We Gave Her Exactly What She Wanted

I had a couple of things wrong in my last post. My grandfather died on the 21st, not the 20th, and my grandma was waiting, but not for that particular date.

She asked to have the door to her sick room left open because Daddy was going to come and get her, and he did that today. 

She died the Sunday before Thanksgiving, just like he did, with her children and grand children surrounding her. 

We held her hand, told her that we loved her, and that we were okay. She could go when she was ready. 

After she passed, my aunt hugged one of my uncles and said "We did it" and started to cry. 

Sleeping in Daddy's Room

Grandma insists on calling everyone's father, "Daddy". She refers to her late husband as "Daddy" and she tells me to ask my "Daddy" things. It's Daddy this and Daddy that and for the longest time it really annoyed me. I don't ever remember referring to my father as anything other than Dad (or Old Fart if I'm giving him a hard time) after the age of 4 or 5.

When she was admitted to hospice, she asked for the nurse Daddy had before he died. A week or so ago she asked my uncle to move her bed into the room where Daddy died. My grandfather died on November 20, 2004 just days before Thanksgiving in his office that was converted into a sick room. When she requested this my mother and I looked at each other knowingly, but kept our mouths shut. I had suspected for a long time that my grandmother missed my grandfather much more than she let on, and that she had a bit of a romantic in her that she would never reveal.

This last weekend my father and I made another trip to see her, and she had declined significantly since I last saw her. My first reaction was a familiar one that I knew I had to squelch. It was fear. This time instead of letting others take charge and move in, I used my education as a Massage Therapist bolstered myself with it. I walked over to her and placed my hand gently on her head. I broke through my fear with the one thing I was confident of at that moment. I was skilled in providing appropriate touch, and I knew how to work with people who are dying. I wasn't scared off when the light touch produced pain. I lightened my touch to her comfort level. I asked her if I she wanted me to stop and she said no. Though there was pain, the touch felt so good to her.

The drive home wasn't nearly as silent as the last. There was much less denial, and more anger from my father, and of course, fear. For the first time I can remember my father admitted is worst fear. "I am so afraid of November 20th" he said to me. "Do you think she's waiting for that day to die?" I asked him, though I had been thinking that for weeks now. "Yes, I think that is what she wants".

You hear stories of people dying on the same day, or two days after their spouse unable to go on. Only time will tell if this will be true for Grandma. I hope she gets what she wants. There is something romantic about it, and in a way life affirming. If she can determine this last day, make her last wish come true before going on to the next world, exhibit this last bit of power, it would make me so happy. We are a stubborn lot, my family, and I would hate for any of us to let the world decide for us.

Much closer to home

I had mentioned in an earlier post that my grandmother was dying and that she was admitted to hospice. This was about a year ago, and she pulled though and was doing great, until a month ago. She is back in hospice, with an even short life expectancy than before.

I went to see her on Sunday with my father and we chatted and cleaned her house for her and visited with the other relatives that were there. I gave her a back and leg massage in her chair and she really enjoyed it. I felt good about being able to do something besides just sit there and be the granddaughter amongst the hubbub of visitors.

Kneeling down by her chair, rubbing her legs, my grandmother started talking to me as an adult, something she rarely does, even though I'm 32 years old. She normally tells me to 'go ask your daddy' things, instead of asking me what I think. This day she told me that she "wasn't faking this, as some of them think" and I let her talk. I did what I always did working with hospice patients, I let it be their time and let them have what they needed.

I left feeling drained and depressed. This is much different. Providing care for your own grandmother, and not someone elses. When I worked in Hopsice there is that magic thing called "boundries" and the knowledge that your responsibilites lasted the hour a week you were in the home. With this I took home much more information that I wanted about my aunts and uncles, about my cousins, about who is being nice, and who is being mean. I just don't want to know.

I rode home with my father, an hour drive, in a pseudo silence. A silence about what we had just expierenced. He is greatful for my help with the massage and my calm demenor during the visit. There is enough arguing and crying and flitting about these days.

