Everflowing

I received an email from a practitioner who has recently been contracted to provide massage for hospice clients. He has no training in adapting massage to this population and therefore has contacted me. His availability for training however is several months behind the beginning of his new venture.

He shared today that he had gone to his first client and the client had declined massage. It seems that the physician had been the referring agent and had not received the confirmation from his patient. He had only suggested it.

In the Everflowing “Providing Massage In Hospice Care” instructional manual I have a full chapter on how, and from whom, to gather information. Let’s cover just a few basics about taking hospice referrals.

The Home-Based Client

1. This initial phone call is your opportunity to acquire information about the prospective
client. The initial intake should include:

• client name, address, phone number
• primary diagnosis
• with whom the client lives
• phone numbers of other team members (case manager, nurse, etc.)
• the client’s physical and attitudinal symptoms
• the goal plan for massage
• how to invoice for payment

In the case of a physician referral, contact the care manager for invoice information

2. Call the client to confirm the interest. If the client is not alert confirm with the attendant or family member.

The referral agent may not have all the information you need.
You will then follow up with the appropriate calls.

3. If a home care nurse is involved, I suggest calling the nurse to follow up on the initial information concerning the client’s physical symptoms. Ask for the following information:

- medication considerations
- site and/or position restrictions
- other special precautions
- goal plan for the session
- anything else they feel you should know

This information will allow you to assess if your scope of practice is appropriate for the referral.
Sometimes this information will be included in the initial phone call however, I suggest checking in with the nurse if appropriate, to introduce yourself, explain your scope of practice, and ask if he/she has any questions for you.

4. A case manager is the team member who can give you information on relationships within
a home setting. If your prospective client is living with family members, I suggest you call
the case worker to acquire clear information on what to expect within the dynamics of the home so you may establish appropriate boundaries. If your client is experiencing difficult psychological
behaviors, the case worker may also give you very important information on establishing trust
with your client.

• If you choose to see the prospective client and the client is home based you will call the on site attendant to gather information concerning the client’s schedule and the environment:

- What time of day is the client’s energy best suited for massage?
- What are the client’s movement restrictions?
- When is a health care attendant on-site?
- What equipment is available, such as a wheel chair, recliner, or hospital bed?
- Are there extra sheets, a blanket, 2 or 3 bed pillows, extra towels?
- Can the client use a massage table? Is there room for a table? Are there stairs? Is there
parking on-site?

Knowing what team member to ask what questions can save a lot of confusion, time, and energy.

For more information on this topic check out the Providing Massage in Hospice Care instructional manual in the Everflowing resource center at www.everflowing.org.

Blessings,
Irene Smith

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“The healing from touch is reciprocal.” This is one of the truths that has kept me in the field for 30 years. This is what I teach and know in my body, and heart. Receptivity to touching however is not always the loudest voice rolling through for me.

Recently, when asked to speak about receptivity to touch, I found myself in an interesting situation with a client that brought a lot of information forward for me.

Evelyn was in the hallway of the nursing home when I arrived. I went into the room and gathered my props for our session including my fold- up stool. Once back in the hallway I set the stool up next to Evelyn’s wheel chair. It was a day for neck and shoulders so I propped one of my feet up on the stool and this allowed me to come very close to the side of the chair. I was leaning against the chair and one of my arms was around Evelyn’s shoulders. My other hand was on Evelyn’s arm that was resting on the chair. This is a very comfortable, friendly position for me.

I began to stroke the opposite shoulder and the upper back. Evelyn brought her body close to the side of the chair and leaned her head onto my knee. Her arms held onto my calf.

This was comfortable. It felt intimate, yet safe..

Then Evelyn started to stroke slowly down my calf; first with one hand, and then the other. I received this with gratitude at first then watched as my mind drifted into the fear zone. My thoughts turned to, “Oh no, I hope no one is watching.”

I gave no outward signs of my mental discomfort.

“I want this to feel good for you too”, she said.

My mind grasped onto embarrassment. I wanted to end the session; tell Evelyn to not do that, and at the same time I noticed my body was receiving and trusting.

