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Archive for September, 2009

More often than I would like, I offer a hospice patient a free massage and they say no thanks.

Sometimes they really mean it. People who are dying experience many intense physical and emotional sensations and sometimes they do not want to be touched. I respect that.

Other times, though, I will try to find another way to sell it.

I asked one end-stage cancer patient if she’d ever had a massage before. She replied “yes, and it was very painful.” I explained that the massage I would give her would be quite different, that it wouldn’t hurt at all because I would use very light pressure.

“Why don’t I just give you a 5-minute foot rub and you can see if you like it?” I asked. She agreed to let me try and then she was sold. I ended up giving her a full body massage. When I thought I was finished with the massage, I asked her if there was anything else she would like. “My chest,” she said.

This is an area I don’t usually massage on very sick people. It is often very sensitive, and massage on the chest feels intimate. Perhaps she’d been sick as a child and was remembering a parent rubbing her chest with menthol ointment. Regardless, this woman who had not wanted a massage was now asking me for comfort and for that I was grateful.

Another patient informed me “massage has never been my thing.” He then explained how he used to like giving his wife (who was in the room) foot massages but that he really didn’t like to be touched.

He started scratching his arms. “It looks like you have some pretty dry skin,” I said. “Maybe you should put some lotion on it.” “I’m too tired,” he replied. I made him an offer: “I could do it for you.” I started by applying lotion to his back. He said, “That feels really good. I guess I like massage after all.” Once again, the not-really-a-massage turned into a full-body massage.

Hospice patients bring with them a lifetime of experience that sometimes includes negative ideas about massage. By acknowledging this experience and then reframing the offer, I can give patients one more chance to receive a few moments of pleasure when they need it the most. Although I understand why some patients would refuse a massage, I like to take the time to understand the reasons behind the refusal to make sure it is the real thing.

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Just before my first session with Liz, Teresa, her home health aide, warned me that she could be a bit “moody.” I wasn’t sure what that meant exactly but I had known my share of moody patients. One day they might swear at me, another day tell me that they loved me. I was trying to be ready for anything Liz might throw at me.

We entered her room and she was in bed, with her eyes closed. “Liz,” said Teresa, “This is Eva. She’s here to give you a massage.”

Liz opened her eyes slightly, glanced at me, and closed them again. “Do whatever you want with me.” Not exactly an enthusiastic endorsement of the therapy she was about to receive, but I took it as consent nonetheless.

She spent the next 20 minutes pretending to be asleep while I massaged her legs and feet. Finally, as I was massaging her shoulder, I decided to try to end her game of possum. “Liz, how does this feel?”

She opened her eyes and stared into mine. “You’re so pretty,” she exclaimed. She closed her eyes again and kept them closed for the rest of the session, but I understood that, by complimenting me, she was trying to say that she was enjoying her massage.

The next week, when I went to see her again, I got some more context for her behavior. It turns out Liz is not merely “moody,” but she suffers from bipolar disorder. Although she is being treated with medication, her moods still vary widely.

During our session she started out resentful, then she began to trust me and relax. When her massage was over, I asked her if I could come back the next week. “Definitely,” she said. My challenge will be to arrive at the next session free of any expectations and prepared to have to earn her trust again.

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Mrs. C., who is ninety-something and is in the mid-stages of Alzheimer’s, spends the greater part of her days sitting on a sofa, reclining on a chaise lounge, or lying in bed, drifting in and out of sleep. I’ve seen her leafing through her mail, though she appears to have forgotten how to read. Sometimes she will get up and wander around her apartment, a common behavior manifested by people with Alzheimer’s. A professor I once had described it as “looking for herself.”

On the whole, Mrs. C. does not talk much. When she does, she is unfailingly polite, and she uses old-fashioned phrases like “I should think so!” and “I beg your pardon?” and adjectives like “marvelous!” and “lovely!”

During our massage sessions, Mrs. C. is very attuned to her senses of hearing and sight, as well as touch. Often we will hear a cacophony of horns coming from the street, 17 stories down, or a siren approaching from five or six blocks away, and she’ll ask me “what on earth is that all about?” Or she will listen quietly to the music I play for her (she seems to like Brahms and Beethoven best) and then react when there is a dramatic moment, or when the music ends, by exclaiming, laughing, or even clapping her hands. At some point during every massage she will say “that feels so good!” as if it’s the first massage she’s ever had.

Her bedroom is on a southwest corner, and gets direct, unobstructed afternoon light. One lovely fall day, with scattered cumulus clouds drifting across the sky, provided a study in the play of light and shadow.

For the first 10 minutes of her massage, the sun was hiding behind one of those clouds. Suddenly the light in the room brightened dramatically and Mrs. C. said, with surprise, “wow! when it’s sunny, it’s really sunny.” I met her there, sharing her wonder at the brightness of the light, and then just as suddenly it was gone. We laughed, and waited for the light to come back.

Each time the sun returned we reacted together, laughing and exclaiming with joy at the beauty of the light. I asked her if she knew why the sun was doing that. She said, “no, I have no idea.” I pointed out some clouds in the sky and explained how they move in front of the sun, making it dark, and then when they move away, it gets bright again. “I didn’t know that,” she replied, delighted.

Although this disease has taken so much from Mrs. C., she has the capacity to experience wonder at the sensory information that her brain is still able to process. She’s reached a place that so many people strive for through meditation practice, a place where the thinking stops and what is left is awareness. For Mrs. C., there is no such thing as past, or future, there’s only now.

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I was about 5 minutes into my session with Norma Jean, an Alzheimer’s patient, when she asked, “So, what do you do?” I was sitting next to her with my hand on her shoulder, rubbing her trapezius muscle. “You mean for work?” I asked. “Yes,” she replied. “I massage people,” I said. “Oh, that’s terrible. Just awful,” she exclaimed.

I started to explain: “I do this, what I’m doing here,” pointing to my hand on her shoulder. “Well, let’s have some more of that!” she replied. “That feels wonderful!”

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