She's a city girl, she doen't know how to can.

As I was walking past rooms in the nursing home, I heard an eldery guest of one of the residents state "Well, she's a city girl, she's doesn't know how to can". I can sympathize, I don't know how to can, either. It makes me feel a bit out of place.

I haven't written in a while for a couple of reasons. For several months the hospice census has remained low. I've had the same three clients with new clients here and there. However the new clients seemed to pass away with in a week or so of me seeing them. My job started to feel hohum and and writing about it seemed a chore.

I was thinking about that today when I decided I should probably write about that a bit anyway.

I got into this job knowing next to nothing about what it would entail. I was prepared for it to be emotionally gut wrenching and dishearting. I wasn't really prepared for it to be like other jobs... the kind that you sort of get into rut and find a little dull sometimes.

Sometimes I don't feel like I matter much to the department because I'm considered a non vital service. The type of massage I perform in hospice is vastly different from what I do in my private practice. On the technical side, I feel like I don't do anything at all. I know it's a lot about intent and what you are there to accomplish...which is providing positive touch, not releasing muscle contractures. Still, when the HHA are applying lotion after baths and then you come in to give a light massage which entails applying lotion... you start to feel redundent.

I have three new clients this week, so things are picking up. That means new people who I can interact with and affect positivly. Hopefully it will blow a little spark into the job and make me feel usuful again.

****

Could this happen to me?

Last night I tossed and turned as thought about what my mother had told me the day before. My mind kept coming back to the situation and going over it my head, while my stomach churned with anxiety at the thought of dealing with it in the morning.

My mother had brought me news related to one of our clients, but it was not about her exactly. It was about her daughter-in-law, who was one of her care takers (along with her son). The DIL found out that she had metastic breast cancer this week and it was too late to operate. She is 40 years old with two school age children and a mother-in-law slowing dying in the back room. Her husband, the son, is due to leave for Iraq soon.

This affects my job only in that our client may be moved to a different care takers home, and that may be out of our range of visits. This is not what I was thinking about all night. What I was thinking about was the awful situation this family has been put in. If the treatment doesn't work, she may well end up being one of our hospice patients. Her mother-in-law may outlive her, because metastic breast cancer is nasty business. And all these thoughts bring up a strange fear in myself. For some reason I am nervous about seeing my client this week, though my client status has not changed.

I started thinking about why it is that Hospice hasn't been has hard as I thought it would be when I started the job. It occured to me that all these patients I see have accepted, more or less, that they are dying and they aren't going to make it. They are taking steps to ease into it, and hospice is one of those steps. It is easier to face death, when the person you are seeing is on the same page. Like it or not, it is also easier because my clients are all old (between 75-90). I expect people of that age to be dying.

This DIL is not one of my clients, but I do see her each week when I visit my client and all of a sudden the anxiety I've been expecting for the last year has popped up. There are some reasons that I suspect: She is closer to my age, she wasn't suspecting breast cancer (she was feeling tired, so everyone is in shock), and she hasn't accepted death yet. She is going to try and fight it; of course she is, and good for her... but what if she fails. What if I see her each week when I'm treating my client and she isn't getting better. What do I say to her? What can I do for her? What if she gets worse and her husband is sent to Iraq and is killed and her children become orphans? I can see myself looking away trying not to meet her eyes.

It's ridiculous how my mind can blow things out of proportion in this situation. How can I face my clients each week and not face her? I think the answer to this question lies in another question I ask... Could this happen to me? I've got a while before I grow old, I can face that. Surprised by a deadly cancer at young age... that could happen at any time and it scares the shit out me when I have to face it.

The anxiety before a situation is always worse than the situation itself. I will go and see my client and it will be fine. No one is looking for answers from me. I will do what I need to do, including a hug if she needs one. It is another step in facing this fear.

Foot in the mouth

I feel like a complete idiot most of the time when I talk to family members.

******

The other day I was standing around the office waiting for a meeting to start and owing to the odd configuration of our offices this meant that I was standing in front of bookcase trying to look inconspicuous while skillfully staying out of the way of passers-by going through the narrow hallway. The bookcase was filled with a variety of books related to death and dying. I picked out a paperback with black cover and white text splayed across the front in a manner which can be easily summed up as 'early eighties'. The title escapes me now because it was so similar to every other book in the case. Believe me when I say it was along the lines of "Death and Dying: The Final Destination of The Journey" or something equally enlightening. The author's name was decidedly Germanic with plenty of umlauts as well. The perfect cover for someone who was trying to look engrossed in standing around doing nothing. That wasn't the only reason I picked that book to read. When I opened the cover, on the inside in pencil was a name. I blinked and read the name again and realized her family had probably donated the book as a gift after she'd passed away. It was from the library of one of my favorite clients.

