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.
I saw this in both parents just days before they passed. It was very distressing, particularly the language and both of their final words to me was how much they hated me and wanted to kill me. Thank for this article, I did take it very personally and now I will believe that they were in this terminal agitation phase that you have described.