94 is a Good Long Life

I am going home tomorrow, hopefully in time to say goodbye to a relative.  He is the definition of "good genes," and I am fortunate to have had him around for this long.  It is, as my husband said, sad, but not a tragedy that he should die now.

We were starting to think he was immortal, I think.  And who could blame us?  This is a man who, in his 80s, fell off the roof of a barn, and ended up with only stitches and a couple of bruises.  In his 60s, he (and the tractor he was driving) rolled down the side of the hill.  He was fine.  The tractor was never the same again.  In his 30s, he survived the war in the Pacific, as part of the "black gang" on a supply ship.  His post at the ship's engines was hard, hot, physical work.  If the ship was attacked while he was at this post, he once told me, it meant almost certain death.  Before that, he worked in the coal mines of Eastern Kentucky, and navigated both the dangerous work and the sometimes dangerous people.  (He carried a pistol in each pocket every day.)

The old saw is that you should never meet your heroes.  I think you should never have heroes you can't meet.  He is a flawed man, sometimes angry, always stubborn.  He is also a gentle, kind soul.  At the end of the war, while he was in Japan, he felt so guilty about eating a donut in front of a starving Japanese child that he still told the story 60 years later.  This is the proper way to have a hero.  To see a person in all dimensions, to honor the good and learn from the bad.  How wonderful for me to have such a person to know.

Tea Truth

Yogi tea is doing a much better job than fortune cookies at capturing the exact mood of the day:

Is it Medicine?

In the lounge at the school where I teach, someone posted an article with this headline:

"Not Just Relaxing, Now Massage Wants to be Medicine"

This kind of pissed me off.  It seemed patronizing to me, written in the same voice you would  use to say, "Oh, look at the kitty sleeping on the pillow! She wants to be people."  The headline struck me as another example of people failing to understand the real physical and psychological health benefits of massage.  Even with all our hard work, education, and growing acceptance of the profession, too many people think of what we do as "rubbing up on people," or something similarly frivolous.

Today, AMTA of Illinois started a discussion on their Facebook page.  The question was whether we thought there should be a separate career path/certification for medical massage (as opposed to relaxation massage.) my first thought is that this would be a great idea.  I envision massage therapy as a 2-year Associate's degree program, and medical massage as a 4-year Bachelor's. If we want to be taken seriously for the real health benefits of our work, we need to take our training seriously.  Our entry level needs to be higher, with deeper understanding of anatomy, kinesiology and pathology.  I say this with the complete awareness that my education, and that of the students I teach, is not up to these standards.

If we "want to be medicine," though, we need to act like it.  First, we should read and perform research.  We all need to become familiar with the scientific process and the rules of evidence as part of our basic education.  If you are a massage therapist, and you see an article about massage in the popular media, you should be able to trace the information to its source and evaluate its impact on your practice.  Example: a recent article in the New York Times talked about a study suggesting that massage does not clear lactic acid from the muscles after exercise, but does have a beneficial effect on inflammation.  I found the study, and found that while the conclusions were intriguing, the sample size was small and limited (<30 healthy, college-aged males.) Its findings were not, therefore, directly applicable to my work with a frailer, more diverse population -- yet.

Second, we need to get our professional act together.  We need to stop accepting a certain level of "flakiness" as part and parcel of the massage therapist personality.  Show up on time.  Be mindful of session start and end times, and for Strunk and White's sake, learn how to write.  I realize I may appear a little old-fashioned in that last point.  I will continue to insist, though, that business emails should follow the same rules of grammar and diction as business letters.  Further, we should endeavor to learn to speak to clients in language that is compassionate, appropriate, and instructive.  While it is fine to talk to our clients in laymen's terms, or even to use humor and metaphors to illustrate an area of concern ("Your shoulders love your ears so much, they can't be separated"), we must follow that up with real information.  ("Your levator scapula muscle elevates your shoulder.  It attaches here.  Notice what you feel like when I work in this area, etc.")

Third, we need to unite.  Massage therapy can be a lonely profession, especially if we work for ourselves.  You spend most of your time working alone with your clients, and while that builds a rich and rewarding therapist-client relationship, it does not enhance your professional soul.  We need to make getting involved in our professional organizations a priority.  If we can't attend conferences or serve on committees, we can take time to chat with other therapists over coffee, or exchange research with each other over email.  We don't work in a vacuum, as much as it feels like we do.  The way I work with a client affects that client's view of all massage therapists, for good or ill.  Regular contact with other therapists helps us form the terms by which we define our profession.

