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.

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.