Everflowing

The skill of letting go of a massage relationship when a client is dying is as important as the skill in the touching.

In early December I received a referral to see a woman with stage 4 cancer. She had a prognosis of less than 2 months.

She was a hospice client, at home being cared for by her family.

I was told the client was having a great deal of pain and depression.

The first time I visited Joan, her response to the massage was very strong. She loved the touch, the interaction, and the feeling of what she called floating.

When her family called to schedule a second appointment they explained that Joan had been energized for 3 days and had accomplished many tasks including planning a birthday party.

She wanted to have a gathering while she was still alive to share with her friends how much they had meant to her.

The family scheduled the massage for the morning of the party. They wanted Joan to be energized for her birthday.

When Joan’s brother picked me up early Saturday morning he was on the phone with a family member who was at Joan’s bedside.

Joan was having difficulty breathing. Her temperature was up and she was unable to speak. She had entered a different phase of her dying process.

The family was gathered around Joan’s bed, waiting for me to come hoping that the massage would energize Joan so she could have her party.

We started our journey to the house.

There were five family members sitting around the bed , all in individual states of suffering. I was given a seat at the head of the bed .

Joan ‘s breathing was like a fish out of water. She was actively dying.

I knew the family needed to see me touch their beloved

Silence became a dear friend as I sat and looked around the bed at each family member. Their love and openness provided my grounding as I took a long gentle breath and spoke to Joan.

I told her I had come to provide her a touch session.

Observing Joan’s body movement, I spoke to her breath,” easy breath, moving in and from the belly. So easy, so relaxed, so open .”

I spoke slowly and softly while gently touching the belly and the chest. I then spoke to the movement of the belly as it rounded and flattened .

“You are so loved, so safe. Nothing to do. Just love.”

Moment by moment the family began to soften expectations. With each phrase I looked around the room and made eye contact with a family member and took a breath.

Encouraging family to lay hands on their loved one, I told Joan goodbye and thanked her for the opportunity to witness so much love.

As I stood up someone took my seat. The circle was complete.

Joan died while the neighbor was taking me home.

This experience stands as a model for me. It was me at my most honest. Afraid yet still finding my voice and trusting my intuition.

This is a story I need to remember for times when I edit my intuition and just keep hanging on.

Blessings and Peace

Irene Smith

www.everflowing.org

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” I have a large tumor growing very fast in my pelvis. This tumor is my friend. It needs more space now and I want to relax and give this friend all the space it needs.”

I had not seen Ted in 14 years . As the Everflowing intern and I walked into his room I exhaled slowly.

With Ted’s permission, the intern and I sat on either side of the bed.

“May I touch this friend gently and introduce myself ? ” I asked .

” Yes please do, Irene.” Ted replied.

I held the tumor occupying the entire left side of Ted’s pelvis, as tenderly as possible. As I placed my hands gently around it Ted leaned his head back and took a long slow breath with an audible exhale.

” That feels good. It feels right.” Ted explained.

” When I was first diagnosed I was angry. I was hateful and violent. I tried to kill my tumor.

The chemotherapy did not stop it from growing. Now it wants more space. It wants space in my lungs. I’m going to die by the end of the week.

I don’t want to die feeling guilty for my violence. I want my tumor to know how sorry I am. I just want to open to this dear friend who has taught me so much. I want to give it the space it needs to continue its teaching.”

My intern and I sat in awe; my hands tenderly embracing this dear tumor as quietly and reverently as possible.

Ted Continued. ” I’m so sorry for my violent behavior. I want my tumor to know that. I want to be friends. I am grateful for all the gifts my tumor has brought forth for me.”

As I listened I was led to ask Ted if he had spoken directly to his tumor? He thought a minute and said no he had not.

I asked if he would like to dialogue out loud as I touched this dear friend.

Ted seemed excited and somewhat relieved to have this option.

The dialogue was an integration of Ted’s cancer and his heart. He asked his tumor for forgiveness for trying to kill it and then he forgave himself.

He thanked his tumor for the teaching of surrender and spoke of how expanded and open he felt .

He offered love and friendship to this great teacher and in words and postures leaned back farther and gave this friend all the space it needed to grow and express itself.

I was led to also lay my hand on Ted’s heart. As I held the heart and this massive growth I could feel the forgiveness of two friends coming together as one, I felt the pathway for union. I was led to speak.

I felt the love as it filtered from the heart, filling the pelvis. I felt the tumor breathe and take in the love. I spoke of this.

The magnitude of hope that was experienced, I will cherish and hold sacred forever…

We all experienced tears as quiet, intimate expressions of joy. The joy of pure innocence.

