Archive for March, 2010

My first couple of massage therapy jobs were in spas and health clubs. Although it did not happen often, I would sometimes encounter a client who crossed a line into inappropriate sexual behavior.

Little did I expect to encounter that kind of situation in hospice work.

It was my second session with this patient, a man in his 40s with metastatic cancer and intractable lower back pain. The week before, I had spent a half hour massaging his back; the massage treated his pain so effectively that he announced, “this is better than any medicine they could give me.” He responded so well to the massage that I even taught his wife, who was in the room the entire time, some basic techniques she could use.

When I arrived on the unit for the second visit, the nurse warned me that the patient was starting to act a little “weird.” He was asking staff to run errands for him, and seemed to be struggling with some serious psychological issues that might be contributing to his intractable pain. I was prepared to say no if he asked me to go to the ATM for him, but I did not feel it necessary to raise my guard any higher.

The patient turned onto his side so I could massage his lower back, as I had the previous week. Within a few minutes he had started moaning. Since he had reported being free of pain before I started, I became concerned.

“Is this hurting you?” I asked. “A little,” he replied. I cautioned him that if his massage was causing pain, we would need to stop. He said it was okay and that I should keep going.

Not only did the moaning continue, but he started squirming around. Still, I suspected nothing unusual, but I became worried that he could no longer tolerate massage. I was concentrating on the sounds and movements he was making, and then I noticed that most of the motion was coming from his lower body. He was holding his legs tightly together and rocking his hips back and forth, rhythmically, and side to side.

Suddenly it occurred to me that the moaning was not pain at all, but pleasure. We all want our patients to experience pleasure while having a massage, but he was turning the pleasure into a sexual experience. Once I recognized this, I calmly announced that the massage was over.

I didn’t make a big deal out of it, and neither did he. But I did report it to the nurse, who was not at all surprised, given his other inappropriate behaviors. Due to what I had witnessed, along with the other behaviours, she arranged for a consultation with a psychiatric nurse; his meds ended up being adjusted and the inappropriate behavior stopped.

This patient’s sexual acting-out was linked to unresolved anxiety. Massage therapists working in medical settings need to report unusual behavior, even if it makes us uncomfortable, in order to help our patients get the care they need.

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Making a living as a massage therapist is an uphill battle. It is unrealistic, and unsafe, to attempt to bring in a full eight hours of paid work in a day. Spas, gyms, and wellness centers often expect therapists to see too many clients, which leads them to develop injuries. In private practice, the overhead means that most of the fees we charge (which clients complain are too high) are devoted to paying for rent, supplies, insurance, and taxes, leaving many of us struggling from month to month.

Trying to work anywhere in or near the healthcare system is nearly impossible. It is only through the generosity of donors that a handful of hospital and hospice jobs exist for massage therapists. I am one of the fortunate few who have managed to obtain one of those privately-funded jobs.

How did that happen? Over the course of several years I built a professional network and kept in touch with people who support the kind of work that I do. The first stepping stone I laid on this path was to volunteer at a hospital-based palliative care program seven years ago.

At the time I was looking to develop a referral base for private clients. I was starting a specialty practice in geriatric massage and reaching out to physicians who were involved in caring for my first client, an elderly woman suffering from advanced Parkinson’s Disease. One of those physicians just happened to be affiliated with a palliative care program that had a volunteer massage therapy program, and she invited me to participate.

Volunteering was not exactly what I had in mind; I was looking to get paid for my work. But I figured that I would gain valuable experience and training, and maybe some referrals would come from it, so I signed up. I stuck with it for about a year and a half, until it was financially impossible for me to continue.

During my time as a volunteer I did learn a great deal. I came into contact with some very sick patients who expressed a profound appreciation of my work. I massaged people who were in their last days and weeks of life, or who were undergoing painful cancer treatments, who received some measure of relief from my hands.

I also felt resentful at times. When the head physician told me she felt that “sometimes massage is the best thing we can offer our patients” I wanted to ask, “why then, if this is so valuable, is our work not compensated?”

Now, all these years later, I find myself in the enviable, yet conflicted, position of running a volunteer massage therapy program at a hospice. When I took the job I agreed, on the one hand, to perpetuate an unequal system whereby massage therapists are the only healthcare professionals who are asked to donate their time and talents. On the other hand, I committed myself to providing the best training and mentorship possible to my volunteers so that someday they would be prepared to step into a paid healthcare job, should one materialize down the road.

Right now I am knee deep in researching foundations that might wish to support my hospice massage program. Because massage is not reimbursable through Medicare or private insurance, we need private funding so that I can keep my job. However, I am looking at this challenge as an opportunity: if I am successful in seeking funding for our program, perhaps I will be able to obtain enough support not only to keep my job, but to create jobs for other hardworking massage therapists.

In the ideal scenario, massage therapy would be reimbursable by Medicare and insurance. That ideal scenario, of course, is impossible, given the fact that healthcare in the U.S. is on the brink of utter disaster. So for now, I will keep on with researching foundations and applying for funds, and working my hardest to provide a quality service for our patients and volunteers.

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