Occupational Hazard

I received a call recently from the husband of one of my regular clients.  I hadn't seen her in a while, and since I knew she was battling an aggressive cancer, I suspected the worst.  When I saw her name come up on my caller ID, I had a momentary flutter of hope.  Cured! Or at least stronger! This one would beat the odds!

Then I heard her husband's voice, high-pitched, sing-songy, clearly desperate to keep it together.  He told me that his wife had "taken a turn," and that she was pretty much bed bound.  I couldn't picture it.  This lively, funny woman who used her entire body to punctuate her sentences lying still? No way.

Her husband remembered that I had offered to come to their house and give her a massage.  He wondered if I could still do this.  I answered before he finished his sentence.  Yes.  For her, yes.  Always.  Tell me when and I will be there.  I don't care that it's snowing and you live about an hour's drive away.  The answer is yes.

He thanked me, told me he would have to check and see when the parade of visitors would let up so she could relax into her massage.  He tried to massage her legs himself, he said, but she said he was just too rough.  And here his voice broke.  He sobbed into the phone, still maintaining a normal conversation.  He talked to me about dates and times and when he could call me back, all through heaving sobs that I could almost feel in my own body.

I checked my urge to say "it's okay," because it wasn't.  I just said, "I'm sorry," and "I will come to see her.  I want to come to see her," and "Thank you for calling me." He recovered just enough to end the conversation with grace and all those polite expressions we use when saying goodbye to someone we don't know very well.

I thought I had gotten better at this, after three of my former clients died in the space of a week last month.  I thought, as I calmly went back to my book after the phone call, I have found my balance of professional and compassionate.  Then I cried into my hands for twenty minutes, thinking of the grief of a husband watching his adored wife waste away before his eyes.  This is my occupational hazard.

In Waves

My client is an artist.  She regularly shows and sells her work at galleries in the nearby suburb.  She also has Parkinson's, so I'm not sure if she is creating new work.  She tells me she used to receive massage every week when she was younger, but that she hasn't had a massage in over 12 years.  She has forgotten that I massaged her once a month for a time last year, but I let that go.  

She speaks clearly and with deep intelligence, but her cadence is stilted.  Her speech pattern resembles a particularly adept computer voice simulation.  Unconsciously, unnecessarily, I slow down my own speech.

She climbs onto the table, and I hold her in my arms like a child to help her gently lie down.  Once we have pillows in place and she is comfortable, she closes her small, piercing blue eyes and goes right to sleep.  I give her a gentle massage, slow and still with respect to her thinning skin.  I am struck by her arms.  Her upper arms are soft, fleshy.  Her forearms, however, are wiry and dense.  I can feel in her muscles the years of holding a paintbrush, moving canvases and mixing colors. 

She falls deeply asleep during the 30-minute session.  She is my last client of the night, so when I wake her to tell her the session is over, I tell her she can lie there until she feels ready to sit up.  She is grateful, and asks for a few minutes.  I sit in a chair in the corner of the room, while she rests on the table.  While I sit quietly, watching to make sure she is in no distress, I start to catch and match the pattern of her breath -- or maybe she catches mine.  I feel a warm surge traveling around the room.  A wave.  A cotton sheet in a summer breeze.  The first touch of brush on canvas.  In the few minutes after the massage is done and before she is ready to get up, I find utter stillness.  I reconnect to my purpose.  

Swim, Dammit.

A couple of the teachers have started affectionately referring to this class as "our girls."  It is a very small class, all young women.  They lost a pretty high percentage of their classmates in the first couple of terms, so the remaining "girls" have grown pretty close.  When they set up to do hands-on work, there are only 3 tables, maximum.  No matter what the size of the room, they set up their tables so close together that they are guaranteed to bump into one another at some point.  I teased them about this one day, running the length of the empty classroom with my arms outstretched, saying "Look at all this room for awesome body mechanics!"  They laughed, and one of them said, "But we've lost so many people.  We have separation anxiety."  She smiled when she said it, but I saw real loss and fear in her eyes.