I had the opportunity to observe these two distinct factors in my ability to receive during the session.

I  wanted to simply receive the touching with the vulnerability in which it was being delivered. I wanted to honor the innocence, and the bonding in the relationship.

I left the session feeling dishonest in my receptivity to Evelyn’s touch. My receptivity to my own process however, left me grateful. I had not shut down to myself and had stayed fully awake as an observer.

Touch has been so sexualized and exploited in our culture that it can be an intense challenge to recognize and receive the innocence of  bonding  in the act of touching.

 Being receptive to the intimacy that develops when tenderly touching the dying, is an on going process for me in how to retain my humanness as a touch professional.

I would love to hear your stories and experiences in this area.

Blessings

Irene Smith www.everflowing.org

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Photo: Pathways Hospice Fundraiser. From left to right, unknown, Holly Smith-Pathways Director, Ken Ross, Irene Smith, Stan Goldberg. 

Being immersed  in the hospice community in San Francisco California I forget that most of what I have the opportunity to be involved with is worth writing about.

September and October have been very exciting .

A couple of weeks ago I attended the book signing for ” Last Acts of Kindness“, a new book by Judith Redwing Keyssar. Redwing  is Director of Palliative Care at the Jewish Family and Home Services of the San Francisco Bay Area. I have had the opportunity of providing touch training for her volunteers for several years.

This was a special event combining stories read by Redwing and multimedia, integrating music and the faces of past clients… “Last Acts of Kindness” is a collection of stories and shared wisdom from Redwing’s personal archives of wisdom from thirty years of working with the dying.

On The 7th of October I had the opportunity of being escorted by author of “Lessons For The Living”, Stan Goldberg, to the annual fund raising breakfast for Pathways Hospice. The event was an award breakfast honoring the late Dr. Elisabeth Kubler- Ross as the major inspiration for the first prison hospice in the world in Vacaville California, founded in 1992. The hospice is named after the late Robert Evans Alexander, a community volunteer in the prison’s AIDS unit from 1985 to 1992

Having been the first volunteer at the prison from 1984  to 1986, for persons with AIDS, I was given honorable mention.

Elisabeth’s son, and Director of the Elisabeth Kubler Ross Foundation, Ken Ross, was the presenter. His presentation was a testimony to not only his research into his mother’s work but also his undying devotion to keeping Elisabeth’s work alive.

He told deeply moving stories of Elisabeth’s blazing spirit that I had not heard, and the clips of her on Oprah brought tears to my eyes as well as many others in the room.

Elisabeth’s passion and spirit are missed. She is a part of hospice history that needs to be kept alive. She is the spirit, and one of the  original voices for care for the dying.

The  most personal experience, in terms of l growth happened on October 10th when I gave a one- hour teleconference as part of a six- week home based practice for the Metta Institute. The six- week practice was based on Jon Kabat  Zin’s book “Coming To Our Senses”, a book for healing ourselves and the planet through mindfulness.

I was asked to give a talk to introduce the fifth week on the sense of touch. The topics were: Knowing the Body in the Body, Touching with Love, Touching the Heart, Touching the Earth and Touching Each Other. Having the opportunity to speak from my personal touchscape was a step in my growth that was fun, creative and exciting.

I was hosted by long- time friend and colleague David Palmer, the Father of chair massage. I loved the medium and am planning to record a series of conversations on touch. I’ll keep you posted.

Last there is an article in the Huffington Post written by Marguerite Manteaurao, a Zen Hospice Project volunteer. I have had the opportunity of teaching in their volunteer training for 25 years.The article is about ten strategies for touching the dying that Marguerite learned in my ninety minute touch training.

So life in the San Francisco hospice community flows on and after three decades I am still honored and excited to be a part of it .

Please write me and let me know what’s happening in your hospice community, and if you like this blog style for a change.

Blessings, Irene Smith

www.everflowing.org

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Listening has been a point of interest and study for me over the past few months. As I more clearly define my touch practice with the dying I become more deeply aware of how I have embodied listening skills ; however  never defined them as such.