Ted died five days later. I hear it was a death of pure peace. As Ted laid his head back, I am told, he smiled.

I am blessed to have witnessed this depth of compassion and to have spent another year in my chosen field. Another year of living with extraordinary hope. I am feeling deep gratitude.

Blessings Irene Smith

www.everflowing.org

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It was Halloween night when I first tried to post this. The spooks were up to tricks and it took a couple of days to publish. So here it is. In honor of the dead I post this song I wrote in 1995.

Deep in the forest there’s a circle of redwoods

with a ring of oak benches all in memory.

Each one is standing for a life somehow ended

and there in the center a bench waits for me.

One day while strolling through the forest unattended

I happened upon this magical place.

So now I do frequently visit my friends there

perform all my fantasies ,

and leave not a trace.

As I step to the stump they placed there for speaking

I gaze over the benches into faces I knew.

I’m always kindly greeted , dearly loved, and received there

and always applauded, no matter what I do.

When performance is over

we sing , dance, and laugh loud

and each one does kiss me

to show me how they care.

Then I’m left sitting in a ring of oak benches

with the wealth of my memories

and the times that we shared.

I encourage you to write a poem or song in remembrance of someone in your life who has died. Your memories are a treasure. Please share them with me.

Blessings Irene Smith

www.everflowing.org

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As hospice massage practitioners how do we measure the outcome of a session? Where are the guidelines for assessing our value during a session when the client is non-verbal and appears detached from the touching? Is an energetic or emotional connection to the touch necessary for a positive outcome?

Does our value with a client include supportive interaction with the caregivers onsite? If we are contracted for a specific amount of time how challenging is it to re-evaluate the session and what criteria do we use in the re-evaluation?

These are questions I ask myself frequently; however, I currently provide massage for a client who is especially bringing these questions to the forefront.

My client has advanced Parkinson’s Disease.

During the first few months of seeing this client the touch sessions elicited verbal gratitude at times, a calming of tremor activity at times, and modeled strategies for supportive touch that could be incorporated by the caregivers at the bedside.

As the disease has progressed the verbal gratitude has faded. For periods of time now, the touch elicits responses of deeper breathing, relaxed sighing, a circulation response of pinker skin, and at times a pleasurable response to the social interaction such as a validating smile. These have been measurable outcomes and clear signals that the sessions are beneficial.

Now with little eye contact, minimal verbal gratitude, and with sensitive skin conditions contraindicating major areas of the body, I am left to establish new criteria for evaluating the value of our sessions.

This has always been a challenge in hospice massage. I am however, usually capable of finding that place where I’m confident in my assessment of positive and negative non-verbal indicators for evaluating the comfort of the client in respect to the touch.

This time I’m left wondering.

When I walk into the client’s room and she is in a state of rest and quiet, although the eyes may be open, do I interface with the current meditative state and present touch? Is this contributing? Is the addition of touch valuable?

There are windows in our sessions where the body seems to expand to receive the touch, or the rhythm and tone that is being established through the touching. The window of discernable positive response by the body might be 15 minutes during an hour session.

The window may come at the beginning or in the middle of the session. How long do I wait for this window? Is a window needed? Or is it simply a given that the presence of touch during times of advanced illness and vulnerability is welcome?

In our last visit the window appeared towards the end of the session. It was as if the body inhaled the rhythm of the touching, and the response was deep relaxation. This lasted for about 15 minutes. My intuition suggested that I bring closure to the session when my client started to resurface by opening her eyes. Stuck in an expectation however, of what the time factor is supposed to look like I searched for another opening.

In the past when I have known a client had a history of wanting touch in his or her life before their illness I may assume that touch at the bedside, unless a negative response occurs, is a positive strategy. But what if a client has a history before their illness, of not wanting to be touched?

Sometimes staying within my professional integrity is all I have as a measurable outcome. It demands my constant attention. Did I follow my intuition? Was the comfort of my client the highest priority at all times? Was I honest in my actions? Am I listening with my heart as well as with my experience? Am I willing to say I don’t know? These are the questions that I am asking myself today.

I look forward to your sharing and comments.

Blessings,

Irene smith

www.everflowing.org

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A Lost Pause

Coming to the check out in the grocery store the checker says, ” paper or plastic.” It sounds like morse code. I ask him, ” what?” He states it again louder. I still think he’s speaking a foreign language. I again ask “what? ” This time the checker is really agitated and yells, ” paper or plastic.” I simply say, ” paper.” I am left in shock.