Lessons Learned

It's been almost a month since I've left the hospice program. 

I still scan the obituaries to see who has passed away, and whether or not I knew them. This last week one of my clients that I had been seeing for over six months finally passed away. I was surprised at first, but in the end I was glad that she is finally at rest.

A few weeks before I left, I had a new client who was recently diagnosed with terminal cancer. We bonded right away and I was able to give her her first massage ever. She was very excited about it and couldn't wait to brag to her daughters about her massages. I've heard through the rumor mill that she really misses me and the massages I gave her.  It was when I heard that she missed me that I had the first pang of loss about leaving my clients. I wanted to say, I'll see her anyway! I'll go over there on my own! But I can't do that. With all the laws and ethics and liability I can't just go over and give this woman what she needs... though in doing it, it would be giving me somthing that I need, too.  

I went into the job hoping to squash my fear of death and the unknown. That didn't happen exactly.  I learned to face towards death and not close my eyes, but the fear is still there. I learned more about love and families than I ever thought I would. I learned to tell people how you feel and to let go of material things because they aren't worth fight over in the end. I learned about the letting go, but I haven't learned how to achieve it yet, and there is still fear.

 I believe this is still progress and I hope that it will help me in my next challenge-- deal with the death of my grandmother who collapsed today and left the hospital with a prognosis of three weeks to live. 


 

Anticipation

Tomorrow is my last day of hospice. 

It will be a good day. 

The two people I see are the most recent clients, and they are great clients.  Both had never received massage before and one took a little convincing, but they both really enjoy it.

Hopefully, all will go as planned... but as I've said before... don't count on your day going as planned in Hospice, they never do.

The First Day of School

I am feeling the anxiety pains of leaving a job I helped to create. 

I knew that when I left they would have trouble replacing me because of the qualifications required for the job. It's not that I'm extra qualified in the world of massage therapy. It's more that for this region I have the papers that say I know stuff. Hospitals like papers that say you know stuff. There are a few of us over here in the sticks, but not many. And of us, there are fewer who are up for the challenge of working with the terminally ill. 

I helped start and develop the MT portion of the hospice program here and I am worried that it will suffer with my absence. Part of the reason I needed to leave was the amount of work it took to start this program and grow my private practice at the same time.  It takes constant attention outside of the actual massages I give.   I needed to be there continually educated my coworkers and clients and remind everyone what I needed to happen to make this program work. This is fine if you can dedicate all your time to this process.  I was doing this very thing for my private practice and being a constant representative for two causes can be overwhelming. 

I am worried that when they find my replacement it will be months after my last day and the momentum of what I helped start will have waned. I worry. I feel like a mother sending her child to preschool. Will it be okay alone for a while, without me to nurture it? 

I have to have faith that it will survive and grow to be a better program.  I am of course sad that it wasn't me to make it great, but I did help get the thing off the ground. 

I can't forget my other child, the business that I started and is in desparate need of my attention. There are something there that I have neglected and need attending before they go awry.  

Time to let go... 

Enormous Guilt

I heard a phrase last week and it all became clear. Compassion fatigue.

I had a fantastic experience visiting Chicago taking a class on improving my clinical outcome with head and neck pain. It was fun, educational, and it reminded me how much I love practicing massage therapy. I like working with people and making their lives a little better. I like seeing the improvement in their range of motion and out look on their day.

In order attend this class, I had to take two days off of work. When I returned one of my clients had passed away. I was crushed. I felt enormously guilty for not being able to see him one more time before he passed. I took a deep breath and let the guilt pass and then turned in my resignation.

It seems I'm not able to seperate this emotions from this job from affecting my life outside of the job. There are enough things that make us feel bad and decided four years ago when I began this career path that I was never going to feel bad about going to work again. I am not the right person for this job, and for this I am sad, but not devastated as I thought I would be.