And finally, we need to maintain our unique compassion and mindfulness with our clients.  I got into this profession because I wanted to work directly with people.  I wanted the leisure of an hour or more to really focus my attention on an individual and work with them to find their wellness.  We use touch as our primary tool, which makes our connection with our clients unique.  We need to cultivate and respect that connection, and reinforce it with knowledge.

Goodbye. I Love You.

Today, I am breaking up with my massage therapist.  She has been my massage therapist for about six months. I met her while I was in school, and kept in touch lightly over the years.  A few months ago, she announced that she was going to strike out on her own.  Around the same time, I was trying to find someone I could trust with my neck.  It seemed like a perfect match.  I respected her knowledge, and I always felt calm in her presence.  I needed a consistent therapist, and she was ready for consistent clients.  Perfect.

Almost.

Every time I saw her, I felt immensely better; more grounded, more aware of my body and with a renewed commitment to taking care of myself.  I even started to notice that my own work improved after a session with her.  But, not too long after we started, scheduling started to become an issue.  She would have to cancel a session because of her other job or family needs.  I would have to cancel for the same reasons.  We would reschedule, of course, with no hard feelings and a true mutual understanding of the demands of our profession.  I told myself how nice it was that we could be honest about our needs, and trust each other to be compassionate.

Soon, though, I realized that the "every two weeks" we agreed on was more like "every month" or longer.  I was willing to deal with this, maybe fill in with a massage from my workplace (where I got a discount) every once in a while.  Yesterday, though, was the end.

I have had a rough few weeks.  We dealt with the death of a beloved pet, I have started teaching in addition to my other jobs, and a few of my most beloved patients have died.  Our session yesterday (rescheduled from two weeks before) was going to be me getting back into caring for myself.  After weeks of stress eating, poor sleep and sporadic exercise, I was going to take the time to reset myself.  As I walked to her office, I thought about how I would express my needs for the session to her.  I looked forward to her getting it right away.  I savored the upcoming gift of 90 minutes of time away from the world.

I got to her office,and the door was dark.  No problem.  Sometimes she ran late.  So I sat in the hall and waited.  10 minutes after my appointment time, I sent her a text message.  10 minutes later, I left. I made the decision to find a new massage therapist this time.  I need more consistency.  I was surprised by how shattered I felt when I realized I wasn't going to get a massage, and decided I was done with all that disappointment.

So, I am breaking up with my massage therapist.  I love her as a friend and a colleague, and I hope we can keep that relationship alive.  I need my massage therapist to be more professional.  I need to respect myself enough to demand that.  I am often frustrated by the amount of flakiness that is accepted in this profession.  It does us no good, and we need to present ourselves as the wellness practitioners we are.

But it is going to be so hard to find someone I trust to work on my neck.

Word Oops

I am a language snob.  I like the way words go, and it makes my skin crawl when people put them together in ugly ways, especially in writing.  But, I am also a collector of misspellings, grammar errors and other language faux pas which make me giggle.  Here are three of my most recent favorites, one for each workplace:

(1)
At the spa we have a handbook outlining specific protocols for body treatments.  One of these protocols advises us to begin every treatment by washing our client's feet in a "silver bowel."

Come for the sugar scrub, stay for the C. Diff. Colitis.

(2)
At the school, the administration has printed up a FAQ sheet for new student representatives.  One of the issues addressed is that of the student lounge amenities.  The students have no coffee maker available in the lounge, the sheet states because the "plumping is inadequate."

Not only is plumping inadequate, I would say, but also inappropriate.

(3)
At the medical center, we have a reference sheet listing various drugs and their side effects.  Today I noticed that many drugs list "hepatits" as a serious side effect.

I guess it would be pretty serious if your breasts turned yellow.

*** **** ***

Any favorite word oopsies out there? I'd love to add more to the collection.

In which the Author Loses a Pet

On Halloween morning, my husband and I made the difficult decision to put down our best cat ever.  He had rapidly declined over the course of a week or so, refusing to eat and becoming more and more  jaundiced.  I was not ready for the heavy waves of grief that came over me in the first few days.   I would notice something -- his favorite blanket, the empty spot in the sun, a clump of his fur in the corner of the room -- and dissolve into flat-out, nose dripping, "boo hoo" sobs.

