Everflowing

Congratulations to Ann Catlin and Lisa Parenteau of the Center for Compassionate Touch www.compassionate-touch.org for the Hand in Hand conference on Massage in Elder Care and Hospice in Orlando Florida May 2-4.

Held in the beautiful Caribe Royale Hotel, this conference was an exciting and exceptionally well co ordinated event.

Ann and Lisa went the extra mile to provide outstanding speakers , networking opportunities and gracious hospitality. I personally had a great time sharing information and getting to know how this field looks in other areas of the country.

 With 27 years in the field of hospice massage I sometimes forget that in some parts of the country it’s a new concept.

So after 27 years a well known and well respected organization has finally acknowledged that hospice massage is a viable profession. To me this was the value of the conference. Sure the speakers were great but just the marketing of a conference with this title has surely brought attention in a big way to the fact that hospice massage deserves to be noticed . It deserves a conference.

I am also amazed at how the universe works, although I don’t know why I should be.

There have been some unhealed places in my relationship with my dear friend and teacher, the late pioneering thanatologist, Dr. Elisabeth Kubler- Ross. The surprise speaker for the Hand in Hand Saturday night gala was Elisabeth’s son Ken Ross ; there to introduce his new book Tea with Elisabeth www.teawithelisabeth.com

Ann Catlin, knowing of my long term relationship with Elisabeth, asked me to introduce Ken at the dinner. 

The profound opportunity to pass the microphone to Ken Ross for his first presentation on his mother’s work, was one of those moments in one’s life that is so profound that there is no explanation of the depth to which it penetrates in one’s being. It was like a last mission from my dear friend. A very honorable mission. It was a completion on levels that I have not yet fully realized.

My heart burst open with love for this son preserving the legacy of his mother. The memories of Ken’s love and devotion that I witnessed the entire 25 years I knew Elisabeth, flowed through me. Any place within me that was not healed was flooded with love and tenderness.

I remain in awe of how healing shows up if we are available.

Ken’s presentation not only provided a look at the development of Elisabeth’s work with the dying but a personal view of what it was like to have such a passionate, inspired and internationally acclaimed woman for a mother.

As the slides recaptured Elisabeth’s life I found tears rolling down my face. Missing her? Yes. Loving her? Yes. Feeling acknowledged by her ? Yes.. Mission complete.

Hand in Hand became Heart to Heart.

A standing ovation for Ann Catlin and The Center for Compassionate Touch .

Blessings Irene smith

www.everflowing.org

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I am posting this comment to me because it touches on such a common situation  in the field of hospice massage. 

  Irene, I have been visiting a hospice client since  May of last year . I am going to call her Iris

I usually go on Friday and beside providing a touch session I also relieve the private nurse. I am there for 4 hours so Iris and I have really gotten to know each other.

When ever I arrive the large flatscreen TV is on blaring w/ a soap opera and the private nurse is speaking very loudly (almost a yelling), her approach even scares me. Once she is gone I turn off the TV and take several deep breaths before I even approach Iris. You can see the relief in Iris’s face and often times I think this act alone could be our brief touch session.

She used to thank me .She is now no longer verbal, but I can see  in her eyes that she is glad  I am there to give her this quiet time.

  Iris is always in a lazyboy chair,when I arrive. About 3 months ago she started asking to be moved to the bed. I was hesitant about this because this was not my roll, but she begged. I moved her to the bed and used the pillowing I learned from you. She was very happy. She looked me in the eye and told me she loved me. This was a WOW moment for me. When the nurse came home she had never seen anything like the positioning, so I showed her.

The next time I arrived she was back in the lazyboy and once again when the nurse left she wanted to be moved to the bed. I did what she wanted. This has continued to this day with the pillowing. Iris and I have some time together and then she sleeps until the private nurses return when the TV goes back on and the loud talking resumes.

I am very new in this field, but what I have learned through you Irene over everything is the approach, breath and manners make a world of difference. I don’t feel it is my place to tell the caretaker and the family what to do, but it is hard not to yell out STOP can’t you see Iris and her needs.

I am not sure if others experience this same thing.

Help!

Peace -

Lora Casey

Lora,

Its so hard to say no to a hospice client, and I have overstepped my role more than once ;however I have to support your asking the nurse , in the future, to make this transfer from the bed to the chair. What an opportunity to teach by example. You can assist and example breathing, slow speaking, slow moving. Take the opportunity to stay in your role. No one else has this role.