The woman in the book related a story about a young doctor who admittedly had never seen a dead person before. She started to talk about how we avoid being around people who are dying because we don't know what to say. We feel stupid being encouraging, because we know they will soon die. This was as far as I got before the meeting started and I put the book back.

I forgot about the book and what I read for the rest of the afternoon. It is that way with meetings I think. They are like television a lot of time. Your brain turns off and runs on auto pilot and you forget about things for a while. I think it has something to do with the fluorescent lighting.

It came back to me when I remembered this weeks visits and remembered the colossal foot I inserted into my mouth more than once this week. A lot of time I don't see the family members while I see a client. They leave the room, or they are not there (because they are in a nursing home) in first place. This week I had two new clients that were imminent, so they were surrounded by family. My massage skills did not suffer, nor my interaction with the clients... but with the families I kind of bungled it. Things as simple as "Are you going to the parade this weekend?" were answered with a simple "No, I'll be here" and a look that says "with my DYING mother!"

Both clients have since passed away. This means I won't have to face the families and possibly embarrass myself again. I also won't be able to say something more appropriate. This is where I remembered the book. I still have no idea what to say to people. I think most people just want to have normal conversations, but I never know. I think I may have to inconspicuously meander by that bookshelf again to find that book. Maybe it will tell me what to say. I'll let you know if it does.

An Old Mansion

There were problems with visiting N. from the beginning. When I was in the office earlier in the day I heard nurses complaining about arriving at the house and banging on the door with no one answering. I called the phone number given to me, it rang endlessly. The house was a old 19th century testament to what the street used to be... now it stood between a mechanic and a small town museum on the life of the pioneer.

I was given a cell phone number of the daughter, but there was still no answer. At least I was able to leave a message, this time. It was to be my first visit and I had not spoken to the family before hand, and this made me a bit apprehensive. I knocked at the old door.

The door was answered quickly by N's granddaughter and I was greeted pleasantly and led through doors that were locked behind me and through a dim hallway of musty archaic air.

It was N's birthday and there were visitors and cake being eaten around N's bed, which was placed in the middle of what could only be described as a parlor. Above the fireplace was an arrangement of arrowheads and several examples of antlers. Shelves of china and porcelain figurines were scattered about the room. N. sat on the edge of his bed toasting his 92 year with a cup of coffee that he was not going to let go of, massage or not.

N was not going to lay down or relinquish his cup of coffee, but he did agree to a back massage. In order to accomplish this feat, I chose the 'sit next you' method and found a spot next to N on the bed, using my inside hand to perform the massage and the outside hand to brace N's shoulder so I wouldn't push this fall leaf of a man off the bed. The most response I could get from him was a slight nod or shake of the head when asking yes or no questions, unless the lotion wasn't properly warmed. Then a dirty look and cry of disgust was passed my way.

The granddaughter told how N would refuse to lie down and would sleep sitting up on the edge of his bed. Through other nurses I gathered stories she told them as well. Cell phones did not work in the house, and sometimes the lights would flicker and the tv turn on and off by itself. One day the grandson saw a glowing light move about the room and they found N lying down with his arms in a protective posture over his face with one arm out. He was found this way more than once.

It could have been tricks of the light, or the actions of a man near death. Or, as his granddaughter speculated, it could be someone lingering waiting for N to joining them. His wife's ashes were in the cupboard next to him. If so her wait is over today.

That's Not The Way I Planned It

"I haven't given you one of these yet, have I." a voice said behind me. It was more of a statement than a question. I turned to see a gray haired grandma handing me a piece of hand made room decor. She explained how she made it from a milk carton and punched holes in the side, where she crocheted a border from florescent orange yarn. "You just stick something in the middle and your done."


I thanked her, still slightly befuddled from being surprised by this gift, and she returned to her table to continue with her craft making.

That day was one of those days that just doesn't go as planned. My mother warned me about those kinds of days. "Don't get to attached to how you plan your day," she said, "things have a way of changing on you."

Isn't that the truth. A few weeks of routine will really lower your guard when things start to get exciting in this job. The day started with me getting an hour behind on my visits because one of my clients was getting her hair done when I arrived and it would have taken longer to leave and come back, rather than wait. The day ended with me leaving work 15 minutes early because my last client died before I got there.

I don't think I would have been prepared for that, had I been running on time. I haven't yet been present for a death, and sincerely hope that fate will steer me clear each time. That the family will decided I wasn't needed because the time was soon, or that they just don't make it until their next appointment. I want to be there for them for as long as they can benefit from massage. I want to comfort them; I want to comfort their family. I don't want to be holding their hand when they die.

I tell myself that I want the family to be the ones that are there for them in the last moments, and that is true. I don't admit to myself that I don't want to face that initial emotion. I don't want to see life leave someones face. I'm afraid I wouldn't know what to do.