Cultivating trust with a client depends largely on one’s ability to listen and being available to the information received.

Research studies by the International Listening Association report that we spend about 45 percent of our time listening, but we are distracted, preoccupied, or forgetful about 75 percent of that time. The average attention span for adults is about 22 seconds. Immediately after listening to someone talk, we usually recall only about half of what we’ve heard; within a few hours, only about 20 percent.

As caregivers developing our listening skills is vital to hearing, understanding, and attending to the needs of those in our care as well as listening to and responding to our own needs .

In my research of listening I ran across the following description from “Slowing Down to the Speed of Love” by Joe Bailey.

“Deep listening occurs when your mind is quiet. Your thoughts are flowing rather than crowding your mind with distractions, interpretations, judgments, conclusions, or assumptions. Your mind is open, curious, interested — as though you were hearing this person for the first time. Deep listening applies not only to communication with another, but also to listening to ourselves and to life in general.

The goal of deep listening is to hear beyond the words of the other person and yourself, to the essence of what the words and feelings are pointing to. Your mind and heart are joined in union….. you are listening wholeheartedly.

Deep listening is effortless; it is more like listening lightly to your favorite music, the sound of a stream rushing by, or a bird singing. When we listen to these delightful sounds we are under no pressure, we aren’t analyzing or figuring out — we are simply letting the feelings and sounds affect us.

Deep listening is not defensive, argumentative, or intrusive. It is not about struggling to interpret. It is a purely receptive state of mind. In a state of deep listening, we realize our oneness. We realize that we are not separate, but truly one spirit — we are connected.

The goal of deep listening is to be touched by the other person and to hear the essence of what he or she is saying. Deep listening is based on a feeling of unconditional love and respect. It stems from our natural Self, from timeless love. In addition, it slows us down to the speed of love”

Blessings Irene Smith

www.everflowing.org

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As I walked down the hallway to Lisa’s room, I felt gratitude to see her and to have a gift to offer. I also felt gratitude that hospitals feel familiar and for having skills and experience that allow me to serve.

Lisa and I have been friends for 30 years. She’s been living with cancer much of that time. Recently she was moved from home into a nearby hospital for hip replacements and is now between surgeries.

Before entering the room I paused, took a breath, said hello at the door before pulling back the curtain and with permission entered. I was introduced to Lisa’s sister then excused myself, washed my hands, and sat and shared in some childhood history.

When Angela [the nurse] entered I introduced myself, explained that I had come to offer Lisa a touch session, and asked if there was any information that she felt I needed to know. With a short conversation about my professional touch background, Angela felt easy about the offering and I felt well informed.

When Lisa’s sister left I pulled my stool up to the bedside. As I was about to begin, a visitor named Jeannie came in and offered to leave to give us privacy but we invited her to stay and be a conscious presence in the room.

As I proceeded to tenderly stroke Lisa’s leg she went into deep relaxation enabling her nervous system to release tension through tiny jerks and twitches. The mouth relaxed and the jaw opened and closed in subtle movements. Her whole body responded as if a tight cord were unraveling .

Every once in a while I would include Jeannie with eye contact and we would share facial animation. Jeannie was moved with the depth of relaxation she was witnessing.

Feeling Lisa’s upper body calling me, I moved to her shoulder and simply began to pet her oh so slowly . Just letting her chest and shoulder know they were safe; they were noticed. In it’s own right it was an embrace, an intimate expression of my affection without needing Lisa to respond.

Lisa drifted into a deep sleep. Her arms responded by raising slightly; a subtle dance of release.

Finished, I sat and breathed for 3 or 4 minutes to allow integration of the session before stating that I was going to wash my hands.

Perfect timing. The door opened and it was Angela to take vitals, then someone from the kitchen to remove the tray.

I said goodbye. Jeannie and I hugged and acknowledged our intimate experience in silence. As I left, she took her place at the bedside.