You are absolutely right, it is never a good idea to tell nurses and family what to do. You advacate for an inservice for the home health aids in your hospice or other contracting agency  and teach them a more skillfull way of providing care.

Home health aids have the least training of anyone in the health care paradigm. They are as are private nurses the least supported and provide the most care.

 Sensitive care providing elicits an intimate relationship and all the feelings that go along with it. Most home care aides and or private nurses do not have the support to be professionally intimate. An inservice that addresses client  sensitive care, must also address personal coping strategies for the intimacy that is experienced. Remember , Iris said ”I love you.”

 You can’t start with the pillows. You have to start with teaching the caregiver to slow down and breathe. Then to sit for 1 minute in silence , have eye contact with the client or other human being,  support them for all the past stories that surface in the quiet, and then you can teach pillow positioning.

The appropriate protocol for eliciting change is through your written reports to your co ordinator. Make detailed reports . Your reports can be used as information that validates your request to provide an inservice. These are two of your  teaching tools along with your ability to exhale and continue to be an example of client centered sensitive care. 

So. you have alot to teach. What a marvelous teacher Iris has been for you.

Breathing through your desire to scream, facing your helplessness in creating immediate change, and continuing to show up for Iris , all speak to your maturity as a hospice massage professional.  

Blessings and gratitude             

 Irene Smith

www.everflowing.org

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I have been concerned for a long time about the way the field of hospice massage is growing. As with any therapeutic intervention that becomes mainstream ,the integrity of the field is suffering. Practitioners with the desire to serve ;however without sufficient training to work with dying persons, are being hired by program co ordinators that have no knowledge in what is needed to facilitate a safe massage program.

I am alerted to hospice programs taking on massage practitioners that have no training in adaptations from working with healthy people on a massage table to working with seriously symptomatic persons in beds.

Many hospice co ordinators are corporate administrators who believe that a massage certification is all a practitioner needs to massage hospice clients.

Although some schools have continuing education programs for working with the dying, massage schools do not teach working with dying persons in core training as a general rule. Sometimes the topic will be minimally addressed in a geriatric or oncology course.

.Twenty seven years in hospice massage gives me the experience to outline what have proven to be challenges in this field ,and areas of training needed for safe relationships between clients and practitioners, and organizations

If you are a massage program co ordinator, educational director for a massage school, or hospice massage practitioner these are a few of the areas that require knowledge in this field.
*Hands on precautions as pertains to massage not nursing.

*Modification of standard massage techniques to meet the needs of the physically and emotionally fragile client. This includes; intention, amount of pressure facilitated through the hands, the speed of technique delivery, and the duration of a session.

*How to adapt massage for working with people in beds and chairs; including body mechanics for the practitioner. Practitioners need to know how to comfortably reach the client to prevent injury to themselves.
*How to gather sufficient information for treatment assessment.

*How to work in a home setting. This involves working in a bed; being with family; communicating with other team members; reporting; setting limits ,and what to take as equipment.
*How to cope with the emotional impact of clients dying which includes personal coping strategies as well as support systems.

This is a specialized field of service that requires practitioners to have sufficient information, supervision and support for the safety of the client and the massage practitioner.

If you are an administrator , educational director or practitioner reading this please go to my website www.everflowing.org and check out the educational resources. Resources are available to give you the information you need. You may download articles for free that will serve you well. You may also ask questions on this site.. Go ahead use me!!!

Many times patients are so hungry for touching, and practitioners are so hungry to make a difference that they don”t recognize the difference in a safe and unsafe session. It’s up to the integrity of the schools, co ordinators and teachers in this field to see that wisdom prevails.

Blessings

Irene Smith www.everflowing.org

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One of the most beautiful aspects of providing massage in the home is the sharing of information and skill with the care team and family members of the client. I always welcome family, with my client’s permission, to be a part of the session either by observing or mirroring my movements as we massage together.

If I can instill the confidence to touch, skills to touch therapeutically, and permission to touch then I know I have brought a sense of healing into the home; eased the helplessness that many times families experience, and have provided an avenue of tender communication that unites and heals what might be an uncomfortable silence at the bedside.

Recently one such story came my way from a colleague and student, Elizabeth Holliday. .

Every week Elizabeth goes to the studio apartment of her hospice patient who is a great-grandmother, Lucita. Sometimes Lucita’s daughter brings her two year old grandson, Pablito.” He watches me like a hawk,” writes Elizabeth.” He watches me doing quiet work with his great-grandmother, and more active work on his grandmother and the nurse, from seated positions in a kitchen chair.”