A group this small, this closely knit, can be beautiful for teachers to work with.  At the end of last term, they all gave presentations about their challenges and experiences with self care.  Every one of them had a meaningful insight, more impressive than I ever hoped for.  Every one of them said something about being positive, being optimistic, being overwhelmed but excited about their future careers.  Our girls were an inspiration, a shining light to look forward to.

Then came this term.  My colleague and I had a throw-up-your-hands moment in the faculty lounge.  Our girls were missing so many classes.  Our girls were not turning in their work, they were failing tests that should have been easy for them.  Our girls were expressing doubt about continuing in the program, with only 15 weeks to go before they graduate.

Tomorrow, I have our girls for class.  All my preparation for this class has been about getting them back to that optimistic group of students who could handle anything.  I see them sinking.  There are so few of them, I feel like I should be able to gather them all in my arms and pull them up.  I could be that strong.  But then I remember this: lifeguards are taught to try every possible method of rescuing a drowning person before they go in the water themselves.  This is because a drowning person could push a lifeguard under in their struggle for air.

So I have to think, have I tried every possible method?  Is it really time to cast myself into the water in an attempt to save them?  I don't know.  I just know, looking at my grade book and attendance sheets, our girls are in trouble.  I know, looking at their faces, our girls are overwhelmed, and they have lost the excitement.  Somehow, between now and tomorrow, I have to find enough excitement, and enough life preservers for all of us.

Your Science is in my Art! No, Your Art is in my Science!

I've been reading a few blog posts lately about the science/art conflict in massage therapy.  I remain confused about why there is conflict at all.  I look at science and art together as the Reese's cup of the idea world -- good apart, but addictively delicious when combined.  Two great thoughts that think great together.

This came to mind again today when I saw a few Facebook posts showing results of some right-brained/left-brained quiz.  As I am a sucker for a good quiz, I took it, and found my results were exactly in the middle.  Unscientific, but every time I have taken one of these quizzes, it comes out the same.  Exactly in the middle.  Maybe I can't favor art or science because my brain abhors extremes.

Or maybe science and art are more delicious together than separate.  I call myself a "science monkey," I warn my students against talking about toxins, I have multiple Google Scholar alerts.  And yet -- Every time I lay my hands on someone I think to myself: "This is (name.) She needs (compassion/peace/comfort/whatever.)" If I don't do this the massage suffers.  When I am in the middle of a massage, especially an oncology massage, I feel a tight circle around myself and my client which physically blocks outside noises, thoughts and feelings.  I describe it as that TV blurry fade, only it just fades out background chatter.

I want to live in my Reese's cup world, where creative combination is the way to practice, not willful exclusion.  Open, but not gullible.  This is how we create new ideas, new methodologies, new relationships.  Let's sit in a balcony and let those chocolate bars fall.

Big Girl Trousers

What do you do when the right decision for you is also the one that causes the most panic?  If you're me, normally you ignore it and hunker down with the safest choice instead. Then, maybe, something happens to split open your life, and all the usual choices are blown to bits. So, what do you do?

If you're me, you take ten steps back, then run directly into the panic, waving your arms and screaming "Towanda!"

A full time faculty position recently opened up at the school. It would be that rare unicorn among MTs -- a job with a consistent salary, regular hours, and benefits. Benefits! I had those when I worked in corporatetown. They were soooo . . . . safe.

I sent in my resume for the job. The salary and benefits would go a long way to eliminate the things I worry about. But, I just started a practice that could be a beautiful expression of my work. I am getting more involved with teaching oncology massage, and I just signed a preliminary contract to provide massage at a nursing home. None of these things have benefits beyond feeding my passion and making me excited to wake up every day. None of these things have security beyond that of knowing I am doing what I was meant to do.

Benefits, though, and the hypnotic charms of financial security. I interviewed for the position, and they wanted me. They hoped I would apply before they posted the job. They saw me doing well in the job. To tell the truth, so did I.

Today, I turned them down. I will still remain as part time faculty, because the teaching makes me a better therapist, and because I do need some consistent income.  I decided to take on this new independent adulthood, and move towards the things I am best at, even if they aren't exactly secure right now. I am running towards the panic, arms outstretched.  Maybe some of you think I've made the wrong decision, and I'm okay with that.  Maybe you're right, and I'm okay with that too.  Maybe I will stumble, fall, crash and even burn.  But I'll be happier for it.