I felt the grief physically -- fingernails scratching the inside of my stomach, a weight in my chest.  This is not a metaphor.  Something heavy took up residence behind my sternum, used my heart and lungs for ballast, pulled them until they pressed so hard on the pericardium I thought it would burst.

I used to complain that every morning he would brush against my legs just as I was getting ready to walk out the door.  The truth is, though, that there was joy in the few minutes of brushing fur from my trousers before I stepped out.  Like a brush of lipstick on a cheek or a sweater bunched up from a tender embrace, this was a reminder of a private moment left on me as I moved into the public world.

He was just a cat.

He was not just a cat.  He was a test, and a promise, and proof that human beings will do loving things for no other reason than the rightness of it.  I knew when he came to live with us that someday we would see him die.  It is fine to know this rationally, philosophically, and even to joke about the day.  When the day comes, though, and the talk is as real as watching your companion slip away as you scratch his head and sing his nicknames, the heart makes its own reality.  It takes away your strength, blurs your vision and forces you to breathe.  It is all well to understand with the brain, but the heart know you must also stop and feel.

Here is when I knew that our life with this cat would be a great love: Shortly after he came to live with us, we went abroad for several weeks.  A trusted, cat-loving friend came to our home every day to feed, water, and nurture him.  Still, our absence made him so nervous that he pulled out all the fur from his neck.  When we got home, he rushed up to us, bare neck and furry face.  He was healthy and well-fed, but he looked like a tiny demented lion.  As he rubbed his head on our legs and purred, I knew that for him, we were everything.

Our acknowledgement of this responsibility made it somehow easier to make the decision to put him down, and infinitely harder to say goodbye.  I hope the years that his life was in our care were well spent.  Was I compassionate? Was I kind? Did I protect and care for that life, and did I make it better? I sincerely think I did, and that I made the right decision to usher that life out of the world.  And I desperately wish I didn't have to.

Spikes and Knives

The Ailing Healer has been receiving treatment for over two years.  She is a consistently calm, warm, and happily anticipated presence. Her disease recently changed; mutated in a way that we all know and fear.  Her treatment changed to keep up.  She learned the news with the same calm attentiveness she brings to everything.  She lost her hair, but smiled as she sowed off her new, short wig.  "My mother always said I would look better with short hair," she said, "and who knew? She was right!"

It was amazing, and comforting, to me.  I watched the Ailing Healer step into her new treatment plan, her new, guarded prognosis, without hesitation, and seemingly without fear.

The massage room has a way of amplifying truth, though.

She came to her appointment with the same smile.  She gave me a hug and told me the same thing -- "whatever you do is lovely."  She got ready without help, without extra time.  But when I touched her, it felt--different.  She was talking, but she always liked to talk a little bit for the first few minutes.  Today, though, she didn't slow down or taper off like she usually did.  She told me a long, complex story about a friend of hers, then another, then another.  She asked me questions then started another story without waiting for my answer.  She hardly stopped to breathe.

After the session, she said the same thing she always did, hugged me just as warmly.  I was exhausted, though, spent and wrung out like I had just been to the wars.  I sat in my room for a minute, trying to place the uneasiness.  It came to me after a while -- spikes and knives.  For the whole hour with her, I had been dodging spikes and knives.  Despite her demeanor and her lovely surface openness, she was frightened to the core by her new prognosis.  She was building and rebuilding her defenses, and meeting the increased violence of her disease with increased violence.  She came to her massage and exposed a surface vulnerability, but kept talking to protect her damaged core -- brandishing her spikes and knives against fear.

My only weapon is no weapon.

Final Exam and The Professor

I harbor a secret obsession with medical books for laypeople.  I absolutely love the feeling of insider knowledge about what doctors do all day.  And I especially love when all this is presented in clear, interesting, unlabored prose. 

Final Exam, by Pauline Chen, explores how doctors are (not) trained to deal with the death of their patients.  In it, Dr. Chen uses anecdotes from her own medical/surgical training and practice to highlight the gaping hole in medical education that is "How to Manage Patient Death."  It is thoughtful, honest, sad, and a lovely read.  It is also a bubble-wrapped softball thrown at the center of that gaping hole.  Somehow, after reading this book, I didn't feel so bad about doctors who can't acknowledge death.  Maybe because the doctor who wrote the book had clearly learned so much. 

