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Archive for April, 2010

Sometimes in my clinical practice I encounter a situation where massage is of no help whatsoever. This is particularly true when a patient is experiencing terminal agitation.

Also known as terminal delirium, this condition sometimes occurs as patients approach the final days of life. It is characterized by restlessness, “picking” at clothing, skin, or IVs, disrobing inappropriately, hallucinating, and/or verbally abusive language. Needless to say, family caregivers find it highly distressing when their loved ones become so agitated. It is also stressful for paid caregivers to see their patients become inconsolable and uncomfortable.

The first time I encountered terminal agitation in hospice, it provided a valuable lesson about the limitations of massage therapy. Tina was an end-stage cancer patient in her fifties who had received almost daily massage for three weeks, while she was in one of our inpatient units. Every day when she woke up, the first question she would ask the nurse was: “When is the massage therapist getting here?” She was truly an ideal candidate for hospice massage.

One day I arrived on the unit and saw a changed woman. Tina was flailing about in her bed, moaning. Her facial expression was vacant and she could not make eye contact. She was clearly in distress. The nurse asked me to go and see her, thinking maybe massage therapy would help. But as I took her hand she recoiled from my touch. I quickly discovered that there was nothing I could do for Tina.

Although massage therapy is a wonderful way to promote calm and ease anxiety under normal circumstances, terminal agitation is a medical emergency that must be managed pharmacologically. Massage therapists working in hospice and palliative care settings need to develop a clear understanding about the appropriateness of the treatments they provide. This is essential to making progress in medical institutions, where massage therapy is just beginning to be seen as a legitimate treatment modality.

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Having been raised in a Christian faith tradition, I frequently came across the concept “laying on of hands” in sermons and bible study. Having left that faith tradition, sometimes I am struck by the spiritual nature of the work I have been called to do and how it resonates with my Christian upbringing.

The New Testament is full of stories about hands-on healing, reported to have been performed by Jesus and usually taking the form of dramatic miracles: the lame rise and walk, the blind now see, and all it took was the laying on of hands.

In hospice massage therapy, the healing that takes place is not “miraculous” in a curative sense, but it can be felt profoundly by practitioners and patients alike.

When I teach about hospice massage, I emphasize the physiological effects of massage on the nervous system. Scientifically speaking, massage is a clinical intervention that triggers the body’s relaxation response. It can provide powerful relief from distressing symptoms.

Psychologically, massage can provide a sense of comfort, helping to relieve anxiety and depression. Sometimes a patient has an emotional release as the result of being touched in a caring way: tears may fall freely where before they had been supressed.

And what about massage in the realm of the spirit? How do we connect with our patients on a spiritual level?

Recently I went to see a patient who had what I can only describe as a spiritual reaction to her massage treatment. When I entered her room and introduced myself, she told me she had never had a massage before, but she was delighted to give it a try.

At the start of the session she was cheerful and talkative, saying how wonderful the massage felt on her shoulder. She began telling me stories of her recent medical treatments. As I was rubbing her feet she told the tale of a life-saving intervention she had experienced, confessing that she wished that God had taken her then. She became quiet and tears started to well up. “So you’re ready to go?” I asked her. “Yes,” she answered, “but it looks like God isn’t ready for me yet. Maybe he let me stay here so I could meet you. Now I know what the angels will be like in Heaven.”

As she continued to cry, I moved from her feet and approached her head. I placed my hand on her scalp and made soothing circles. She looked at me and asked me to say a Catholic prayer that I did not know. Then she began reciting a number of prayers, including the Lord’s Prayer, which was familiar to me. I recited a few lines with her: “Our Father, who art in heaven, hallowed be thy name.” As she prayed, she entered into a deeply relaxed state, almost like a trance. I held one hand on her head and another over her chest. As I finished the session and thanked her, she did not respond. She had entered a state of complete relaxation and I could no longer reach her with words.

For this patient, faith in God was central to her concept of self. When she experienced massage in the context of hospice, it resonated within this faith and with her belief in the afterlife. As a practitioner it is not necessary to share this belief system; it is enough to support the patient’s experience of her faith as a manifestation of her bodily experience.

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