Towanda.

I Reject Your Reality and Substitute My Own

We humans are born storytellers, aren't we?  We can make waiting in line to buy gum into a full narrative with a dramatic arc, heroes, villains, possibly even a quest and the revelation of unknown truth.  As a way to connect with each other and make sense of our lives and motives, stories are powerful beyond understanding.  But we are also easily trapped into common narratives that oversimplify our experience, making it less rich.

As we learn to listen to and understand stories, we also learn that every story has a good guy and bad guy.  At some point in the story, these guys will confront each other, and thus the central conflict arises.  When we are very young, the good guys always win.  As we get older, we tell ourselves more sophisticated stories where sometimes the bad guy wins, but the good guy learns a valuable truth.

Lately, though, I am trying to storytell my way out of the good guy / bad guy dichotomy.  What if the stories were rewritten so that no one was bad?  Mistaken.  Conflicted. Confused. Possibly even delusional -- but not bad.

Isn't this what is meant by unconditional positive regard?  That we approach every human without judgement, and without placing them in opposition to ourselves and our fellow questers?  Here it is, the fourth time I've taught one particular Ethics class, and I am discovering that it's not so much about creating a therapeutic persona as it is about changing the story structure altogether.  It's about learning to construct a compelling story without the benefit of a bad guy to despise.  I know this can be done because Ann Patchett has done it in every book she's ever written.

Maybe it's not so surprising for a Lit geek like me that eventually everything goes back to narrative.

Living It

I have been thinking a lot about the idea of "flow," and how to structure my career so I can find it more often.  As part of this, I have been doing some writing exercises from the book Bliss by Katherine Ramsland.  Here is what I wrote today about a recent session with a new client:

As I entered the room, I felt like I was stepping into a higher version of myself.  I felt my pulse moving and yet I was completely relaxed.  My mind was not thinking forward or backward.  I felt like the nerve connections between my touch and the interpreting parts of my brain had been widened and cleared of debris.  Everything I did was a sun salutation, with movements happening at the rhythm of breath.  I was pre-verbal, able to communicate through gesture and intention alone.  It wasn't that training, knowledge and science didn't matter.  It was that those things were so completely absorbed into my being and doing that I didn't need to actively reference them --- the way you don't need to reference the contractions of the cardiac muscle in order to have a pulse.  The session was a deep and meaningful conversation, conducted in total silence. I used my body, I worked hard, but I didn't notice until I stepped out of the room at the end of the session.  Even the sore quads and fatigued hands felt like gifts that were oddly energizing to my mind and spirit.  It was the experience of feeling and doing two totally opposite things at once, where the logic brain gets so confused it taps out and the art brain takes over.

Rhythm and Flow

This afternoon, my ducklings graduated.  This class of students started massage school the same term that I started teaching.  A number of them didn't make it through, and at least one of those still breaks my heart a little.  (I will always wonder what more I could have done for her.)

But, today was a celebration.  Their designated class speaker said a few words to and about every teacher they had.  About me she said, "you inspire us."  Here at home, hours later, I finally feel the humbling impact of those words.  To inspire.  To give breath.  To infuse with spirit and life.

I try to give every client I touch something beyond a focused, knowledgeable treatment.  Similarly, I try to give every student I teach something beyond the material in the syllabus.  Call it energy, call it presence, call it compassion.  I call it space and time, open to be filled with whatever a client or student needs to grow.

I never really know how well I do this, especially with students.  With clients, I can see the changes in breath and posture that go along with an infusion of hope and optimism.  With students, aside from the occasional satisfying "aha" moment, I don't know how deeply they take in what I am offering.

Today I found out --at least for these few new massage therapists.  I am remembering moments with them when we were learning together, focused intently on ourselves and the questions at hand.  I am remembering those moments of flow, where I could feel them pulling just the right words out of me -- the words that made it all come together.  Their class speaker said I inspired them, but the truth is that any breath I gave them came from their own lungs.  

