She didn’t look like she needed to be in bed. But there she sat, texting on her cell phone, fully dressed in country club attire. Sharon, in her late 70’s, had piercing blue eyes, a healthy tan and a megawatt smile. When I introduced myself as her massage therapist, she threw her head back and laughed. “This place just keeps getting better and better,” she said.
Sharon’s multiple myeloma first came to light when she suffered a spontaneous fracture. She was proud to tell me that this occurred on the putting green where she had just collected first prize in a golf tournament several months prior. But once the diagnoses was made, it all made sense: the pain she had attributed to activity, her failing eyesight, the bruises that appeared out of nowhere. Treatments took a toll, but Sharon’s attitude toward hospice was optimistic. She told me she’d come to the inpatient unit to “feel better” so that she could return home and “resume life.” Her oldest daughter shared that a fulltime caregiver had been hired to assist Sharon back at home. But the woman I met that Wednesday did not appear to need a lot of help.
Sharon shared at our first visit that she had loved deep tissue massage prior to her cancer diagnosis. We had a brief conversation about the ways that massage would need to be adapted for her compromised bone health. Her primary complaint that day was back pain, and she wished to remain upright on the edge of the bed in order for me to access her back with lotion. After five to ten minutes of level 2 pressure Swedish, I gently coaxed Sharon into a more supported supine position, with the head of the bed slightly elevated and pillows under her head, arms and knees. Sharon smiled as she attempted to drift off to sleep, but her massage was repeatedly interrupted by visitors and phone calls. She commented with a twinkle in her eye that she was “standing up lots of people” with whom she’d scheduled meetings and social engagements. “People won’t believe I’m here, in hospice,” she said. I asked whether she would like to put a Do Not Disturb sign on the door and she gratefully said “yes.” But she chose to leave her phone on, “in case someone needs to reach me.”
I returned to Sharon’s room two days later on a Friday for her second massage. She was sitting on the balcony of her room, visiting with her daughter. She still looked amazing, but shared that she’d had “a rough night” with extreme pain that did not allow for much sleep. I asked whether the medical team was aware and she said yes, that they were working to get her more comfortable. She requested to delay her massage that day until the new pain medications had been started. I observed that her bare feet (on a chilly day) did not reach the concrete below her chair. I brought a folded blanket to place under her feet, covering them with the top fold.
Later in the afternoon, the staff texted me to say that Sharon was in bed, medicated and comfortable. I entered her room and she opened her eyes. She winked at me and said “You’re just in time.” Sharon was lying on her left side and close to falling asleep. “Do whatever you can in this position,” she said, “I’m too comfortable to move.” The nurse had already place a pillow under her top leg and another under her top arm, but I didn’t like the way her top foot was dangling; I placed a third pillow under her foot so that her spine was in perfect alignment. I worked over Sharon’s pajamas in a side-lying position. The session involved gentle caress to her head, followed by light compressions over her posterior torso that became slower and slower until I was simply holding her. I finished the session with a bit of Reiki. By then, Sharon was sleeping deeply.
I returned to the unit three days later on Monday. The medical team advised me that Sharon had suddenly declined that morning and that she now appeared to be imminently dying. Shocked to hear this, I approached her room to find two of her daughters weeping outside the door while the medical staff repositioned her. Sharon’s daughters hugged me and said, “We can’t believe it. Mom had a good weekend but she looks terrible today.” We had a brief conversation during which Sharon’s son-in-law arrived. I spoke with him, while the daughters went to meet with the chaplain. Given all of the activity both inside and outside the room, I asked Sharon’s son-in-law if a short massage would be helpful, acknowledging that the family might prefer privacy at this point. The son-in-law said “maybe not now,” and I quietly slipped away, assuming I might not get to see Sharon again.
Later in the afternoon, the RN entered the break room looking for a second staff person to help reposition Sharon. I offered to help, using a draw sheet to pull Sharon up in bed as I’d learned from our inpatient staff. Sharon’s daughters were alone with her and the atmosphere was peaceful and quiet, unlike the morning. I offered again to provide a brief massage, and this time the daughters accepted. “Mom loved the other massages you gave her,” they said. “She’d probably like that.” Sharon was lying supine at this point, with pillows under her head and knees. The color was drained from her skin, her face drooped, her breathing was noisy and congested, she was wearing a hospital gown, and had no resemblance to the woman I’d met the previous Wednesday. I applied a tiny bit of lotion to my hands and simply caressed her head and forehead while her daughters observed and told stories about their mom. The strokes, level 1 pressure and very slow, went from Sharon’s forehead to her posterior head and neck, down to the tops of her shoulders. I applied lotion to her left hand, while one of the daughters applied lotion to her right hand. I gloved and applied a thin layer of lubricating jelly (one of our standard supplies on the unit) to Sharon’s dry lips. There was laughter, and there were tears. The session lasted all of 10 minutes. Sharon died late that evening, with one of her daughters at her side.
Sharon’s story is unusual in that her decline was extremely rapid. But the story is worth sharing because it reflects the way that massage changes (in this case, a very short time) during the dying process. Massage begins with options for positioning, and the client as an active participant; often level 2 pressure and a session between 40 and 60 minutes. As the client’s condition changes, positioning is likely altered to accommodate growing discomfort and fatigue; pressure may stay at a 2 or less, with a shorter session and slower strokes. At the end, pressure will likely be a 1, and the session likely 10 minutes or less, focused on the upper triangle. As therapists, we need great sensitivity at this juncture. Time is limited and precious and belongs to the family to use as they need. A last session, if the family wants it at all, is so short and simple (one in which some of us might think we hardly “did anything”). But Sharon’s last session left a big impression on those two daughters, who wept as they said, “That was so loving and so beautiful.” Leaving a sample of lotion behind was a way to encourage them to keep touching their mother right up to the end.
What we do matters, to the clients, and to the loved ones who remember those last hours. In our work, less is more. Less time, less pressure, less “technique.” More presence, more stillness, more love.