Massage Tales, Oncology Massage, Thoughts on the profession

What Did You Notice?

She’s a climber, a dancer, a multi-sport athlete.* She biked to the clinic and will most likely go to a yoga class on her way home. She eats clean, but she’s not obsessed about it or anything. She will eat a piece of birthday cake or a cookie when she wants to.

She is healthy, and she is doing everything right. I say that every client is the expert on their own body. She is the expert-archetype. She knows her body so well, takes such excellent care of it, that she found her melanoma before it was much more than a spot just beginning to touch the dermis, the layer underneath the top layer of skin.

After the massage, as I hand her a cup of water, she stretches her shoulders and looks at me, earnestly. “What did you notice?” she says.

I stammer for a moment, surprised. What did I notice? She lives so fully and attentively in her body, I wonder why she even wants to know what I might have noticed. It seems more appropriate that she tells me what she noticed, that she educate me on how best to support and care for her.

She looks at me, that direct gaze, with the question still in her eyes. She wants something from me, something that I am not sure I even know how to give. She wants the report card.

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The report card is the after-appointment summary, where the massage therapist lists all the spots of tension, adhesions, tightness, or just plain wrong-ness that they felt in the client’s body. Supposedly, it is a tool to encourage repeat visits and to begin documenting the effectiveness of massage for this person.

I was trained to give the report card after a massage, even though it always felt wrong to me. First of all, every client will have extensive direct experience of their body and how it feels and functions. Even if I work with someone for years, I will only have a fraction of the embodied information each client has about themselves. Secondly, as the provider of the massage, it is my job to receive a report card, not to give one. I’m not here to rank or rate any human body. I’m here to support, to love, and to learn.

She won’t give up, though, this client of mine. It is a quality which makes her an excellent athlete. I suspect she was also a good student, since she seems to be following the same massage training book I was given years ago. That book includes the report card. This box must be checked before we can call the massage complete.

So, what did I notice?

I spread my hands wide. “I noticed your breathing, the rhythm of it. I noticed your pulse as I massaged your hand. I noticed that you move with ease.”

She raises her eyebrows, just a bit, then draws them close together. The vertical line between her eyes quivers a bit as she tilts her head to one side. There will be no demerits, no suggestions for improvement on this report card.

She keeps her quizzical expression as she leaves. I peek out my office door and I see her pause and shake her head at the bottom of the stairs.

I’ll be honest — I’m tired of the assumption that any interaction with a health care provider or wellness professional ends in a list of instructions on how to be a better, more complete human. I’m tired of leaving every doctor visit, massage appointment, or acupuncture treatment with a list of where I went wrong and how to correct it. I think some clients might be tired of that too.

What would happen if we started with the assumption that the human in our care is already complete? What if we also acknowledged that they are the expert on their own experience? And what if, maybe, we led with humility and curiosity, keeping expertise for later, after our client has had a chance to educate us?

What would happen if we threw out the report cards? I hope that on the other side of report cards is a land of real conversation and exchange of information, as equal partners working towards the same goal.

*- This client is a composite of several different individuals. All identifying information has been removed.

Oncology Massage

The Woman on the Plane: a short, “true” story

She and her husband were in the last boarding group for the early morning flight on Southwest. They rushed onto the plane just before the doors closed. The husband came down the aisle first, squinting towards the back of the plane, his unzipped jacket lightly brushing the elbows of everyone in the aisle seats. He strode past my row, near the back of the plane and found a seat.

She stomped behind him, lips pressed together and breathing in sharp little exhales. She wore a black scarf wound artfully around her head, eyelashes too long to be real, and perfectly arranged black leggings under a voluminous, colorful sweater.

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Only middle seats were left on the plane. In my row, a quiet older woman had the window seat and I had the aisle. The woman in the black scarf carried a half-unzipped backpack in front of her. She stumbled over the emergency light strip just before my row and a tumble of makeup, brushes and lotions spilled from her bag. She blew a forceful gust of air through her lips and crouched down in the aisle to pick everything up.

She mumbled to herself as she filled her hands with the debris from her backpack. When a man on the aisle leaned in to help, she waved a hand at him and shook her head. Finally, she scooped everything from the floor back into her pack, pulled the zipper mostly closed and shoved it into the bin right above my head.