When Words Attack

In my previous life as a teacher of freshman comp, I developed a kind of affection for the grammar mistakes all students make.  I had to, or else I would have become a bitter, angry person.

Massage therapy students don't do too much writing, but I happen to teach two of the classes where a major final project involves a paper.  Sometimes, the errors are just too good.  Here's my current favorite:

A student wrote about working with a woman who was a breast cancer survivor.  The student spent time researching the surgeries her client had so as to better understand what might be going on with her client's body.

The surgery in question, according to the student? A double vasectomy.

Best. Mistake. Ever.

I will beat a $&@/*#%!

I supervise student clinic on Saturdays.  Kim* has been in my clinic for the past two terms.  Kim has been in one or another of my classes for her whole time in school.  She used to be a fighter.  Like a semi-pro fighter, do she knows how to give and receive a blow.  Once I overheard her telling her classmates how someone tried to mug her and she laid the guy out flat.

Yesterday, Kim called a few minutes into the clinic shift.  She was sobbing, and all I could understand was ". . . Some dude.  . .  backpack . . .  On my way in the police car . . ."  I told her I would meet her at the door and we would sit down and talk.  When she arrived, she had a wide-eyed, panicked stare and tears running down her face.  I walked her to the office and closed the door.  Then she told me that she had been mugged on the way to the train.  The guy jumped her and because of her bag, she couldn't throw a proper punch, so she wrestled helplessly while he smashed her head into the ground. He ended up stealing a bracelet that was a family heirloom.  He only stopped beating her when some other guys ran up to help.  She filed a police report and came straight to her clinic shift.  I brought her ice for her already-swelling face, convinced her to call a friend to take her to a hospital, and let her wait in the office.  She said she felt safe there.

I checked on her often, and each time I did,  Kim rode another wave of the realization of trauma.  She could have died.  She lost an irreplaceable family heirloom.  She couldn't fight him off, even though she knew how.  I held her head in my hands while she breathed, and I made her promise to text me from the hospital.

In one of my classes, we talk about working with trauma survivors, and our responsibility as massage therapists.  We talk about the balance of compassion and professionalism, and how people don't need us to weep with them.  They need us to hold a calm, safe space.  A non-judgmental space.  I know this is difficult, and I used to think I was good at it.  But I couldn't help crying with Kim for her loss of security.  And I can't help wanting to beat that m*****-f***** into the ground.

Kim is fine, physically.  As I said to her, the emotions will come in waves, probably for a long time.  And I will focus on wishing her wellness instead of wishing harm to her attacker.

*- name and identifying details have been changed

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The Sky has Fallen. Long Live the Sky.

Recently, the faculty at the massage school received an email.  The text of the email, in its entirety, read: "(Beloved Education Director) is no longer with (school.) if you have any questions, please see me and I will do my best to answer them."

Well, yes. I do have questions.  When the woman who basically built this school is no longer here, with no warning and no goodbye -- I have questions.  What do I tell the students?  This woman supported, pushed and believed in every one of them.  One evening in my class, I watched her sit with one of my students and lay into the student about her shaky academic standing.  All with love.  Love of the profession, of learning and educating, and of the students.

The night of the announcement, I taught a class, and I told my students.  I told them that I was sorry I didn't know more, but out of respect for her, they should not speculate.  After class, I met a colleague outside the faculty lounge, and held her while she cried her contact lenses out.  Our mentor was gone. The sky had fallen.

Since then, we have been going on with what we do, trying to support the students with the same dedication and passion she had.  Some of us are focusing on those things we can control.  Some of us are spiraling down into rumors and negativity.  Last night, I saw a colleague who had been out moving house when this all went down.  "Well," she said, "we just gotta keep on keepin' on, right?"

Ah. Yes.  She's right.  I looked up last night, and the sky had not fallen.  It was gradually darkening gray criss-crossed with streaks of pink clouds.  We thought the sky had fallen because we were bent down with our frustration and grief.  We are still apprehensive about what comes next, and we are now saying goodbye to more people who see this as a sign to leave.  But our students come to class, and we have information for them.  We keep on keepin' on.