I have learned a tremendous amount about the value of positive touch and the dying process. I will never regret taking this job, but I do not believe I will regret leaving it either. I do not ever want to have my passion become a burden, the minute it does, I will have to stop doing it because I am of no value to my clients if I do not love what I am doing.

I am hopeful that the therapist that replaces me will have this passion and bring what is needed to this position. I am excited about the chance I know have to dedicate more time to my private practice. To be reinvigorated by my recent educational travels and channel that energy and excitement to benefit my clients.

I think I may keep this blog going for a little while as I still have a month left of the job and I am sure with the stress of the job off, I will possibly come to some more conclusions about this experience.

I encourage all massage therapist with intrest in hospice massage to explore the possibilities in your area. It is definitely worth your time. A life lesson to say the least.

Two Years Already?

It seems like I was just making posts last week about how I've been doing massage for hospice clients for a year, and now it's almost to the two year mark.

I expected this job to be more than a job in a lot of ways. When you sign up to bring comfort to the dying, you think to yourself "This is going be a an amazing, scary, fullfilling, life changing job". You pat yourself on the back for having the cahoonies to take the job in the first place. You feel good about the recognition you recieve from your peers, friends, and community. In a lot of ways the job is like how I expected to be. Some of the most common things I hear are "I could never do this", "It's so great that YOU are doing this for people who really need this", etc...

It didn't go to my head too much though, because I still had my mother, who is a hospice nurse, to give me some doses of reality. My sister said something to the effect "This is the last job I would expect YOU to take" and she was right, this position was a bit of stretch for my personality. The reality of the position, is while you are helping people while on visits, the times you are in the office are very much like any other job. There are co workers who don't shut up while you are trying to document your visits, nurses who still don't write a referral for MT correctly, state inspectors you have to perform for, and paperwork that boggles the mind.

The funny thing is, I have a much less glamorous job as a Chiropractic Assistant that seems less like a job than this one does. That was not what I expected when I signed up to "change peoples lives"

I've come to conclusion that this is a very worthwhile, fulfilling, giving thing to do as a massage therapist. It is definetely something that we need to see more of in hospice programs across the nation. When I graduated from massage school, I was asked to give the speech for my class during the ceremony. I gave a nervous speech on Passion for what we do... I felt that passion that day and I feel it for my private practice, but I don't feel it doing thing work for hospice anymore. People in hospice deserve that passion. I see it in the nurses and aides that work with them, I see it in the clergy and social worker that visit them, but I don't feel it in me and I think that is wrong.

I am thinking about leaving hospice, but I want the person who replaces me to be committed and passionate about what they are taking on. This has been a difficult realization for me to accept. It's nice to be thought of as an amazing person for working with dying people, but that's not the reason to do it.

I imagine it will take me several months to go through with this in the end. There are logistics and of course the aformentioned 'cahoonies' to give up in the middle of something that is going so well for the other people involved.

The First Has Left

Today the first hospice client I ever treated was discharged from hospice. She had stabilized and even gained a pound of weight, so it was determined she no longer was in need of hospice services.

I have been wondering for so long what it would be like when I wouldn't have her on my schedule anymore. I have been seeing her once a week for two years. I honestly didn't think it would be because she was discharged, and it is almost a relief. I got out of having to deal with my first client pass away.

****

I've come to notice that a lot of people who are referred to hospice see it as the first step in a death sentence... and I guess I could see how they would feel that way, most of the time it is. Instead of taking advantage of hospice right away, they wait until the last minute when there is little time left for help to be given.

I guess I would be the same way. I would like to think that I'm enlightened and would face death without fear, but I know that isn't true. If there is one thing that this job has taught me, it's that watching other people die doesn't solve my issues. It's not the death of others that I fear, it is my own. That is something I still need to face on my own.

I pray for your hands

I have been working for the last couple weeks with a man whose family is very happy with his hospice care. It took them a little while at first to adjust to the idea of their father dying and the influx of people visiting, nurses attending, and dad declining. They refused massage therapy at first, but then as things settled down, they decided to give it a try.