*****

While driving between visits, there was a near accident between myself and a oncoming car. It was a small town with an uncontrolled intersection and they seemed to know where they were going. Only my unfamiliarity with the intersections in town slowed me down to look for the stop sign. I almost didn't stop, because I didn't have one, but I noticed just in time, they didn't either. At the speed they were going, I would have been seriously injured. My first concern when I imagined the accident was whether or not I would be able to use my phone to call the office and let them know what happened, and adjust my schedule accordingly. Then,"how would I work with broken bones", not once did I think about 'what if I had died?'. I try not to think about that when I'm driving.

Working with dying people is not the quite the same as facing death. I thought it would be when I started this job, but there is still that fine line. They are still alive when I see them. I'm not a nurse or medical professional, so my services are considered 'non-critical', which means if death is imminent, my services are cancelled most of the time. I've learned a lot about the act of dying, but I still have not faced my fear of death head on. I've only skirted around it, acting brave and seemingly unafraid.

Beyond your wall of misgivings

I have found a release working with the dying. A release from my own strictures.

Meeting people is never easy. There are so many expectations and interpretations that are made. "What did he mean by that?" "So, does this mean she really likes that kind of music?" First meetings are guarded and veiled. Walls of doubt and misgiving need to be scaled. Most of the time our true selves don't come out until much later. I call this time of meeting people "The Assessment". Observations need to be made and calculated against risk factors. This can be done in a matter of seconds or maybe days... or for some people months. Weeks and weeks of trying to impress one another or leaving subtle clues of innuendo to who you really are in hopes that they pick up on it and translate your message. Your message of "I want to be your friend" or "Don't talk to me anymore".

The difference with my clients is two fold. I'm not there specifically to get to know them or be their friend. That is something that is a side effect of what I do, but it takes the pressure off. I don't need to worry about if they like me or not. The second is, they don't have that kind of time. If I want to interact with them on any kind of meaningful level, the walls have to come down. The ritual must be bypassed and being straight forward is the easiest way.

In recent months I have found it easier to get to the heart of the matter. I used to candy coat things and hope that I could avoid situations that are uncomfortable. I still hope I can avoid them, but if I can't it's been much easier to say what is on my mind.

There are still boundaries. Every new client is not my new best friend and I keep as much private information to myself as possible. My work with them is about their needs not mine and that's kind of a relief as well.

Taking this outside of work I feel that I waste a lot of time hiding myself from people that I want to know better. I read in the paper today that Stevie Wonder received a Lifetime Achievement Award from the National Civil Rights Museum and in part of his acceptance speech he said this "...Tomorrow is never promised to any of us. You must be the best you can be right now." I think that includes dispensing with pretense and falsity as well. A friend of mine will often say "Say what you mean, and mean what you say". This is key to presenting yourself honestly and truly.

How would things changed if we didn't feel that tomorrow was promised to us and we said what we meant?

How would we treat others, or present ourselves to others if we honestly considered that they might not be here tomorrow or next week.

I hope it would be with honesty, respect and integrity.

Knocking On Unknown Doors

With each new client there is a new world upon which I enter. I start each visit with an address, phone number, name, and diagnosis. Each new client is a challenge, an unknown that I must face as I walk up to unfamiliar doors. Questions race through my mind as I wonder who will be waiting for me. Should I knock or walk in? Should I say the word 'dying'? Should I leave my shoes at the door? Will this be a well kept home? Will this be a 'dysfunctional' family?

Behind my uniform and name badge is someone who feels she doesn't quite know what she's doing. "All I do is rub their feet" I say. "How hard is that?" I remind myself that half the challenge, is the attempt at doing it. The willingness to go into a home filled with grief and attempt to do something that is frightening to most everyone. Massage with hospice patients is not difficult in terms of technique. It is the simplest form of massage. Much of what is difficult is the intent behind the motion. The putting your fears aside to alleviate the fears of others. To look family in the eye and say "If C is with us next week, I will be back" and not feel embarrassed about pointing out that I might not be back. To touch someone who is dying. To give to them what their family possibly cannot.

I do this each week with trepidation. I wonder will this be the last week I can face this, and by the end I say "No, it will not". I started this to challenge myself and beliefs and I'm not finished yet.

*****

The trepidation on the job is matched by a over-assurance off the job. When I am around others not involved in hospice, I feel like I am the keeper of sacred knowledge. My ego is kept in check with every hospice visit that follows and by my mother. My mother is sweet and unassuming in nature. She has been working with the elderly either in nursing homes or hospice for 35 years. My experience with this is nothing in comparison. I imagine that the novelty of newly acquired knowledge will temper itself and then I will see this all with less fear and cockiness and hopefully a higher level of understanding about life.