Back out here in the real world, though, I'm stuck looking at medical professionals who daily fight to beat back any shadow of patient death.  And I admire them for it -- especially when our most recent losses are of patients who are so young.  It's such a strange balance, which The Professor brought into crystal clear focus in a 30-second exchange today:

"Is there a reason why you can't massage my abdomen?"

"Well, in this medical setting, I need to take extreme care with what I do so that I don't tax your body, but rather support it through your treatment.  'Do no harm' applies to me as well."

"And yet the doctors who 'Do no harm' are the ones ordering noxious chemicals for me to take." 

******

The Professor, restarting his treatment after a particularly nasty go-round with side effects, had a point.  But he wanted his doctors to do this calculated harm, for now. When he stops wanting it, though, how hard will it be for his doctors to accept?  And how hard will they fight to convince him not to die?

The Yellow Rose of Texas

The Yellow Rose of Texas is not doing so well.  When I first met her, she would marvel at the ease of her treatments "this time around."  No side effects, just a little tired.  Unbelievable how good she was feeling.  Those supplements must really be working -- and did I know how good grapeseed oil is for your hair? 

The Yellow Rose looked ten years younger than I do, even though she is five years older.  She smiled often, showing one pointed snaggle tooth.  Her skin was clear and soft.  Then somewhere along the way she got a bad scan result.  Progression of disease concerning enough that she paused her chemo to have radiation treatments. 

Now, the Yellow Rose is fading.  Her grapeseed-oil soft hair is straw-dry, gathered back into a ponytail thinner than her pinky finger.  She is in constant pain on one side of her body.  Nothing helps.  She can't even get some respite through sleep.  (Although today she pulls down into the deepest wells of her endless optimism to tell me she slept last night -- four hours.)

I learned today the pain is cancer.  Cancer and more cancer, findng the weak spots in her body to live.  An insttructor once told me cancer is just aberrant life, not a cause for war.  The instructor was trying to express that our violent metaphors for cancer treatment often do not allow us to treat the body and the person with the necessary tenderness and attention. 

But the Yellow Rose is sitting up on my table (because lying down is too painful) gasping in pain, squinting in pain, telling me my hand on her shoulder feels good.  I can't breathe because I feel useless, punched in gut by her suffering.  I want to punch back, violently. 

It won't do for both of us to be overwhelmed.  Like my instructor knew, any small measure of peace can't happen that way.  I tighten my core and take the punches, absorb the violence and try to give back to her only tenderness and care.  Later, in my car on the way home, I will sort out the damage.

Snark Allowance

When I started futzing around on this thing, I promised myself that I wouldn't post all grumbles and snark.  I wanted to use this space to explore significant experiences as my massage career developed, and maybe come up with some Big Thoughts about touch, compassion and humanity.  Besides, other people do much better snark than I do.

But I can't hold this back.  Within the space of five minutes today, I was privileged to hear the highest concentration of spit-take-inducing ridiculousness I have ever heard.  I need to share this.

Quick background:  today I was working at a spa.  It is a nice place, and the other therapists are very talented, but because of the environment, it is not nearly as weighty as my other workplaces.  Example: on our breaks at the spa, we read People Magazine, while at the clinic, we use our breaks to look in Pub Med for articles about neuropathy.

The speaker of the following statements is in her late twenties.  She is a massage therapist at  the spa, and this is her first job.  Ever.  In her life.  (No, not even a summer at a fast food place.)  I will refer to her as "Zsa Zsa."  There are often things she says or asks that make some of the rest of us roll our eyes inwardly -- things people who have had jobs already know.  Today, Zsa Zsa was in rare form:

Zsa Zsa was eating a black bean burrito for lunch (which another co-worker picked up for her.)  She looks down at the burrito after a couple of bites and shouts: "Oh my god! Why is this black!"

Zsa Zsa on the proper way to hold a baby shower: "Aren't you supposed to rent a gigantic hall, like the Palmer House or something?"

Zsa Zsa on skin care: "I'm black and I go to tanning beds."

Zsa Zsa on Tori Spelling: "I hate her 'cause she's skinny and pregnant."