The second time I came, the daughter thanked me for my 'talent', happy that after I had been there the week before, her dad had slept four hours straight. While working with him yesterday, the client started coughing up flem (which he had been trying to do all day) and the daughter exclaimed "Could it be! Can massage do this for him!" As I wasn't pounding on his back and was keeping the work pretty light, I told her it was probably a coincidence. She kept calling my hands "miracle hands" and told me that they reminded her of her late sister's hands.

As I was leaving, the daughter was thanking me again and she told me that she "prayed for my talent" and that she was so thankful for my being there.

Maybe it's my midwestern upbringing, or my general lack of relgious particpation, but this effusive blessing and thanking was making me a little uncomfortable. I smiled and thanked her for the compliments and then continued with my day.

When it comes down it, I've had my share of blessings and prayers of thanks in my name. It is flattering and of course I like that I'm well regarded, but I don't like participating in other's religons. I don't mind people blessing me, but I think I would rather they didn't tell me.

The more I think it about it, I think it must be the midwestern upbringing.

The Ol' Switcheroo

I guess I didn't realize how many times you get asked or told the same thing in this industry. It's kind of like being called "Shorty" when you're 6'10"... everyone thinks they are being funny.  

For me, I get the "I was going to switch places with so and so and get his massage today!" and countless variations on that theme.  The caregivers laugh and look to me and hope that I'll cave in and say "hop over to that couch and I'll massage you, too!" They know it won't happen, but you can tell that they hope one day they'll be wrong. 

While, I never found those comments annoying, I did find them a bit baffling on how to respond... because my first thought is.. "Hop on to that couch and I'll give you a massage, too!" So instead, I laugh along with them and let the humor fill the room hopefully lightening their day a bit. 

One of these days I want to find a way to bring massage to the caregivers of the dying as well. I think there may be an oppertunity for it to happen in the future, but as with everything in the health care industry, it's a logistical nightmare. 

Until then, they'll have to resort to the Ol' switcheroo... though I haven't been fooled, yet.

Window of the Divine

The sun shone in the window after a day of rain. The light gave vibrance to the vases of flowers, greeting cards and startched white linen sheets. No machines were beeping, no nurses were scurrying, and no one sat in the chair in the corner. Walking further into the room I saw her face turned toward the window awaiting the divine.

She used to be the hospice chaplin whose duty it was to bring spiritual guidance. I pictured her on the opposite side, sitting by the bed, holding the hand, watching the eyes of countless people looking in anticipation towards whatever it was that came next.

I held her hand softly and looked into her face. I could not help but wonder if her life as a pastor had prepared her for this moment. Would she get to go to the head of the line on at the gate?

Choices

My boss stopped me in the hall to ask me a question. She said the foundation was looking for a way to do more for the hospice clients and their families. The idea was brought up to provide massage in some way for the primary care giver, and she wondered what I thought of this idea and if I could think of a way to implement it.

I'm initially excited by this idea. Admittedly, I am frustrated by my job right now and need some sort of change. The source of most of my frustration is that the three main clients that I see, don't talk. They barely acknowledge my existence. It's hard to convince yourself that they even know you are there and that they are benefiting for your service. In fact, one of them seems to wish I wasn't there, but she can't talk to tell me to buzz off, and she has such severe contractures that she can hardly move as it is. Although I give a lot of myself for this job without complaint, I am not completely selfless, I need to have some measure of progress.

In the last 6 months I have had these same three clients. There are no stories to tell about them because nothing changes, except maybe the room they are in or the color of the blanket on their bed. I have had new clients of course, but most of them have passed away with in a couple weeks, leaving me back with these three clients who are still with us despite the prediction that they would not be.

