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January 30, 2012

Palliative Massage

I had a patient on my list in the cancer and palliative care ward, her diagnosis: anemia. I checked prior level of function and her lab values - she was dependent in bed mobility. As a PT intervention, I can perform range of motion exercises, teach her rolling skills so that she may assist her caregivers, maybe sit her on the edge of the bed to improve stamina and trunk control for sitting unsupported, a necessary precursor to walking.

The patient was lying in bed, sleeping, her breathing loud and labored. Her husband was there and seemed to shrink into the corner when I arrived. Something struck me as NOT right here. My instincts said, "let her rest," so I went to speak with the nurse to get the scoop on why a patient who might be weakened by anemia sounded so bad. The nurse simply stated that the patient was usually agitated and thrashing against her covers, that this was the calmest she had been in a while. I kept trying to glean from the nurse whether I should leave her be and let her rest, but the nurse wouldn't say. She did jump to action, however, when I mentioned the patient's breathing seemed labored. I wrote my note, deferring treatment to let the patient rest.

Back at the nurse station, I got the full story from the Hospice nurse. It's a torturous history: loss of a daughter to leukemia, then a grandson in a car accident, then the diagnosis of ovarian cancer just days preceding the death of her father. This poor woman, who for all appearances looked healthy except for the labored breathing and her forgotten husband in the corner of the room, deserved some respite. As my instincts had told me, something, indeed, was NOT right. And then the Hospice nurse suggested the obvious, something to soothe the patient: massage.

I entered the room and encountered the husband gently cleaning his wife and changing the bed pad. She was awake now and moaning. I jumped in to assist him, holding her steady, soothing her as best I could. He gently cradled her to roll her again to clean her other side, I taught him what strategies I knew. And when we were finished, I performed massage on her arms and legs. She remained calm during this time, exhibiting Cheyne-Stokes breathing. She stopped breathing for what seemed like forever, then a breath, then a second, a modest pause and then a third. I said to her, "keep breathing," praying, "God, don't let her die on me." Her husband hugged the corner, almost shyly, watching from across the room.

As well intentioned as my ministrations were, I felt like an intruder. This should be his time with her, and if she was going to die, it was not my place to be there. She stopped breathing again, but then resumed, a pattern emerging that so long as it didn't change, I could stay and finish my work. I left the lotion for him, and began to rearrange furniture. I put the chair by the bed: "sit." I had him hold her hand, and I began to work on him: shoulders, neck, scapulae, paraspinal musculature. In all this, I wondered, who might be taking care of him?

This was a risk I took. This was possibly outside of my scope of practice and certainly not a billable service, working on the family member of a patient. But I believe it was the right thing to do. I'll work late to make up the time, reporting that I was on break time, if it becomes an issue. But I told no one (until now*). Only his wife, who cried out and flung her arm wide, may know of my attempt to lend her spouse some small strength for the final hours of her life. This tragedy is not hers alone; he, too has lost a daughter, a grandson, his second father, and now his best friend and life companion as he watches on helpless to do anything. Could anyone begrudge this man a human kindness at such a critical time?

*So why mention it at all? Am I such an ego maniac? Well, it turns out that looking into the face of death is quite weighty, and since I don't have a psychologist on retainer, I've decided to talk it our here, with my 8 faithful readers. :-)

I guess all this dying reminds me of my father. There must still be unresolved issues, mostly guilt. As my mother gets older, I dread the anticipation of her passing. Death makes me take stock of my life, my actions and thoughts. And while I've done the best I can to lead an interesting life so that I may have fond memories to look back upon, at a time like this I turn morose.

There have been so many things in the callowness of youth, the stupid things I have done and the lame arguments in an attempt explain my actions. Even now, as I attempt to move toward wisdom, I cringe at my vagaries and childishness.

I try to approach my life and other people with a smile, because, after all, who wants to hang around with someone who's a drag. In this attempt, do I come off as a frivolous fool? Unfortunately, those closest to me rarely get the best of myself. They get the darker more introverted self, "the real me," and that can be a real drag.

And so, in the face of death, a very emotional meeting, I must balance the self-chastiser with forgiveness for the learner who is just trying to figure out how to muddle through this world as best she can. Maybe I'm not alone in this, and so I share.

Posted by linda at January 30, 2012 7:50 AM

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