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Rhythm Heals.

I hope N.E.D. (www.nedtheband.com) will forgive me for borrowing their song title for this post, but it fits exactly what I want to say.  I have been thinking about oncology massage and geriatric massage, and why I am drawn to it.  I get asked this question a lot.  My stock answer is : "It suits me."  I never truly tried to dissect why.

Then I saw a documentary about this amazing group of gynecological oncologists who formed a rock band called N.E.D. In the documentary, one of the doctors talked about how music could help patients find hope and optimism in the face of a devastating diagnosis.  After the film, my friend and I talked about how nice it was to see physicians talk about the healing power of Art.

Which brings me back to what suits me.  Art suits me.  For me, the creation of any kind of art requires first a basic compassion towards and optimism about humanity.  To build something new and lovely out of one's mind and heart works best, I think, when the artist loves their audience.  Even when they don't know who their audience is.  For me, massage therapy, the Art side of it, feels like a pure and tangible form of love and optimism.  And working with oncology and geriatric clients magnifies that feeling.  As I reach out to touch people who are often at war with their physical bodies, I find that my technical skills and scientific knowledge mean nothing if I don't begin with love.  By this I mean what Christians sometimes call "Agape," the deep respect, care and compassion for our shared humanity.

I may not be making music like the #Rockdocs, but I am tapping into and creating rhythm.  The rhythm of breath, the rhythm of movement, the rhythm of a treatment addressing and responding to a person where she is, right now.  It heals.

***********

Check out N.E.D.'s song here:
http://youtu.be/HwpbGSXZye8

"I absolve you, mediocrities everywhere!"

I went to my first faculty meeting.  Besides the usual talking-too-much-about-nothing which plagues every meeting, this one had an extra level of despair.  The campus director was talking to us about student retention -- quite a challenge with our student body lately.  She berated us for saying sometimes that we thought this or that student did not have what it takes to be a massage therapist.

She told us, in all seriousness, that employers needed graduates at all levels.  They needed superstars to come in and be amazing.  They needed skilled journeyman-level workers who could come in and knock out some solid relaxation services.  And (she hesitated) they needed less skilled people who they could train how they want.

Pardon? I looked at my colleague to my left.  She looked like she was going to turn green and Hulk it out all over the room.  I looked at my colleague to my right.   She was rubbing her ears as if something was messing with her hearing.  Did our campus director really just say that employers WANTED mediocre, unknowledgeable therapists?

I started teaching because I love this profession and I want to make it better.  I have met and received massages from some pretty mediocre therapists, and rather than complain about them, I wanted to be part of the vanguard that made them better.  My vision is massage therapy as a 2- or 4-year program, depending one whether one wants to be a generalist or specialist.  I see myself, and my students as part of the health care continuum which includes physicians, nurses, napropaths, and a whole range of highly trained professionals. There is no room for mediocrity in my vision.

I do understand that students who struggle often become therapists who do amazing work.  I am willing to work with these students to get there.  I am not willing to push along a student who will not take anatomy or kinesiology seriously.

One of the two colleagues sitting next to me put in her resignation after the meeting.  She was that disillusioned.  Sometimes I wish I had the financial wherewithal to do the same.  But then, I remember the woman from Arthur Conan Doyle's "The Noble Bachelor," dismantling the walls that held her from inside, brick by brick.  Subversion takes years, sometimes.  It takes patience, always.  I tell myself that this is what I am doing.

They Got It!

Last night I gave one of the lectures I both like and dread the most -- the lecture about working with geriatric and terminally ill clients.  At some point during the lecture, I can guarantee that I will see a room full of "lemon face," which means my students are actively trying to protect themselves from the icky ideas of aging and death.  

Last night, however, I got through the whole lecture with no lemon face.  This very small group of students are just as young as any other class, and just as oblivious to the concept of aging as something even they are doing.  They skipped lemon face, though, and went right to compassion.  