The thought of mixing the work with the caregivers seems like it would be a good way to bring some satisfaction to the job. I've been wanting to work with the caregivers since I started this job. They need massage just as much as the clients. I haven't figured out how it work, though. It would mean cutting back on my private practice, and I'm not willing to do that. So here I am left with a choice of being unhappy because one job is frusterating, or changing that job and being unhappy because I don't have time for my other clients.

I still have to think about this.

Several thoughts, really.

In the last month or so, I've thought about quitting almost everyday. I don't like this feeling.

Often I feel like I don't know what I'm doing, but I know that isn't true. I also know that there is high turn around in this area because of the stress and 'emotional' toll it takes on a person. If I quit now, it will be because I couldn't hack it... I don't like this feeling either.

********
Meeting people who are dying is interesting because they are not the people they once were. Today I was at a client's room working with her, when I noticed a photo of her in better days was hanging on the wall. It was a professional portrait and she had her hair done up and make up on. Looking at my client on the bed, unable to speak, barely able to move, I barely saw the resemblance. That picture wasn't the person I knew and I felt a little distorted about the whole thing. For a brief moment, I was lost in my purpose.


********
I've been a terrible employee lately. I leave late, I hurry through things that can be hurried, I don't participate in office bru ha ha has (aka meetings, etc). I set my own schedule and am on call, so techinically I don't have to do any of these things, and I'm never really late... but I know that when I get in the car that I had really wanted to leave 10 minutes earlier. This is a pretty good sign that something needs to change with this job.

********
As I was massaging J today, he began to thank the lord for sending him comfort in his final days.

This job is hard.

The truth is, this job is hard. It's really, really hard. It's not the skills or techniques that are difficult, but something more. It's getting to know families and then not being a part of their lives anymore. It's liking a client and hoping simultanously that they die soon so they can be free from pain, but hoping they don't so you can spend more time with them. It's recieving compliments for the work you do when you know that you are barely hanging in there. It's wishing that more people would accept hospice so you can keep your job and help others, but hoping you don't have new clients because your tired and don't know if you can handle another death this week or month.

This job is hard and it gets to me sometimes.

I had a 'scare' a week or so ago where I thought for sure my client was going to die soon. It freaked me out a little bit and I told a friend about it. He replied "Well, I hope your wrong". He was well meaning, I know, but it didn't sit well with me. It's a tricky line, hospice. I would not want to be in the kind of limbo that my current clients are in... they are waiting to die, not getting better, but not really getting worse either. I can't say they have a poor quality of life because they are very well cared for and surrounded by people that love them... but they are not participating in life either. They don't converse, they can't move themselves, they can't feed themselves. I don't wish them death, but I do wish them something better.

But these are not my family members, it is not my place to wish anything for them, and that makes this job hard.

I saw D. today and asked her how she was doing. She answered me. Then I asked her another question and she answered that, too. When I started her massage she exclaimed in her Virginian accent, "My that just feels like there is ice in it!" when I applied the lotion.

D. hasn't spoken to me in months. She has barely uttered a coherent word, much less a sentence complete with southern drawl. I think she spoke to me more today, that she has the entire 9 months I've been seeing her. I told my mother what happened when I got home and she said "I hope you said your goodbyes to her before you left". I did.

My mom confirmed what I suspected. Often a person will seem to miraciously be better after a long time of illness, only to pass away soon after. It seems like it is the body's way of saying goodbye to everyone before it goes. I've never seen this happen before, and frankly I became a little nervous when D. started talking to me so clearly.

I very likey could be wrong. It could just be a fluke... but I don't know. When M. died, I was shocked and mad that I missed the signs when they were there in front of me. I think it would be better to prepare myself for the possibility of D. dying soon.

******

I've been writing this journal for awhile now in order to help figure out this job and death and living with these fears face to face. I wanted to extend an invitation to readers to ask questions or make comments about this journal. If there is something or some expierence you want to know more about, I would be happy to write about it if I can. Thanks!