Last time I saw him he watched me from the foot of the bed as I was finishing up with his great-grandmother. I gestured for him to come over. I showed him that I was holding the center of her hand. I showed him this spot on her hand, and on my hand. Then I took his hand, and showed him where it was on him. He then held that spot on his own hand, and looked at me with those familiar big eyes. I went back to my work. He stayed close by as I finished the session.”

“Today”, continues Elizabeth,” when I went to my appointment, the little boy’s grandmother was there. Before I left she said, “You taught Pablito something. Whenever I sit at my computer, he presses down on my legs the way he has seen you do. Also, whenever we visit Mommy he shows us all that spot on the center of the hand, and he holds her hand, just the way you showed him.”

I could feel Elizabeth’s heart as she wrote,”I thought my heart would burst. I’m so touched by this little boy, and by the great honor of being of service in the family home.”

How sweet and ordinary this child is, to bring such innocence to the bedside of his dying great grandmother. His ability to love without fear and Elizabeth’s ability to share from her heart, brings a healing to everyone in the household. This is the essence of hospice massage.

I thank Elizabeth for sharing this story and I look forward to you sharing yours.

Blessings

Irene Smith

www.everflowing.org

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Those of you who live in big cities will especially resonate to this urban mystery.

Last weekend I was in the middle of my winter intensive and needed to go to the grocery store that I prefer to use which is 47 blocks from my classroom. We had finished our Saturday class and it was 6 30 pm when I got to the train stop. I asked my angels to get me to the store fast.

No sooner had I asked than the train appeared. Being rush hour, I was amazed to have a train that was two thirds empty and few stops were made. We got there fast.

To my surprise the store was almost empty. I was finished with my shopping within fifteen minutes of arriving.

The health food store is at the beach and the train stop was very cold, and windy. I asked the angels once again to grant me speedy transportation.

There were no trains 2 blocks down where the drivers take their break. It looked like I could be there for at least thirty minutes because one was coming from the other direction.

The train passed; however it did not take a break. It simply traveled 2 blocks, turned around and stopped to pick me up. I got on.

  The driver stood up, and opened the door to the compartment that separates the driver and the passengers. “I’m so sorry” he said. “My doors are broken and I can’t stop to let people on. I have to take the train to the station; however I’ll take you home. Where are you going?”

I told the driver the name of my stop, and made the remark that the angels had sent me a private chariot. He laughed and then said “Oh. There’s someone else.”

He picked up one other woman. Once again he got up, greeted her, and asked her where she was going. Looking stunned she sat across the aisle and remarked to me. ” What’s going on.”

I told her my story.

By this time we were coming to another stop and the driver said on the loud speaker,”Forgive me, my doors are broken and I can’t pick you up.”

Every time we passed other people the driver repeated to forgive him for not stopping.

. The woman and I had moments of shy to curiously intense eye contact, and whispers of “This must be a miracle,” as we proceeded on our journey.

I explained that I had asked the angels to get me home fast. She admitted she had gotten very cold on the train stop and felt afraid by herself. After a moment of silence she simply remarked, “Prayer is very powerful.”

The next time we had eye contact we agreed that it was absolutely a Divine Ride!

I look forward to hearing your stories of Divine Intervention .

Blessings

Irene Smith www.everflowing.org

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Helplessness

This week during a nursing home clinical practice, a student was faced with a day of complete helplessness.

The first client was in severe pain when we went into the room, and in pain when we left the room.

The second client was very open for touch for the first 10 minutes and then transitioned into a second personality; becoming paranoid, confused, and agitated at everything around her. The client was left agitated and confused.

In both situations; however, the clients experienced moments of pleasure and obvious intimate contact.

In the first client’s room the client was completely engaged for 45 minutes, holding the student’s hand periodically, and gazing into her eyes. The client animated pain quietly through facial expression, and expressed verbal gratitude for the company and the touch.

What greater gift can we take to the bedside than the gift of sharing the pain and witnessing the suffering of another human being.

However, as a witness for a client who is experiencing pain and/or whose disease is progressing, I am confronted with the loss of control by my client and myself. There is no longer a separation in the helplessness. Living in a culture that teaches us to value ourselves according to what we can fix, change or correct, turns feelings of helplessness into embarrassment, low self-esteem, shame, and/or guilt.

The first few years of this work when I felt unable to help a client, it was hard for me to sleep. I was depressed and anxious. The sense of failure and guilt struck deep. These were difficult feelings to have. They were overwhelming.

Through allowing my feelings to be present, and through sharing them with people involved in the same work, I realize that the feeling of overwhelm comes from my fear of failure — my fear of being helpless.

