exercise that gave me a profound sense of relaxation (for about 10 minutes). We did some yoga, and he talked about Ayurvedic health principles that he believed were therapeutic and restorative.

At his suggestion, I tried buying a bath brush and scrubbing my skin all over before I took a shower. But I just couldn’t wrap my mind around using olive oil instead of soap or shampoo for bathing, as he said he did. Or to bathe in cold water. His dietary recommendations included steamed kale and brown rice for breakfast. This from someone whose physique was, unsurprisingly, borderline anorexic.

I wish I could say that, on that particular day, I learned a dozen positive habits and have been practicing them religiously ever since. Or that I am now a channel of divine energy, writing this blog post from up on my self-aware mountain, beckoning you to join me in the bliss of perfect stress relief.

Instead, I am writing from a place of suffering and struggle, which I hope will be helpful to you, my beloved readers.

Holding stress in the body is something nearly everyone experiences. I see it every day in my work, and feel its effects underneath my hands as I perform each massage. I lead my clients through guided breathwork to facilitate the release of their muscle tension, and at the end of each session I observe the positive effects of massage. I frequently recommend self-care measures like massage, yoga, and exercise,  and I remind people to at least try and keep breathing when they are under stress.

In my own life, I try to practice what I preach. I get lots of sleep, I eat vegetables, I exercise. What I don’t do very well is relax.

Lately the stress in my life has manifested in a month-long headache. I have spent the past week practitioner-hopping, from massage to acupuncture to chiropractic and back to acupuncture, trying desperately to get some relief.

The culprit seems to be a recurrence of TMJ dysfunction. In lay terms, this means that I clench my jaw and it leads to a constant background headache. Underneath this dysfunction lie a host of connected issues. Physically, I have a postural imbalance, where my shoulders slump and my head juts forward. And mentally, I seem to be unable to process stress and let it go.

“I feel like a big fraud,” I complained to anyone who would listen to me this past week. “How can I help other people relax when I am carrying all this stress in my own body?” My friend L and her husband M laughed. “I work at a computer store and I don’t have a shiny new computer,” L said. “Yeah,” M chimed in,  “and doctors get sick. Why do you think you have to be perfectly relaxed all the time?”

My husband offered his own observations. “Because you do this work, you’re probably more aware of what is going on in your own body.” He doesn’t think I have more stress in my body, just more awareness of its impact. I suppose that thought gives me some comfort, although it hasn’t taken away my headache.

As someone whose profession involves advocating stress reduction, I’m a work in progress. In order to help my clients reduce their stress, I need to foster healthy awareness of my own. And, although I love kale, I can’t quite see myself eating it for breakfast, or otherwise becoming a health-obsessed lifestyle extremist. That wouldn’t be fun for me (or my family) and it certainly wouldn’t help my clients any. I’d rather be someone they can relate to.

New Continuing Ed Requirements for NYS LMTs

This week, the governor signed a new law requiring LMTs in New York to take 36 hours of continuing education every three years in order to be eligible to renew our registrations.

Unsurprisingly, this decision has been met by some grumbling among massage therapists in NYC. “We make so little money as it is,” said one of my colleagues, “and now we are being forced to spend it on courses.” Others have complained that it seems to be another way for the state to raise revenue during difficult economic times.

As an individual massage therapist I tend to agree with these sentiments. I already take courses that I feel will enhance my practice and help with my professional development. But I suspect that the profession overall will benefit from this new requirement.

Massage therapy continues to struggle for inclusion within the health care system. Several years ago the basic educational requirement for licensure was increased dramatically, from a certificate program to an Associates Degree. Ironically, it was this change in the law that led me to go to massage school when I did; I knew I would never be able to afford a two-year program, so I squeezed into the last year of the one-year program and was “grandfathered in” under the old licensing requirements. I also had attained a BA and an MA already, so I did not feel I needed to add an Associates to my list of degrees.

When I began to meet up with new graduates in the workplace, I envied their additional training. And now that I work for a healthcare organization, I appreciate the fact that the massage therapy license requires a level of education comparable to nursing, terminating in a college degree. It gives us a measure of professional respect that a mere certificate cannot confer.