Mantras

I must not fear. Fear is the mind-killer. Fear is the little-death that brings total obliteration. I will face my fear. I will permit it to pass over me and through me. And when it has gone past I will turn the inner eye to see its path. Where the fear has gone there will be nothing. Only I will remain. - Frank Herbert

How do we get through the day? We plan things. We say, Tomorrow I will do this. Next week this project is due" We think beyond our current moment or think of past moments and analyze them. Every once in a while Now catches up with us. We have stopped and the Now shows it's face and in that moment we recognize it. One of two things happen. We either exalt in inspiration or cower in fear.

We have our mantras, our Gods, our higher powers, our lucky charms to get us through those moments. When the moment has passed, we move forward, almost always forgetting about that profound moment, continuing in our pattern of past and future. Sometimes, when I am cowering in fear, repeating to myself "I must not fear, Fear is the mind killer..." it changes from the fear to the exhaltaion. I have a future to worry about and to plan for. I am what I create myself to be and I have the power to do it.

Two things happened this last week that lead to an experience of that nature. One event was very minor. It was an email quiz that asked "If you had one day to live, what would you do?" I couldn't answer it at first because I know what I day to live looks like and it doesn't leave a lot of options. I know this was a hypothetical question assuming that you could do anything you wanted, but I couldn't answer it that way. My 'now' was the truth of that situation and my fear was facing it. I must not fear... and the second truth of that matter is, I have many more days to live to that which I would want to do... "Tell them that I love them".

On the major side of things, my grandmother's health has improved enough, that she is no longer eligible for hospice. For the last 6 months I have been preparing for her death and impact on the family. I can't say how she feels about this, but I did try to imagine what it would be like. No longer will she go to bed at night wondering if she will wake up. She will have to start worrying about the future for a little while longer. It will be both exciting and frightening, I think.

I wonder if it is possible to live in the Now as an adult, or if it can only be these brief moments of fear and excitement. Does this change with the knowledge of dying?

Other Duties

As part of duties for the hospital, I also provide staff chair massage and help out at hospital promotions. Since my hours are dependent on the number of clients, this is a good way to supplement hours.

On Monday, I am presenting Massage Therapy as a Career to high school students. The hospital wants me to focus on massage in the medical community, which I think is great. I'm excited about this because it is a change to explain that MT is much more than a vacation treat on a tropical isle.

I'm also exited that the hospital is sponsoring this. As a CAM (Complementary and Alternative Medicine) practice, massage is often disregarded by western medicine. As I have been researching this aspect of my presentation, there are lots of reasons presented why massage fell out of favor in the west.

I find it interesting that through out the world and history, massage has always been looked upon favorably. It seems that it only started to fall out of favor post WWII and we are still struggling for legitimacy today (although great improvements have been made).

Hippocrates, the same guy that gave western doctors their infamous oath, also stated "The Physician must be experienced in many things, but assuredly in rubbing..."

As I was reading, one of the theories for the disfavor, was not because the practice of massage did not work, but because cooler toys. Technology in medical devices and medications were making leaps and bounds and massage was just old fashion. The public was not exposed to massage as therapy, but only as way to vice in massage parlors.

I have to give my employers credit. They are small community hospital promoting another form of thought on health care. I hope I can inspire these kids to question the current health system.

It's simple, really.

A good friend of mine said to me the other day "I haven't been up for reading it [this blog] lately. You have to be in the right state of mind". So I looked through my posts and realized, they are mostly heavy topics dealing with the emotional consequences of working with the dying. While those topics are what affects me the strongest, they are not the only ones that affect me.

It reminded me of when your best friend starts dating someone you haven't met. The stories that are told are the ones that are the most extreme... or make for the best story. How great they were on Valentine's day; how awful they were on their birthday, etc. How often do we talk about the every day things that make the relationship important?