I don’t know if I’ll ever lose this fear, but knowing how it is triggered, and the rhythm in which it rises in me, allows me to integrate it into my consciousness. The fear of helplessness has become familiar to me. I don’t have to be overwhelmed by it.

This process of integration expands my heart and deepens my awareness of compassion. Having compassion for myself, I may now receive my client more fully.

I look forward to your sharing and questions.
Blessings,

Irene Smith

www.everflowing.org

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 Last week a woman named Beth called me to schedule an appointment on the referral of her hospice nurse. I asked if we could explore her situation over the phone first, to see if we were a good match.

 Beth is 84 years old with a 20-year history of Parkinson’s Disease.

She said she had low back pain and that’s why she wanted a massage.She was also experiencing right side weakness, frequent falls, and a large open wound on her right leg that wouldn’t heal.

She also explained that she had two brain surgeries 1 year ago. A brain stimulator had been placed in her head with the second surgery.

 With encouragement Beth explained that the wires to the stimulator ran from her chest up the right side of her neck and the back of her head.

 I asked her if she had experienced massage before, and she said yes. A month prior to our conversation a massage therapist had come over with a table and given her a deep tissue massage.

 I paused and explained that I offered very gentle work for someone with the many sensitive conditions she had explained to me. She did not adjust her request. Beth wanted more deep tissue massage.

 She asked if I could refer someone else. I told her I would check and call her back the next evening.

 After much consideration I called her to let her know that, with my experience, I could not refer her to someone for anything except very gentle massage.

 Beth was seemingly despondent when she asked me to hold on for a moment.

 She returned to the phone and said, “My sister just reminded me that I was in a great deal of pain after the last massage and fell several times. She suggests that I try some gentle work.”

Beth’s tiny room in the assisted living community was beautifully decorated.

 After assessing the amount of space around the bed, and deciding on positioning strategies I helped Beth into her bed, and on to her side.

 As I gently touched Beth’s back I was astonished at the sensitivity of her muscle tissue and tendons. Her body was like touching water and the slightest touch seemed to cause her internal structures to roll back and forth as well as in and out.

After a while I had Beth turn onto her back to work with her legs, feet and head. Using any pressure at all, on her right side, initiated a nerve response that caused her body to jump. I worked gently, slowly, and with caution. Beth slept deeply throughout the session.

 I called Beth the next day and left a message. I called a second time several days later. Beth explained that she had been in the hospital. Her doctors had discovered the brain stimulator was causing too much stimulation. It had to be adjusted.

She also explained that she had deeply relaxed during our session and would call me again.

 Recognizing one’s scope of practice; owning the responsibility to gather information, and knowing when to say no, is the professional integrity that must be honored during the growth of this field of massage.

I look forward to your input on this  important issue.

Blessings

Irene Smith www.everflowing.org

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 Sunday August 22,2004 I came out of my shower, went into my bedroom ,layed on top of the bed to relax and looked out to the tops of the trees from my 3rd floor attic apartment.

I sat in utter amazement and wondered what it meant. After about two minutes it flew away.

 I immediately got my animal spirits book and looked up hawk. A Native American omen of healing, rebirth, and a sign that I should be alert to what is coming ahead. The eagle is the messenger to God who takes our prayers to Heaven. I knew I was being given a very important message but I wasn’t clear what it was.

 I emailed a good friend in Arizona and related the event.

I look forward to your stories of vision and spirit.

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One day my hospice client, Edna, asked me to just get into the bed and hold her. Edna had bone cancer and was in a great deal of pain.

I sat by the bedside and froze.I told her I couldn’t do that. She asked me again, “Just hold me.” She said, “I’m in so much pain.” I told her again I couldn’t do that.

Feelings of discomfort, shame and guilt flooded over me and I was relieved when the session was over.

 That evening I called the care manager and talked to her about my experience.

 For the next couple of weeks I felt uncomfortable seeing Edna. I was however, deeply exploring my feelings surrounding her request.

Right before Edna died I had worked with my feelings of fear to the degree that I was able to meet her need.

 I got into the bed, positioned her head on a pillow in my lap and stroked her hair, her face and her shoulders until she fell asleep.

 How wonderful it felt to let go of how I thought professional was suppose to look and answer a call of the heart.

Confronting my fear of intimacy as a professional has been an ongoing challenge in this field. Being an intimate professional is not easy.

I look forward to your discussion of this topic. Please share your stories.

Blessings

Irene Smith

www.everflowing.org \

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