Archive for October, 2009

When I take a yoga class, I tend to project a fantasy about the perfectly balanced life of my teacher, assuming that the serenity she projects during that 90 minutes extends to all aspects of her life. When I think about my clients projecting that kind of fantasy on me, I have to laugh. One of the more challenging aspects of giving massages to people with health issues involves performing the job under the stressful conditions of everyday life.

Last night I got back late from a three-day road trip. I was scheduled to see my first client at 9 a.m. this morning. I set the alarm (or so I thought) for 7. My husband abruptly woke me up at 8:20, both of us having overslept. I managed to jump into some clothes and get out the door in 10 minutes. Grabbing a corn muffin and a coffee on the way to the subway, I tried to gather the strength for my upcoming session.

When I arrived nearly 1/2 hour late, my client was irritated. She’s the busiest 82-year-old in NYC and she had a full schedule ahead. I managed to get her on the table so I could get to work. I was obsessing about my day ahead and I could tell that she was suffering from a similar obsession. After about 15 minutes, she had begun to relax, and so had I.

A similar dynamic continued throughout the day as I saw more clients. The third, a cancer patient, is always late for her session and today was no exception. Because I only had a short time to work, I hurriedly began the massage with her legs, which always ache from the chemo. I was distracted and thinking about my schedule for the rest of the week when I heard her sigh. I thought she was reacting to the sirens outside so I chuckled. Then she said, “I’m having a hard time letting go of my thoughts.”

I wanted to say “So am I!” but that would be inappropriate. Instead I began offering her some guided breath meditations. I encouraged her to follow her breath, to feel her abdomen expand and release, to pay attention to the feeling of the breath entering her nostrils. As I instructed her, I found myself focusing on the work I was doing at that moment rather than imagining the work I would be doing the next day. I ended the session feeling grounded and, dare I say it, serene.

The great paradox of giving massages is that sometimes the work itself is relaxing. The stresses of my own life can fall away if I am able to make myself fully present for my clients. It doesn’t always happen, but I can’t think of another job that has the potential to help me relax just by doing the work and doing it well.

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A geriatric care manager once referred a 90-year-old man to me for massage. He was a retired surgeon, recently widowed, who was experiencing age-related physical problems but whose mind was still perfectly sharp. His care manager told me that he was rather depressed, and she thought that massage might help with his psychological issues. She warned me that he’d never had any kind of massage therapy or other body work, and that, as a surgeon, he is skeptical of “alternative medicine.”

When I met Dr. P., it was not for a massage, but for an interview. Along with his care manager, we met to discuss his condition and how massage might help. He agreed to give it three sessions, which we were to start the next week.

During the first session he had a difficult time positioning himself comfortably on the table. He was very nervous about falling off the table when it was time to turn over, so I made a point to stand so that my body would block any chance of him falling, reassuring him that he was safe.  He asked me a great deal of questions about what I was doing and why. By the end of the session, though, he seemed to have let go a little bit and he admitted to enjoying the massage.

The next two sessions proceeded similarly; he would ask me questions about massage, asking me at one point: “under what diagnosis are you treating me?” During these sessions he had shared a bit more about his mental state, and I realized that, in his case, the primary benefit of the massage would likely be psychological.

I explained to him that the massage would help with his circulation and stiffness. In addition, I responded, “You’ve reported to me that you have been feeling depressed. Massage is known to help relieve depression and anxiety. Fundamentally, I am here to help you feel better.” I felt I was being honest and forthright with this man, who was showing a kind of vulnerability that must have been very difficult. At that, he stopped asking questions and seemed ready to receive what I had to offer.

At the end of the third session I asked him how he would like to proceed. He responded, “I’d like to try three more.” In the six years I’d been in practice, this was the first time I had encountered this kind of extended trial period. On the one hand, it felt good to have “won him over” in part. On the other hand, I felt like I wasn’t sure what more I needed to prove. Clearly he had some issues with committing to this course of treatment, but I wasn’t getting all the information from him.