During my last Everflowing intensive one of the participants asked me why I was pausing after I, or someone else, spoke. This issue continued to be a point of discussion throughout the class. At times it became a joke. Guidelines of listening without verbal response, and allowing a pause for personal reflection after someone spoke, were continually misunderstood and uncomfortable for some participants.

Last weekend I was teaching and I paused to take a breath. A participant called out my previous sentence, thinking I had forgotten what I was saying.

Many times the first day or more of my courses is spent teaching the skill of listening to one’s self or, the pause, eye contact, and the concept of an exhale that does not have verbal information along with it.

The exhale seems to be considered a technique, and questions as to how and why to pause and exhale, are asked over and over again.

Personal reflection, listening to the texture of the body, and responding to the emotion of bonding all require us as practitioners to be quiet, breathe and listen to ourselves. This process also allows the person we are with, a moment[ the pause] to hear themselves in order to fully receive the action that has already been provided.

The pause is the space where trust deepens, this is the space where bonding takes place, the place of integration.

This is the empty space in a tea cup. The space that allows the cup to be filled. The empty space is in fact the most valuable space for without it there are no possibilities.

In a world where everyone has something in their ears, looking down at something else while performing a task that is totally unrelated to the previous two actions, humans have learned a digital form of being that has no organic relationship to human communication. There is simply no space to fully respond to the initial action.. The space is filled. Actions remain surface stimuli bouncing towards a target over and over and over, with no space in between.

The result seems to be agitation. More and more children as well as adults are being diagnosed with nervous disorders.

Human communication is about listening and interacting with the reflections of ourselves that come forward in the silence… in the pause.

The massage profession is reaching far and wide, taking its place in the world and seeing it’s potential.

We must, as the voices in this profession, remind, or actually teach practitioners that touch is not something we do to someone else. It’s an action that we involve ourselves in. Touch requires listening, and the willingness to recognize and respond to the bonding factor in the tactile relationship.

Bonding is the core element in the act and texture of tactile communication. It is a complex action, due to the emotional component, that requires space for trust, response, union, and then separation before moving on to the next touch, otherwise the result is confusion.

.No matter how unfashionable, the process of skillful touching requires [The Pause ]

Blessings

Irene Smith

www.everflowing.org

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Beyond Massage.

How as touch professionals can we acknowledge the consciousness and vulnerability of the body we are touching.

As healers we would never rush the healing of trauma with a child who has seen a parent abused. Why would we expect the body to hurry? How can the feelings[ the emotion underneath the pain or resistance] of any wounded part of the body be validated?

Recently I was called to work with a dear friend two weeks after his triple by pass surgery.

The trauma was very present and the vulnerability filled the room. As I sat and listened to the details of the surgery I was deeply moved by the surface trauma, with the underlying waves of trauma and the body’s grief waiting to be acknowledged.

My questions to myself were, am I tender enough? Am I honest enough? Am I vulnerable enough, to hold space for this grief.

To lay hands on such fresh trauma demands that I realize I am to do nothing. I am only there to witness and provide a resting place; a blanket of trust allowing the body to exhale in it’s own time.

Our sessions took many forms from this resting place..

We verbally honored each body part that had been involved.

Honoring the grief of the ribs that could not protect the heart from exposure. The chest, cut open without its permission. The arms that could not cover the chest in protection.

Such deep sadness in not being allowed to fulfill their missions. A need to be recognized; a need to be forgiven.

The profound empathy and gratitude expressed to these wounded servants was as vulnerable and deep as the sadness..

Into the third month of recovery my friend made the move to driving. I remember the visit as he described the arms so tentative to take the steering wheel. It required deep understanding and patience to be present as the arms left their place at his sides, their place of protecting the ribs throughout the healing process.

We held space for the right arm to develop enough trust to slowly release into a resting place. In this session I simply supported the arm and breathed for over an hour, validating the unfolding of the arm verbally as each cell began to trust the other, trusting the texture of the touch, and trusting my friend.

I will never forget the chest as it swelled with an inhale, one rib at a time. A wave of trust expanding as the arm took refuge in being fully supported and validated.

In a later session we held space for this arm for over two hours. Just trusting the breath, trusting the arm, trusting ourselves.

The arm trusting that, if it released it would have a place to rest without expectations of any certain function; supported, validated and confirmed for the profound mission it had preformed

This awareness beyond massage is where my intention lies. Im interested in how I can be present to honor and validate this consciousness with the full spectrum of feeling and emotion that it demands.

Blessings and Gratitude

Irene smith

www.everflowing.org

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www.everflowing.org

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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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