The thing that has affected me the most recently has been quite simple. It hasn't been what the client has said, or the pain they are enduring. It has been what has been sitting on his bedside table. There are three containers carefully dividing the client's favorite candies. When I first saw the bright orange of the jellied orange wedges I smiled. There was something special about those candies. Next to the orange wedges were handmade nut rolls in a ziplock bag. They looked delicious. I couldn't stop smiling at the thought of the sweets on the bedside table.

When I was walking through the hospital later that week, I saw across the lobby into the gift shop. There was a rack of bagged candy and at the top were the orange wedges. My legs were on auto pilot and the next thing I knew I was handing over a $1.36 for the confection. The sweet citrusy scent brought that same smile back from the other day. Nostalgia... that's what it was. The simplicity of these candies reminded me of my grandparent's house. They had a special jar in the window that held butterscotches. The cellophane bag reminded me of the days when my parent's would give my sister and me their spare change and allow us to walk to 'the candy store', which was the convience store. They reminded me of some of the simple things that seem silly to talk about in comparison to 'the big things' in life, but they are the things that make the relationship important.

She gave me hug, I should have known then.

I've been thinking about M. all day. When I saw her last week, she wasn't looking well at all. The visit was okay, but I really didn't feel good about it. I didn't feel like I was connecting with her like I usually did. She didn't always know where she was or who exactly I was, but she knew she liked me. M. gave me a hug good bye at the end of our last visit. I was a little surprised at the gesture because she had never done that previously. I had been under the impression that she didn't like hugs at all. Her son told me a story when I first starting seeing her about how she would maneuver across the room to avoid recieving a hug, and he was frankly surprised she was enjoying the massages I was giving her.

She passed away before I saw her again. I was surprised at first, but then when I remembered how my last visit went, I wasn't really that shocked at all. I was upset at first. I hadn't expected her to go this week. I was also upset that I didn't feel satisfied with my last visit. I could have done more, I SHOULD have done more. I was mentally waiting for certain things to happen that would clue me in that she was near her time, and I missed them. They were there, but I expected them to take another form.

I've been thinking about her all day.

What am I doing here? It doesn't matter.

Some times we get so caught up in what we know, we forget what we were taught. Working in hospice has been like that for me. Everyday I wonder if I know what I'm doing, or if I'm doing it right, or if there isn't someone better suited for the job.

I decided to go back to the text books and review what I was taught. It was good to read what I already knew... I DO know what I'm doing. I was also good to be reminded of the things that I forgot. Not the the techinques or contraindications, but the purpose behind it. WHY was I doing this. It certainly wasn't because it was easy. I seem to remember telling people I wanted do something challenging (why did I ever want that!).

While re-examining my texts, I came across this:

"Relationships often revolve around what we do together, but when illness and death become a part of life, there must be a transition from "doing" to "being". ...Through massage we can simultaneously be "doing" while "being" with our friend, client, or family member." _ Gayle Mac Donald "Medicine Hands"

(The book goes into more detail, so if you're a massage therapist intrested in working with people with terminal illness, I highly recommend checking it out.)

In the end, it doesn't matter what I am doing. Not really. I've come up against this obstacle before and I have to keep reminding myself the other factors involved. The intent of my presence. The act of being there when others cannot bring themselves to be. I'm conditioned to produce a product with a tangible result. I do something really nifty with my hands and people heal and get up skipping and jumping. If only it really worked that way.

I know that there is a result from what I do, however I don't always get a clear answer to what it is. Some clients can't tell me, or they don't know how. Today I was lucky. My client is in a lot of pain on daily basis. He has three fentnyl dermal patches and morpine for breakthrough pain. As I massaged his shoulder, a constant area of pain, he sighed and said "that's better than any pain pill"

Damn' it feels good to be a massage therapist.

As in life you never quite know what the next day will bring. For the last several months I have been working with the same few clients with out much change in their status (rate of decline) or in my massage plans. This week there were five new clients to be added to my list of visits. I didn't get to see all of them because some didn't make it until my scheduled visit, but it added a sense of choas and urgancy to my day that I found I had kind of missed. Things had been starting to feel a little ho-hum lately, and this boost in activity was welcome. (It coinsided with a successful marketing plan in my private practice that have left my arms a little sore and about ready to fall off!)