As I walked to the elevator I once again felt gratitude for the skills to be of service to my friends in such an intimate way. It seems that all the years of professional practice have been so I can simply participate in my life fully. Lisa is one of two 30-year friends now in advanced stages of illness.

Do you feel more equipped to be with your ill friends and family because of your chosen field? Are you using your skills professionally or as a skilled friend?

I’d really like to hear from you!

Blessings and Gratitude

Irene Smith

www.everflowing.org

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Last week while preparing for a presentation on listening, I leaned back in my chair at the computer wondering what story I could tell about listening deeply. Not just involuntary hearing but truly listening to the meaning of the words. Listening with my heart as well as my ears.

My heart burst open and I started to cry. I heard my mother say “I made soup.

“My mother had severe crippling arthritis, scoliosis and heart disease. Her physician was an osteopath and she combined acupuncture, herbs, supplements and homeopathic medicine in her health care. She never went to the hospital .She would simply stay in bed for days at a time.

Cooking was very painful for mother so friends would bring food or take her out to eat most of the time. This was her program for the last 20 years of her life.

 In her last few months every time mother called me she would say “honey, I made vegetable soup. It’s so good!”

My response was always , “Great Mom.” I actually remember being somewhat bored by these conversations and not really interested in her soup.

I harbored a well of anger with my mother and didn’t work through that before she died. It clouded all our communication.

Last week, 16 years later I got it. “I Made Soup”meant, honey I’m out of bed today; Im feeling strong and I was able to cut vegetables. It’s a glorious day!”

 ” I Made Soup” was a statement of mother’s courage and independence and her ability to push through her suffering .

  Deep Listening is a practice and a philosophy developed by Pauline Oliveros. It is said in this practice that listening deeply requires the temporary suspension of judgment and a willingness to receive new information. It is a process of learning.

 Truly listening allows us to not only hear what someone says and, what they think, but allows us the understanding of what it means to them and why it matters. There is perhaps no greater way to show our respect than to truly listen to someone.

Many blessings and please share your listening stories . Your stories mean so much to the community.

 Irene smithwww.everflowing.org

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Over the years I have been blessed three times by the appearance of very large birds perching on the back deck of my attic apartment. Each time the sudden shadow of large wings has occurred during my morning yoga.

This morning my deck was shaded by the shadow of wings. I focused and held my breath as these wings slowly grounded a large crane onto the deck’s thin wooden railing twenty feet from me.

This magnificent being became completely still as time stopped to allow me the visual impression of extraordinary elegance and ease.

With its long neck  stretched out, the head moved in slow motion to survey the terrain in all directions.

Then the gaze settled directly into my bedroom.

 We made eye contact. I did not move. I shifted my breath into my pelvic floor and held the trunk of my body in total stillness. The moment seemed endless. There was only the mirror of gazing into a river held motionless in time.

 Then I felt my arms rise over my head in prayer position, then lower to my chest with head bowed. I am so blessed to have this omen, this physical presence of peace before me.

As this spirit departed, wings once again sheltered my deck. I went to the door and watched as the physical presence of this magnificent bird soared beyond the trees in the distance.

As in the past I looked up crane /or egret in my animal spirits book. The native meaning is peace, harmony, good luck, and/or the end of conflict.

This is a time of great change for me…a time of letting go of struggling in my life and opening to a greater depth of surrender. I am ever so grateful to the universe for this beautifully orchestrated symbol of being on a path of greater harmony.

 I express my gratitude for the wisdom to hear spirit.

 Please do share your spirit stories.

Blessings Irene smith www.everflowing.org

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A Comma Problem

Blogging has become much too serious. I joined this format so I could share my passion and wisdom late at night when the creativity and time to share comes around.

The world however wants perfection. My passion runs wild . So wild that I have been informed that I need an editor for everything.

Last week while posting a paragraph on a forum I was told that I have a COMMA PROBLEM. Yes, A COMMA PROBLEM. Also, that sometimes I have a SPACE PROBLEM.

It was my  former editor that was very seriously telling me this. At first I was serious as well. However, after a few moments of horror, I burst out laughing.