There is a posture students get when they get truly excited about a topic, and start to yearn for more.  They lean forward.  Their eyes get bigger.  They open their hands and unconsciously reach out towards me.  Everyone in the room last night had that posture.  I could almost feel their curiosity pulling information out of me.  When we started doing hands on practice, they went immediately into their focused place and committed.  To everything.  

What a joy for my barely-functioning shell to see this next generation of massage therapists get excited about working with people who are transitioning out of life.  I may make it through summer after all.

A Burnt Out Case

While I am not quite ready to go find a leper colony in the jungle, it is clear that I am becoming a Burnt Out Case.  There are cracks in the facade, and plaster is starting to rain down.  Work and school used to be my sanctuaries.  I could go and teach or do a massage and be so fully in the moment that I literally forgot everything else.  Even if the train ride in was a sea of screaming babies, seat stealing suburban tourists and surly conductors, by the time I walked into my classroom, I was the picture of calm, professional control.  When I went in to give a massage, I could disconnect from everything else and draw fulfillment from the simple act of doing something I love.

This week, though, it's coming apart.  I try to tap into those endless reserves of grounding, calming strength, and I find that the connection is lost.  Somebody unplugged my grounding circuits.  I try to fill myself up with breath, and I can almost literally hear the echo of wind in a hollowed-out soul.  This week, I got a new client.  A friend referred her to me.  I almost didn't take the appointment, although I desperately need it.  I barely mustered the energy to do my best massage.  Afterwards, I had only enough energy to pick up the crappiest food I could find and sit on my sofa trying to hypnotize myself with computer games.

Just in time, I think, I realized what this is.  This is what burnt out feels like.  This is the thing I spent all those hours in Ethics lectures warning students against, and making sure they knew the signs and the dangers of ignoring those signs.  Well, crap.  Now it looks like I need to take my own advice.

I used to think that knowledge was the answer.  The more I learned, the more energetic I felt, and the more I wanted to do.  More classes.  More challenges.  More studying.  It turns out I was just pushing myself further into my head, where the gasoline and matches live.  Whoosh.  Burnt out.

I find myself looking longingly at pictures of mountains and streams -- truly quiet places with no trains or cars in the background.  I have just enough left to get through the summer, then I think it is time for this Burnt Out Case to seek a brief sanctuary in the mountains.  Massage sabbatical planning is under way.

There Are More Things on Heaven and Earth

Last time I wrote about Christina, and I talked a little bit about True, as in, "what happens on the table is True." (quote by Tracey Walton.) "True" is the word that stuck with me after our session, and the word that keeps coming into my mind at unattended moments.  It came to me again in the form of Gina*, my client.

Like many of my clients, Gina has cancer.  She has a difficult cancer that most places would call end stage.  As in terminal.  As in: don't waste your time with chemo, Gina, just enjoy the time you have left.  Gina isn't having it.  Last time I saw her, she spoke for a long time about her quest for the next level of treatment, and about how the massages brought her to a calm place after living every day in anxiety. She asked me, in all sincerity, what kind of energy work I was doing with her.

I told her I wasn't trained in energy work. I didn't have that knowledge or skill, so I couldn't possibly claim to be doing energy work on her.

Smiling, Gina said, "Bullshit!"

She climbed on the table for her session.  I focused and grounded myself, like I always do.  I massaged her gently, cautiously, and slowly, like I always do.  I silently wished her peace as I did so, like any human being would do.

Gina's breathing slowed, her shoulders dropped.  After the session, she told me she felt a light and calm presence surrounding and infusing her body.  I thanked her, and hugged her, and decided not to wonder where that came from.

True.

*-- name and all identifying details have been changed

The Question of True

"The bear is chasing you," she said, "You need to get out of that sympathetic state."  She twisted my ankle back and forth directing me to move my eyes.  Eyes open.  Eyes closed.  Eyes open.  Eyes closed looking up.  Eyes closed looking to the left.  She gave me words to focus on.  True.  Grudge.  Moral.  Joy.  Each one unremarkable in itself, but somehow every time she said a new word, a new wave of tears broke over my face.  I was the ocean, finally breaking through the futile walls built to control and contain.