She stood in the aisle then, right next to my elbow, scanning the back rows. “Stan!” she whispered, “How could you do me like — ” and she sighed deeply. She looked down at the empty seat in the middle of my row and started to climb over me to reach it.

“Please let me stand,” I said. I got up to stand in the aisle, brushing heavily against her as I did. She did not move from her position right against my seat. Her gaze hovered somewhere behind me and her brows knit together ever more tightly.

She took her seat, crossed her legs and arms and started bouncing her foot. “. . . so stressed out . . ” she said, then pushed her scarf-covered head into the headrest and closed her eyes.

Up close, I could see that the eyelashes were, indeed, fake. Also, her perfect brows were drawn on. Underneath the expertly applied foundation, her skin hovered at a shade between pale and gray. Her nails were acrylic and the fingertips underneath were chapped and red.

You never know what someone is going through, but in this case, I had an inkling. I put aside my book (The Cancer Chronicles) and spent the flight focused on loving kindness meditation for her, and for everyone on the plane.

May you be well.

May you be free from suffering.

May you live with ease.

Near the end of the flight, as she and the other woman in the row started talking, I learned she was on her way to a treatment center for a recurrence of her cancer. She named the type and the diagnosis. It was familiar to me, as was the typical prognosis. (May you be free from suffering.)

She mentioned neuropathy and I asked if I could show her something that helped my clients sometimes. She agreed and as the plane landed, all three of us in the row held our left hands with our right hands and gently, mindfully, lovingly paid attention to every part of our fingers and hands.

In the moments before boarding, we learned that I had worked at the center where she would be getting treatment, and the woman in the window seat was also suffering from neuropathy — hers related to an auto-immune condition.

“See –” the woman in the scarf said, “We’re all family and we didn’t even know it until now.”

Except that if we are paying attention, we know it all the time.

MLD, Modalities, Oncology Massage, Thoughts on the profession

Absolutely Maybe

I have spent the weekend at a conference doing one of my favorite things — talking to other nerds about nerd things. The weekend started with discussion of the adaptations of lymphatic drainage protocols for specific types of plastic surgery, and ended with speculation on the titles of our future TED talks.

Mine is: “The Metaphor is Everything.”

But that’s not what I wanted to talk about today. Today I want to talk about certainty. Or, more accurately, capital-C Certainty.

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The end of the first day of the conference featured a panel of super smart guests, ready to talk about their particular view of oncology massage. It was a house tour of the neighborhood where you’ve always wanted to live — a chance to peek into the day-to-day lives, the medicine cabinets, and the private closets. (Metaphor. See what I mean?)

The first speaker made an entrance. She strode out from the wings of the stage and solemnly said her name and her specialty, then went on to spend her allotted time sharing images and stories of her work. I found the images and stories fascinating. I found her approach challenging.

After she introduced herself, she talked about the specific training she received, similar to mine, as it turns out, and talked about the danger of deviating in any way from the tenets and protocols of that training.

Here is where I admit that I have been deviating from the tenets and protocols of that training pretty regularly. I have a whole new kind of clientele — young, healthy people recovering from plastic surgery. For them, the exact protocol is often not as effective as some critically reasoned deviations.

I found myself becoming more and more uncomfortable as she spoke. She has been doing this a long time. She has gotten great results with some really challenging cases. She knows what she is doing. She is certain of it.

That is what made me uncomfortable. The certainty of it.

There are so many things in this profession that we were “certain” of — that massage increases systemic circulation, that mechanical pressure can change certain body tissues from solid to a more pliable gel, that we should never touch people who have cancer. Thank goodness enough open-minded, curious, smart people have challenged these and other certainties and proven them mistaken. Because of these people, who were uncertain, we can reach more people and provide much better care and education about these bodies we live in.

Certainty is a hard stop. It is the period at the end of a sentence and “The End” written at the bottom of the page. Certainty freezes us in time. I don’t want massage therapy to become dusty and desiccated like those life-size dioramas that used to terrify me at the Natural History Museum.

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We are, like the bodies we work with, living and growing. We may be educated, we may be experienced, we may be confident — but I hope, for own future growth and the benefit of our clients, we never become certain.