The second set of sessions went much more smoothly. Dr. P. still seemed anxious about falling but I was getting the sense that he was beginning to trust that I would not let that happen. He also showed a marked change in affect at the end of his sessions: he came off the table looking relaxed and content, instead of tired and anxious as he had seemed when I arrived. While session six was taking place, his son, J, came into the apartment. At the end of the session J told me how glad he was that his dad was having these massages, and that he would lobby Dr. P. to continue them.

When it was time to discuss the future of his massage treatments, Dr. P. asked J to leave the room. He then told me that he had decided to suspend his massages. “I don’t think it’s good for me psychologically to continue.” I paused and tried to digest that information. After all, the main purpose of the massages, from a treatment standpoint, had been to relieve his psychological symptoms. At the end of each session he seemed like he was feeling better. What was going on?

Dr. P. reassured me that I’d done a great job, but he reiterated that he didn’t feel like it was good for him, psychologically, to continue. He admitted that he had some issues that were getting in the way, but he declined to elaborate. He promised to keep in touch should his circumstances change. I thanked him for giving massage a thorough trial, shook his hand, and said goodbye.

As I left the building it occurred to me that massage therapy might have been too intimate an experience for an elderly widower who had never received touch from any woman other than his wife. The nurturing touch I provided might have triggered his grief on a deeper level. Or he may have become sexually attracted to me, and that may have been uncomfortable for him. Without a detailed explanation I can only guess, but his care manager seemed to agree with my interpretation.

Until meeting Dr. P. I’d always thought that I would want to have massages at the later stages of my life. Even though massage is familiar and comfortable for me, I wonder how it would feel to be grieving the loss of my spouse and to have someone else touching me. I can honestly say now I don’t know the answer, but that maybe, when one is faced with such a profound loss, massage might become a trigger for grief rather than a comfort.

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Working in the hospice field, death becomes a part of everyday life. When I started my hospice job ten months ago I wasn’t sure how it would change me, but yesterday I realized that my perspective had in fact changed significantly.

I arrived at work and the head nurse told me, “Mrs. P. passed away.” Without even thinking about it, I answered, “Oh, good.”

One of the main objectives of hospice care is to allow our patients to die comfortably at home. They only come into the inpatient unit when they have an acute medical issue, such as symptoms that cannot be managed in the home setting.

During the prior month and a half I had seen Mrs. P, a woman in her 80s. come into our inpatient unit three times. I met each of her four sons, who kept a 24-hour vigil at her bedside in rotating pairs. It was devastating for them each time she was hospitalized.

Two of her sons allowed me to give them massages. One was quiet, and the other told me how anxious he was, unable to sleep. As I massaged each of them I could feel the way the stress of their mother’s illness manifested itself physically: tightness through the shoulders, neck, and lower back; shallow breathing; pain.

Her death was the only way that she and her sons could obtain relief from their suffering. So when I heard about it I was glad, because I knew that she was no longer in pain, and that these kind, loving men would be able to grieve, sleep, and eventually start to breathe again.

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What do you send someone who is sick? The default is something that says “get well.”

But what do you send someone who will never get better, who has a progressive, incurable illness? In some cases, it seems, people will still send a “get well” greeting.

Norma Jean, a patient with advanced Alzheimer’s, recently turned 82 years old. Her son and his family sent flowers for her birthday, with a balloon that said “Get Well Soon.” I wonder what they were thinking when they chose that balloon.

Was it her grandchildren who picked it out, who were too young to understand that Grandma was never going to get better? Her son, or his wife, trying to be brave in the face of a terrible, progressive disease?

I was initially so glad to see that they had sent her flowers, then saddened by the sight of the balloon. The patient would never know about her family’s wish that she get well soon and, oddly enough, that seemed like a blessing. She would not have to look at that balloon and say to herself “that’s not going to happen.”

If the balloon said “Happy Birthday” instead, would that be any better, considering that she has no capacity to comprehend her birthday, or even any knowledge of how old she is? She also received a card for her 82nd birthday from a friend of hers¬†that reads, “When we’re 88, we’ll still be friends.” Somehow, even though she can’t understand it now, it seems fitting that her friend chose to honor the sense of humor that I know Norma Jean used to posses.

I hope one of my friends gives me a card like that when I’m in my 80s, and I hope I’ll be able to get the joke.

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