I went to massage school with Christina, and I am ashamed to say I don't think I treated her as well as I should have.  She was deep into energy work, fields, auras, chakras and all that.  I was deep into science.  The evidence-based path that I knew was the only way to build respect for our profession.  We left school, parted ways, stayed tangentially in touch.  I went to see her because I was buying a room divider from her before she moved out West.

I couldn't help it -- she asked me how I was and I told her the truth through tears.  Not good.  Not fine.  Generous, lovely Christina -- she would not let me leave without doing some work for me.  She gave me her gift of time, attention, and, yes, energy.  I don't pretend to understand the systems she used.  I never studied energy work.  But I decided in my broke-openness to accept.  Just accept the gifts being offered to me.  I don't understand what happened, but I know I left feeling stronger, lighter, and better able to breathe.

I am reminded of something Tracey Walton said in a workshop about massage therapy research: "What happens on the table is true."  I couldn't find any evidence to support what I was felt except that I felt it.  I used to say, in my arrogance, that I didn't "believe in" energy work.  That I preferred to focus on the known and proven/provable physiological effects of massage.  I thought the woo-woo ness of some energy-based bodywork cheapened our profession.

After some years doing oncology massage, I was coming around a little bit, but still maintained a healthy skepticism.  But now I must admit that the work Christina does is, in the fullest sense of the word, True.

Can I talk about this? I mean, it's right there . . .

I am teaching a course now where we explore massage considerations and adaptions for various groups : pregnant women, the elderly, people who have chronic illnesses, etc.  On our first day of class, we were having a discussion about how and why we might need to classify certain groups as "special populations" and what that label might mean.  One student raised her hand and asked me to silently read her written-out question because she "didn't want to be rude."

The question was: "Is obesity a special population?"

This was not an abstract question.  One of the students in that class is clearly obese.  The stress of her weight on her body shows in the way she moves, and in the way she tolerates work from her classmates.  The first time I saw her, I wondered if she would even make it through the first quarter.  Massage is a physical job.  It's not ultra running, true, but you still work standing up (usually,) and rely on your body to do the work.  The first quarter, she could barely make it through a half hour practice without stopping because she was "tired."

She is now in her third quarter, just barely scraping by.  This has more to do with missing classes and failing tests than with her physique.  Her endurance has improved, but she still tires easily.  I wonder if and when it would ever be appropriate to discuss her weight with her.  I have talked to several other teachers, and we all agree that it is outside our scope of practice to discuss this with her directly.  We are not physicians or dietitians.  We don't know her actual health details.  We know the physical demands of massage therapy, but we also know that you don't have to have a healthy BMI to do great massage.

It is still a dilemma to me, though.  I firmly believe it is not my place to initiate a specific conversation about anyone's weight.  I can speak realistically about the physical demands of the job,
though, and hope students make their own choices to support themselves.  Meanwhile, I realize there are more prevalent barriers to her success, which have to do with responsibility and time management.  In that she is hardly unique, unfortunately.

C Word

Yesterday I behaved in a way that makes me ashamed of myself.  Someone reached out to me for a nonjudgmental, caring touch, and I pulled away.  I don't want to make excuses, but here's the story:

Once a month, my friend and I work in the memory care wing of a nursing home. One of the residents, "Agnes," has. Been there since we started two years ago.  She never wants a massage, but she does want to say hello.  She regularly peppers her language with cursing and insults.  Example:

"Hello Agnes.  How are you today?"
"Shaddup ya c***."

Recently, she has taken to spitting at people to get their attention.  She does this with a noisy warm up, so most of the time we can cut her off with a simple, "Agnes, please don't spit on me right now."

Every time we see her, we ask her if she wants a massage.  She always says no.  We try to sneak in a little bit of caring touch.  She will let us hold her hand for a few seconds, and sometimes even lets us rub her shoulder.  Agnes has surprisingly strong and sharp nails for a woman her age, though, and after a few seconds of hand-holding, she will rake one against our fingers -- hard.  I am ashamed to say that I am always cautious when holding her hand.  She has nearly drawn blood a couple of times.