There is a certain excitement to new clients with illnesses that are fast moving. I only work two days a week, so sometimes I don't get to meet the clients, but when I do there is an feeling of action about the first visit. I wonder what I can do for the person and how much time they have left. Will I have enough time to make an impression on them and their family? Will I be able to ease their pain or suffering?

*****

As much as I would like to look at myself as a completely alutristic human being, I do have elements of pride that surface even in this profession. I work very hard to make the visit about the patient... but I'm proud of that fact too. One of the things that I've learned about myself after working hospice is that those all to human traits such as pride, anger, resentment, apathy are still present when your job is 'for the greater good'.

I don't think that is wrong, because we are human, after all. The skill comes in managing those reactions and emotions and choosing the right time and place to express them. Many people say to me (and my mother, a hospice nurse), "What you do is so great." which I usually translate to "I don't know if I could ever do that, thank you for doing it so I don't have to". There is a lot of beauty in working with people who are dying, but you see a lot of ugliness as well. Family squabbling, emotional distress, side affects of drugs or tumors... it's not pretty. Though it is easier to face other people's problems than your own. We leave these families and go back to our own with a new appreciation for what we have. The time we have on this Earth, the relationships that we've built and the love that we share.

*****

So, going into a new clients home and seeing the potential for influence on the last moments of their lives is exhilerating. If a family memeber sees me calm down their mother who's been agitated all day, I feel like I've earned my education. In truth it is mostly pride, and I try to keep it in check, but damn it feels great to be good at what I do.

Fatigue

One of the benefits of hospice is that it relives the fatigue that often assails caregivers. Taking care of a dying family member is a lot of work. Especially when they can't eat, go to the restroom, take baths, get dressed, or medicate themselves.

Hospice supplies nurses, aides, and volunteers to help do all of that for you, so you can take care of the everyday things about life as well as spend quality time with your family member. It is really a great service.

Unfortunately the fatique hits the nurses, aides and therapists as well. Two of my clients have been with us over 6 months, and one just hit the year mark. Neither of them can care for themselves or can speak. I feel tired when I think about going out to see them. Each week they are they same, not worse, not better. When I am there I focus and bring my attention to the client and do my best job possible, but prior and post visit, I get tired. I find myself wishing for some sort of change so that my SOAP notes and weekly reports can have a little variety in them.

Another one of my clinets, one that has dementia, but is still fun to talk to (even if I have to negotiate the conversation through her perception that I'm a realtive, or that we are at a family reunion instead of a nursing home) just hit a turn in her health. I think she will be declining rapidly. It feels unfair that she is starting to decline and these other clients are not. I know it is selfish, because my real hangup is that they aren't as fun to visit as other clients.

I see the lovin' in my baby's eyes

Driving through the snowcovered fields of Iowa and Minnesota, a song was playing as I returned from one of my visits. It was a song I'd heard before, but this time the chorus, caught my attention.

I see the lovin' in my baby's eyes...

I immediately thought of the client I had seen earlier and what I had seen in her eyes. Confusion, fear, nervousness, that's what I saw in her eyes. She doesn't know why I'm there, and she can't speak to ask. I have been telling her every week for the last year that I am there for her, to give her massage, comfort. Her look rarely changes.

I saw exhaustion in another client's eyes. They were haggard, as if she had been awake all night. Her eyes lit up briefly when she saw me, but she doesn't really know who I am. I bring light to her day, and I see it in her eyes. When, I leave, I notice they start to look tired again.

Another client's eyes were far away and seemed resigned. She has recently moved to the nursing home and I haven't seen her smile since.

All of these client's have dementia of some sort. Even though they couldn't tell you the year, or where they are, or even speak at all, you can see in their eyes, that deep down they know. They know and are waiting.