On Writing, Oncology Massage, Thoughts on the profession

Beyond Stillness

I am currently re-reading The Emperor of All Maladies by Siddhartha Mukherjee. It is a fascinating, novelistic, nerdtastic telling of the history of cancer. There are so many facts and nuggets in it that are buried in the larger story, and are breathtaking in their own right. Today, I am thinking of one of those nuggets.

In my edition of the book, Mukherjee states (somewhat erroneously) that the root of the word “metastasis” means “beyond stillness.”

Let’s put aside, for the moment, the actual root of the word, and consider the breathtaking poetry that is “Beyond Stillness.”

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Metastasis, as we currently understand it, is the movement of a disease from one part of the body to another. In cancer land, this can exponentially increase the dangers of a particular disease process. Every cancer patient hopes to be free of metastasis, leaving the rest of their body intact and functional. (As much as it can be after systemic treatments like chemotherapy, anyway.)

We shorten metastasis to “mets” in talking about progression of cancer. Breast cancer with bone mets. Lung cancer with brain mets. This short, sharp, easier to say word that contains within it layers of fear, anxiety, and potential physical pain.

Which brings me back, to beyond stillness. With cancer metastasis, the disease has moved beyond the stillness of a body at rest in wellness. It has moved beyond the stillness of an in situ tumor which yields obediently to removal or treatment. The disease moves beyond stillness into a kind of strobe light-illuminated motion, where the confirmation of movement comes through the flashes of a PET/CT scan.

And what exists beyond stillness?

Is it the growth of the opposite, a kind of frantic and endless motion that never quite rests, never quite allows the body to rest?

Or can we find, beyond stillness, another level of stillness — something even more quiet? Is the movement beyond stillness like the movement from the parking lot at the top of a hiking trail to the spot a mile or so down the trail, where all the city noises are erased and the senses can expand into this new space?

The simple etymology of metastasis, mistaken though it may be, leads to a particular kind of poetry. This is the poetry of words that lead into a compassionate and loving meditation on life, disease, and death. This is the poetry of breathing and being in a vulnerable, human body.

Oncology Massage, Thoughts on the profession

It Depends

There’s this thing that gets said a lot in almost every class I teach, no matter what the subject or how (in)experienced the students: “It depends.”  Meaning: more information is needed before I make a recommendation.  Meaning: every human is different.  Meaning: never stop thinking.

I am sitting at a desk in a remote location, away from home and away from people, planning out my 2019. What are my goals for the year? What do I want to create? What do I need to let go of?

I used to do this on a fairly regular basis, but it has been a couple of years since I actually sat down and wrote out the plan for the next year. The first time I did it, the words came to me faster than I could write them down. There was so much missing from my life at that point. It seemed lots of plans and ideas wanted to rush in to fill the vacuum.

Before I started writing today, I looked at that plan. Most of it didn’t happen. Or at least it didn’t happen in a way I expected. There was one sentence though, stuffed into the middle and written when I was tired and wanted to go to bed, that happened exactly as I wrote it. It was eerie, how precisely this thing happened. This one, half-forgotten sentence that became the thing that shifted my entire life.

So, can you plan an entire year before it happens?

It depends.

To me, this writing is an exercise in continual awareness of the kind we want our students to have when we say, “It depends.” Standing rigidly with knowledge or plans or protocols limits our ability to help. And it kills our ability to find wonder in the unexpected, half-asleep moments of our lives.

We stand, in this profession, in our knowledge and our experiential learning. We are not, should never be, trapped by it. We work with humans, after all, in their infinite variety. Every one of them is different, and if we stop thinking we stop serving.

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Let us not be constrained by the container of our own understanding. Instead, let’s try to flow, like cats do — adapting to the shape of the container before us, or abandoning it entirely when it doesn’t serve.

May your new year be full of awareness, critical thinking, and the magic of conditionality.

Inner World, Oncology Massage, Thoughts on the profession

Objectify

Last night I watched this documentary about Maria Callas. I had a small sense that there was something tragic and sad about her life outside of opera, but I had no idea just how tender her story was. She existed in this space where she had attention, celebrity, adoration — but she didn’t have the love that she wanted. In her last relationship, she was literally a commodity, a glittering novelty collected by a rich man who loved the idea of her.

