Relating to the seriously ill and the dying through the intimacy of conscious touch differs in a number of ways, compared to massaging relatively healthy, mobile and active people. Hospice patients may be in shock from receiving a diagnosis of an incurable illness, or traumatized by the effects of various invasive procedures, such as chemotherapy, radiation therapy and drug therapy, and by the prospect of dying.
Almost every hospice patient will go through a number of emotional, as well as physical, ups and downs in the process of learning to accept his or her illness and impending death. The patient and the patient’s caregivers will be in various stages of acceptance, and each may have vastly different reactions, responses and strategies for coping.
While touch is important, many massage and bodywork techniques are not appropriate for those nearing death. Some are too stimulating. Other techniques are specifically suitable or adaptable to end-of-life care. In general, slower, gentler techniques aimed at calming and relaxing are best used on hospice patients.
Practitioners also must let go of specific goals and agendas with regard to massage, letting the patient and the situation set the tone, and make the decisions as to what kind and how much touch is most comforting.
In a private practice, you set up your work environment exactly the way you want it, from the height of your massage table to what scents are in the room, and what kind of music you play (or don’t play) during a session. In working with hospice patients, you not only have no control over the environment (which can range from chaotic to serene), you may well be working in a space fraught with tension. The people you encounter may be traumatized, confused, angry, overwhelmed and/or in despair.
In hospice work, you may be massaging people connected to various kinds of medical apparatus and devices, such as oxygen tanks, catheters, feeding or IV tubes, and monitoring equipment. It may be necessary to work around narcotic patches, diapers, bandages and so on. The person you are massaging may be weak, confused or disoriented.
Touch is a powerful catalyst in releasing emotions. As a person nears death, he or she is often in a fragile, vulnerable state. Your client may react to touch differently at this time than he or she has at other times. A person may respond to attentive touch by letting go of long-denied feelings, releasing tears, or by talking about things he or she has been unable to discuss with family members. Thus, communication skills, such as active listening and acknowledgement, become an important aspect of working with the dying. Listening without interruption or evaluation—simply being there—is a significant gift.As a person nears death, the simplest physical contact assures the person that he or she is not alone.
Massage sessions with hospice patients are often shorter in duration than sessions with other clients. What feels good to a patient one day may be inappropriate or intolerable on the next visit. At some point, the person will no longer be able to carry on a conversation, or may simply lose the desire to communicate through words. It then becomes even more important to proceed intuitively, scanning carefully for nonverbal cues as you work, and to touch with caution and sensitivity.
As a massage therapist working with hospice patients, you will encounter situations that simply do not occur with other types of clients. You may need to hold a container while a patient vomits, you may be called upon to help change a diaper or to aspirate a mouth full of saliva in the middle of your session. You may need to stop whatever you are doing and just hold a patient or a caregiver while he or she screams or cries. You may be tempted to run out of the room, screaming or crying yourself. You may be the only person present when your client takes his or her last breath. You must learn to notice your own reactions or feelings, and be willing to set them aside (to be examined in more detail and processed later) in order to remain present with the person who is dying.