Similarly, requiring that massage therapists continue to study and learn throughout their careers is another step towards professional legitimacy. Doctors and nurses have strong industry-based standards for continuing education, such as specialized certifications, that are pretty much required if they are to advance in their careers. Massage therapists have a national certification board with continuing education requirements but there does not seem to be much professional incentive within New York State to carry this certification; jobs do not require it, and salaries do not increase for those who attain it.

Reiki and Hospice: One Massage Therapist’s Struggle

One of the most gratifying aspects of providing massage therapy in a medical setting involves seeing my profession gain respect and legitimacy among doctors, nurses, and other healthcare practitioners.

More and more studies are appearing in mainstream medical journals documenting the clinical efficacy of massage therapy for symptom relief, and exploring massage as a way to promote well-being among people who face health challenges.

And then there’s Reiki.

Reiki is a hands-on therapeutic modality that relies primarily upon energy rather than the physical manipulation of muscle tissue, as in the case of massage. It is a spiritual practice that has its roots in Japanese bodywork and lots of people really believe in it. Me, I’m not so sure.

As a massage therapist I am certainly aware of energy in the body. I have felt myself interact with my clients’ energies in ways that I find a little bit mysterious. But I tend to be skeptical of larger claims about energy that can’t really be validated scientifically. I like science. I believe in science. Reiki seems more like religion to me.

In fact, Reiki is a lot of things to a lot of people. That’s part of the problem. There seem to be so many definitions of Reiki floating around out there, and such a wide variety of educational and practice standards, that the barriers to integrating this modality into medical settings seem particularly high.

Hospice, as a medical setting, is a bit of a rogue. It champions an interdisciplinary approach to treating patients and their families that most people do not encounter in doctors’ offices or hospitals. It uses volunteers as a core part of its mission. Pastoral care is routinely offered to every patient, and bereavement services are provided free of charge to families after the patient dies.

It’s not surprising that a hospice might be more open to Reiki than, say, an academic medical center. In fact, my own hospice has asked me to start a Reiki program.

So here I am, a Reiki sceptic, about to embark upon a research and educational process so that I can become better informed, in order to build a program that has clear (and high) standards of training and practice. I plan to document my own process here, on this blog, and I look forward to your feedback.

New Yorker article about hospice

This article appeared in the most recent issue of the New Yorker. It is written by a surgeon and details his own discovery of the purpose and value of hospice care. More importantly, he situates his personal journey within a context of the greater health care system and discovers that, paradoxically, patients on hospice often live longer than patients who do not forego “curative” treatment.

Massage…yes! Therapy…no!

The language we use to introduce massage to elderly and sick patients can make a tremendous difference in the ability of those patients to accept the treatment being offered.

“Massage therapy” is the standard clinical term for hands-on manipulation of muscles for the purpose of symptom relief and/or stress reduction. Massage therapists frequently go to great lengths to define our work as “therapy,” especially as we strive for professional recognition within the medical field. We avoid terms like “back rub” or “foot rub” because these are not clinical terms. It’s easy to assume that everyone knows the standard definition of massage therapy, but that is not always the case.

At hospice one day I entered a patient’s room and offered her massage therapy. Her reply: “Massage…yes! Therapy…no!” To her, “therapy” meant physical therapy. PT can often be strenuous and painful, and certainly it’s too much for many people as they approach the end of life.

Sometimes even the word “massage” has negative connotations. At baseline, massage is usually somewhat vigorous and can even feel painful. Someone who is sick might assume that the massage I am offering will be similar to one they may have had in the past.

Many massage therapists have fought hard for the privilege of working in the medical field and have done so through the introduction of clinical language. However, the fight for legitimacy is secondary to the mission of properly serving our patients. When working with special populations it’s important to be open to alternative language. When the word “massage” is too scary, I find myself offering a “back rub” or “foot rub” instead.

Massage Research and Conventional Medicine

Recently our hospice massage program was nominated for an Innovation Award within a large consortium of hospitals and healthcare organizations. Although we did not win, at the awards ceremony I had the opportunity to meet some other healthcare providers and learn about what they are doing.

One doctor I met, who is a medical school dean, expressed interest in our hospice massage program. “Eva,” he said, “Did you know that neurological research is discovering that touch has a significant physiological impact? Of course massage is a nice thing to do for people, but it’s turning out to be so much more than that!”

Usually it’s massage therapists trying to point out research findings to doctors: how lovely to experience this dynamic in reverse.