Yesterday, she was letting me hold her hand, and even put both her hands around mine.  Quite suddenly, she pulled down on my hand, and by instinct I pulled away.  When I looked int her eyes, she looked devastated.

I immediately bent down and gently hugged her and laid my head on top of hers.  She has never
accepted so much touch from me.  Still, I knew that I had rejected her when she was most vulnerable.  She tried to pull me closer, and I pulled away. I tell myself that I am on a mission to bring human touch to those who need it, to show people that age and infirmity should not exclude you from the world of warmth and connection.  In that moment, though, I failed myself.  Every time I see Agnes, I will try to make it up to her.

The Peace that Surpasses Understanding

Everyone should have a person in their life whose default approach to every situation is kindness.  I had that person until early last week, and tomorrow I say my final goodbye to her.  She was 95, and as someone pointed out to me, we have been saying  goodbye to her for at least eight years.  A routine surgery followed by a fall and T.I.A. started a slow decline -- so slow we barely noticed as we adjusted to the new versions of her.

But I am not here to remember those last eight years.  I am thinking of the previous 87.  Or, more specifically, of the smaller portion of those years where I knew her.

My most enduring memory of her is of leave taking.  She would stand in her doorway -- or on the porch if it was warm enough -- and wave to us as we drove away.  Every time we drove away.  It didn't matter if the time between our visits was less than a day -- she watched over our leaving every time.  When I was younger, I would get so sad as I watched her figure, framed in the doorway, grow smaller in the distance.  As long as I could see her, I felt heavier and heavier until I thought we had to -- HAD TO -- turn around and go back to her.  I just assumed she was lonely when we left, even when her husband was still alive or when she had more people still visiting after us.

I see it differently now.  We have been going through old photographs to put together one of those barely-adequate displays of someone's life.  I realized that in every photograph where one of her children is in the picture, she is looking at the child, not the photographer.  And she looks serene as the Buddha in each one.  This was her gift to us, and although it sounds like not much, it was more than most people can offer.  Her gift was watching, with love and attention.  That is why she always waved us out when we visited.  Her attention belonged to us, for as long as we were with her, even if ours was elsewhere.  And her attention was always kind.

In my work, I strive daily to reproduce this kind of attention for every client.  I try to model and teach it to my students.  It is a struggle sometimes, but when I know I have it working, I feel a peace that can't be explained.  How wonderful to think that most of her life was built on that kind of peace.

Deep Issue

We knew this day was coming.  My colleague and I have spent the past year or so pointedly avoiding mentioning the words "deep tissue massage" in the hearing of the professionals who run the clinic.  We knew they had the (to us) sorely mistaken idea that deep tissue massage was safe for people actively undergoing  chemotherapy.  We figured we could do our thing, practice within the bounds of what we felt was safe, and avoid the issue.

Recently, though, we have been forced to speak out.  A patient who was a regular recipient of deep tissue massage before diagnosis decided she does not want the lighter touch we are offering.  And the management wants to know why.  My colleague and I have spent the better part of the last week reading, highlighting and summarizing all the research we could find on oncology massage, deep tissue massage, and any intersections of the two.  We have piles of research that all definitively says the same thing, and that thing is . . . .

Nothing.

While every acknowledged oncology massage expert I have come across asserts that deep tissue massage is not recommended or safe during treatment, there is no research which has tested this assertion.  As my colleague pointed out, this is most likely because there isn't a massage therapist anywhere who would agree to do the "deep tissue" arm of any proposed study.  We did find numerous articles emphasizing the importance of having a trained therapist work with oncology patients.  We also know that any legitimate training includes extensive discussion of pressure restrictions.  We have also found some studies where light massage proved beneficial for oncology patients -- but in these the question was not about light vs. deep pressure.  The question was : does massage in general offer a benefit? (Answer: Yes.)

We have taken this peripheral, tangential, observational information and gathered it into organized packets of relevant information.  The management is busy with patients and, well, management.  We don't know when our full-on discussion of this topic will happen.  It may never happen, and even if it does, they may not want to listen.   We have done our research, and we feel confident in our opinion. For now, we are staying crouched in or foxhole with our not-ideal ammunition, hoping for a truce.