I doubt that on my death bed I will look at my angels and state’ If only I had fixed my comma problem.’

Is there no one out there that can hear me through the need for administrative perfection?

Is punctuation the beginning and end of it all? Doesn’t passion and, oh yes, experience ,mean anything?

By the time I  revise the post several times[ which can actually take a week] it has become work.

Oh yes, my posts are great but they have become stories, articles, edited paragraphs that delete the reason I want to blog. I have books, articles and stories. That’s work. I want more . I want spontaneity!!

So this feels like a post!

I’m pushing the button .!!!!!!!!!!!

Im begging for your compassion!

Can you accept my wisdom with a few space and comma problems?

I look forward to your comments

Blessings Irene Smith www.everflowing.org

The above blog post is in no way meant to discredit my current editor. She is a treasure and I am blessed with her support. Id be lost without her!!!!!!!!1    Irene smith

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Reading the Massage Magazine special issue on pain relief I am reflected into how working with pain differs in my hospice massage practice from more traditional modalities.

A couple of months ago I was working with an intern at an inpatient hospice. We went in to see a woman with cerebral palsy who was not on our list of referrals.

Sabrina had spent most of her life in hospital wards. Her body was a roadmap of surgeries and called out loudly for tenderness.

Sabrina spoke of her legs and back being in great pain. She continued to speak of her discomfort as I positioned myself sitting comfortably at the foot of her bed. As I slowly lifted the sheet to assess her right leg my heart shed a tear for the dwarfed limb that was exposed.

I cupped my hand around the thigh and softly spoke, ” I am honored to offer this limb some tenderness….I feel your leg loves the attention…. I’m so glad we’re here.”

While gently holding and tenderly petting this leg Sabrina replied, “If someone had done that years ago I might still be at home.“ I covered the leg as Sabrina asked me to touch her back.

Although she was in a lot of pain she requested that a nurse position her onto her side so I could touch the exact spot.

After positioning was completed I sat comfortably behind Sabrina on her bed, uncovered her back and with Sabrina’s permission I came very close. With one hand slipped under her head pillow as to hold her, I simply laid my other hand on her back and said, “Oh, I know you have been in pain for a long time. I’m so glad we’re here.” As I became comfortable I could feel Sabrina going to sleep.   Before the room fell  silent she expressed  her gratitude. Sabrina’s pain had been validated.

 After a couple of minutes I slowly removed my hand from underneath her pillow and changed places with my intern.

The Everflowing intention is never to remove pain from someone’s body. The intention is to validate and honor the symptomology that is being experienced, and to create an environment where the client’s anxiety about having pain can be eased.

We are in a culture that insists that pain is something we have to get rid of. We essentially make pain wrong therefore when pain appears we are afraid of it getting worse. We defend ourselves, and hold ourselves tightly. We want the pain to go away. This directs a profound degree of energy to the pain, and creates anxiety.

As an Everflowing practitioner, I want to create a resting place as I walk into a room or up to someone’s bed. A place of stillness first, and then a place of very gentle movement like a breeze or a soft wave of water as the tactile relationship begins. A place where there is no resistance. A vulnerable place.

This is achieved through slow body movement, slow speech, slow audible breathing, and a willingness to find my own place of physical comfort. I am just a witness.

This resting place, this alternative rhythm, eases a lot of tension in the room. The atmosphere appears to be more spacious. The client might experience a feeling of less pressure and find a greater level of comfort. .

If I can stay grounded and comfortable in body and mind then the static and resistance has been broken. The cycle has to reestablish itself. This change in the pain cycle can cause a decrease in the pressure being experienced by the client and give the client an alternative strategy for coping with the pain.

Pain is multidimensional when someone is dying and may be my client’s most familiar response to his or her condition. I cannot assume that alleviating it is the kindest strategy. I feel I must validate the existing relationship and give models for reestablishing a more compassionate communication with one’s self and one’s environment.

 This is the Everflowing approach to pain. I look forward to your sharing your approaches and stories.

 BlessingsIrene Smith Www.everflowing.org

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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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