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.

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.