Listening is our bridge to the deeper wisdom in a massage session with a hospice client. Entering into a hospice client’s space requires the practitioner to integrate into the existing experience. This requires the practitioner to pause, listen and observe the activity already in motion. This pause involves observing the environment and noting any obvious changes to the clients comfort care such as bed positioning or client positioning, Is there any new equipment by the bedside? What is the clients overall demeanor, skin tone, body animation? Are there sounds; labored breathing or moans? After a verbal intake from caregivers, this visual assessment, even before entering the client’s immediate space, gives the practitioner current information about what is happening in that moment.
There may also be other support team members in the space. This is a common occurrence in hospice massage. The hospice massage practitioner is not the primary support as in other massage practice environments. In hospice massage the practitioner is a part of a greater support team. Although I may have an appointment I must take a seat at the larger table and integrate my piece of support with the wider care plan. The pause allows me to sense and feel the dynamics already present in the client’s space and assess how I might enter into the current dynamic without a sense of intrusion This might include speaking softer than usual moving slower or saying hello to a number of other visitors or team members before saying hello to my client or introducing myself to a new client. I may also need to sit while conversations or activities are completed or need to simply wait outside the room. There may be several layers of activity happening besides my appointment.
The pause also allows the practitioner a moment to adjust his/her level of receptivity to the physical pain and emotional stress that may be present in a dying person’s space. There are many layers of pain involved with the dying process. The client may be experiencing physical pain as well as depression and unimaginable grief in regards to leaving loved ones, the loss of one’s personal identity, regrets and all that one might process in reflection of one’s life journey. Others in the room, including the professional caregivers, will all be in various stages of grief and grieving in their own unique ways. Everyone experiences grief differently. Feelings may vary from anger, fear, and resentment to deep sadness and withdrawal. Attitudes such as mistrust, defensiveness, aloofness, chaotic humor, or the inability to process any new information, including my name and why I am there, may be exhibited as byproducts of grief. The room is already full. There may be no receptivity to input. To walk gently and slowly and speak softly is in honor of the unknown and / or the unseen and unspoken. This is the silent dialogue we must pause and listen to.
The second level to this silent dialogue is that of the practitioner observing his/her responses to these dialogues and listening to one’s own dialogues that are triggered within oneself.
Both the physical and emotional dynamics of the client, the environment and those in the clients space require the practitioner to pause, observe and listen. To deeply listen requires a commitment to be fully present and available to the space in between the breaths; the silence. We listen with our eyes, we listen with our heart, and we listen with our hands.
The following protocol gives practical physical steps as a guide for entering into a hospice clients space.
- Begin entry with a pause. Be still.
- Feel your feet on the earth.
- Observe the moment and breathe.
- Observe your client’s environment; your client’s body. What’s happening? What experience are you entering into? What is your experience? Observe yourself.
- Breathe
- Integrate the experience you are witnessing.[ intellectually and through the senses ]
- Ask permission to enter into your client’s space.[ This may be a hello to other team members in the room and being asked to enter or with a lone client who is non verbal , stating what you are going to do and observing the body language as to comfort or discomfort to your entry.]
- Integrate into the experience you are witnessing[ Listen, sense, observe]
- Breathe with exhale included.
- Listen deeply, listen with your head, your heart and your body
- Ask permission to step to the bedside or chair.[ In case of a non-verbal client, state what you are going to do and evaluate permission or lack of, through your client’s body animation. This requires a pause for observation and a quiet mind.]
- Breathe with exhale included.
- At the bedside, ask permission to touch or state exactly where you are going to touch if the client is non-verbal.
- Observe your client’s body animation.
- Approach the body slowly, honoring the space around the body.[ The energy fields surrounding the physical body are scientifically the most sensitive of the bodies Move slowly and gently, so as not to create anxiety.]
- Offer the hands as a point of regard for whatever your client’s body is expressing.[ This is the practice of witnessing, rather than the intention to fix or change.]
- Always feel your feet grounded with the earth.
- Breathe with exhale included; rest and touch.
- Observe your client’s body responses and facial animation.
- Integrate the experience.[ intellectually and through the senses ]
- Listen to the silence, this requires a pause. Listen with your head, your hands, your whole body and with your heart.
- Observe your responses and breathe with exhale included.
- Continue to touch or massage with this pause [ the breath ] for observation and integration as your guide.
- Always feeingl your feet grounded with the earth.
- Always breathing. Always resting.
- There is nothing to fix; nothing to change; nothing to heal. Your experience is already perfect.
This is an excerpt from Massage in Hospice Care, an interactive iBook by Irene Smith
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