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.

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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"