The idea of her.

This led me to thinking about a recurring, spiraling conversation I often have with my friends. Our conversation is about humanity, and about our particular skill in honoring humanity. Too often, our default mode is to objectify, to make of each other a one-dimensional thing. The person in my way at the store. The person who is driving too fast. The person talking too much at the end of the day.

Another recurring and spiraling conversation I often have is about the role of massage therapy in health care, about how we can integrate the profession into the medical model in a way that elevates patient care. Believe it or not, watching that documentary brought both of these conversations together in my mind.

What I am hearing sometimes, even in my own head, is that we might be taking on the least desirable parts of the medical model. We might be turning people into objects. The frozen shoulder. The back spasms. The testicular cancer with distant metastasis.

While this objectification might be useful for a moment — we have to apply specific knowledge to be safe and effective, after all — it too easily becomes a habit. And hidden within this habit is the seed of what could be damaging cruelty.

Turning someone into a limited object is a door that opens onto a path. This path has so many stops along the way that drift us further and further from each other. Stops like: not listening with full attention and an open mind, ignoring someone’s stated needs in favor of our own assumptions. In the darkest depths of the path as it winds through the shadow side that is in all of us are the -isms and oppressions that break our collective hearts.

I am in no way saying that integrating in the medical model will make us into a crueler, harsher profession. I am saying that constant vigilance is required. May of us went into massage therapy because we loved the idea of working with a whole person. Many medical professionals love this idea as well.

As Maria Callas grew into her talents and found fame and recognition, her personal life started to fall apart. As this profession grows into its next phase, we must be ever-aware of the state of our own being.

Maria Callas often spoke of herself as two different beings: Callas, the diva and performer, and Maria, the woman. By all accounts, she didn’t find a way to integrate those beings. As we grow into next-level massage therapists, let’s continue to find ways to integrate our two beings: the evidence-based practitioner with the human-loving soul seeking connection.

Inner World, Oncology Massage

Into the Rabbit Hole

I have a writing task.  A big one.  I am choosing to take the advice of The Little Book of Talent and keep the biggest plans secret.  It’s not important to know exactly what the task is, just that it is.

 

I have been a writer since second grade.  Our teacher told us to write a Halloween story, and I went to town.  I had elaborate costumes, a haunted house, multiple plots coming together, and a hero facing certain ruin by ghosts.  I also had what I later learned was a deus ex machina — an ending dropped from the sky where the hero of the story got to survive and get away all in one piece.

 

Okay, it was a ghost extinguisher.  I gave my hero a ghost extinguisher.

 

So, maybe plot-wise, it wasn’t my best effort.  But for sheer love of the process of writing, it was enough to keep me hooked for years.  I can still feel what it was like to sit at the dining room table and write that story.  How I could hardly move my pencil fast enough.

 

As many things do, writing became both easier and harder as I grew up.  I learned about plot and foreshadowing.  About the nuances of character and exposition.  I also started writing essays, nonfiction.  I practiced translating facts into a readable story.  I found that this worked best for me if I had piles of facts and supporting facts that I could pick and choose from in the process of writing.

 

I felt most comfortable drawing from a deep well.

 

close up of rabbit on field
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Which brings me to today —  my writing task, based in fact and research and looming large over my life for the next several months.  I am breaking it into smaller pieces, and finding that each piece comes with its own rabbit hole attached.  These pieces sit before me like tiny cyclones, and if I’m not careful I could get sucked into the vortex of each one, disappear for a while, and come back with not even a pair of ruby slippers to show for it.

 

Today I am perched on the edge of a rabbit hole, trying not to dive in.  If it weren’t so fascinating, if every piece of information didn’t lead to twelve others, if I could just write one crappy sentence —

 

There it is.  The thing I keep banging up against is the first sentence.  More precisely, allowing the first sentence to be crappy and moving forward anyway.  Because, as I used to tell my writing students, revision is more than half of the writing process.

 

It may help me to look at this craft the same way I look at the craft of a massage.  Prepare.  Deeply and thoroughly prepare.  Then, when the person is in front of me, empty my mind and trust that the training is there.  Right where I left it.  Just make contact and go.

 

Just write that crappy first sentence and go.  Forward.