Five minutes for all this snark fodder.  Fabulous work, Zsa Zsa*.

(*-In the interest of fairness, I would like to say that Zsa Zsa is a very effective, often requested massage therapist.  Just not so good at the activities of daily living stuff.)

Tom Dooley

Once a month, I work in the memory care unit of a nursing home.  My business partner and I have a couple of hours to squeeze in massages between everything else being done to residents after they eat lunch.  ( Despite some recent person-centered training, this staff still does most things "to" residents rather than "with" them.)

One thing that happens every time we visit is the Sing Along.  The activity aide puts in the same familiar VHS tape with the same familiar songs.  She goes around trying to cajole residents into singing, moving, dancing, or shaking one of the many bells-on-a-stick things they have floating around.  For the most part, this is effective because music itself is enlivening.  I have seen  people who can't speak their own first names sing every word of some obscure song that was popular in their youth.  I fully expect that when I am in memory care, the staff need only mention "Friday" and I will be off with my own warbling rendition of "Friday I'm in Love."

As I am trying to finish up some massages with less responsive people during the Sing Along, I don't often listen to the music or pay attention to the video.  Today, I found myself facing the overly gigantic TV screen as the video played.  I was mesmerized by the home basement office green screen effects and the main singer's unfortunate porn star mustache.  This video also featured the lyrics to every song as subtitles.  I tried to concentrate, but the person I was working with had fallen asleep with his hand gently, but firmly, wrapped around mine.  He seemed content with simple human warmth, so I watched the video a little more.  I looked up just in time to learn the full lyrics to "Tom Dooley."

Holy. Domestic. Violence.

Did you know "Tom Dooley" is about some guy who lured his poor girlfriend to a secluded place so he could stab her to death?  The song is about his upcoming public execution.  It's a deceptively cheerful little earworm.  I used to find myself whistling it in the car on the way home from the nursing home.  Today I realized how deeply strange it was -- this song about a murderer playing on the big screen while one woman sang along with every word in a bright, clear soprano, tapping out the beat on the arm of her chair.  On the other side of the room, the activity aide had another woman up, dancing a shuffling two-step while Mustache sang about the "white oak tree" where Tom Dooley would hang.  To death.

Music pulls us together and is powerful enough to expose our hidden humanity, as this recent video shows so powerfully.  On the other side, though, music tells our darkest buried stories.  ("Strange Fruit," anyone?) It gives us a framework to relate in the daytime things that would make us cower in shame or fear if we tried to speak of them in conversation alone.  Music wraps our nightmares in foam and crash pads so we feel safe enough to fall right into the middle of them.

Cutting for Stone

I like novels that make me cry. I enjoy that total absorption in a fictional world that opens up some fiercely protected emotional reserve and pulls it out -- all with the gentle force of words. Only words -- put together in a specific way by a human mind that has all the same organic parts as yours and mine. It feeds my fragile optimism to realize that a person, just a person, can produce a fictional world so real and powerful that it makes me cry.

I recall three contemporary novels that have this particular power: The God of Small Things by Arhundati Roy, Bel Canto by Ann Patchett, and now, Cutting for Stone by Abraham Verghese.

I believe I came to this book a little late. I put out a plea on Facebook for something good to read, and at least four people mentioned this book. I found it in the new books section of the library. Only one of the five or six copies was available for check out. Somehow, this "new" book already had the darkened pages and slanted spine of an often-read book. I had just seven days to get through 550-plus pages.

I finished it in three.

The story, if you don't know, follows twin brothers, conjoined towns separated at birth, and their lives at a hospital in Africa. This is a gross over- simplification of a complex story, but I hesitate to summarize a story so perfectly compact. Yes, despite the heft of the book, the story was compact, contained. Every possible loose piece that could have rattled off into space found a way back into the puzzle of the story. Tragically deceased mother, troubled absent father, brothers drifting apart by distance and betrayals -- it all comes back together. Despite the tragic tones of the resolution, the ending of the story was deeply satisfying. Overall, this book has the feel of a life well and fully lived -- I grieved for the end but still felt grateful for the journey.

So now I will add my recommendation to that of my four or five (or more) friends. This is a well-crafted, lovely book. It is elegant in language and precise in construction. It reflects, I believe, the best of author's other profession (Verghese is a doctor) as well.