lillian

LILLIAN

On my way to Lillian today, I met an older woman in the elevator ride up.  After the doors shut, we looked at each other,  I smiled and we began a small chat.  She mentioned that the elevators were indeed quite slow at this particular facility,  most likely because the residents were very slow, and needed more time getting in an out, in wheel chairs and  walkers. And it prevented them from getting bumped by the closing doors, and moving anywhere too quickly.  She made me laugh and I appreciated her sharp wit. I asked her if she liked it here.  There was a long sigh, and her mouth tightened up a bit.  She then said “…it’s okay.  This is my fourth retirement home.  They always sell them with such glamour, and then there are the disappointments that follow.  I’m working on my expectations she said”, with a smile.  Her eyes, however, looked both resigned, and sad.                                                                                                  I could feel my heart, and how I wanted to make it better for her.  Perhaps we could share a cup of tea, and she could share with me some of the grief in her heart.  This didn’t seem to be how she had planned on it going. 

Lillian is 90 years old this year, and is in severe pain after a fall she took in May.  She landed on her back and hip, and refuses to take pain medication.  She is wrapped up in her over sized flannel shirt and standing in the middle of her bedroom, leaning on her walker.  It is over 90 degrees out, but she is in pain, and feels cold.                                             “Hey Lillian” my face I am sure is beaming pure joy as I smile at her.  She is not one for grand displays, but I see a grin emerge at the corner of her mouth.   I love meeting with Lillian.  She is so honest and sincere, that I usually tear up when I am working on her, when I know her eyes are closed, as she is resting.

Today her daughter, who is up from California since her mom’s fall, mentions that Lillian has been awake for almost 3 nights due to the pain.  She, Fran, looks exhausted and worn to the bone.  

I lay Lillian on her side and very lightly, start massaging the channels of her body.  I start on her arms, and gently stroke the triple warmer channel, and then work on her back, hip and leg.  Part of my ongoing challenge in working in hospice and palliative care, especially in people’s homes, is how to position my body so that I am not stressed to hold a posture.  I want to be close to her, yet i can’t help her much if I’m in pain.  So, I kneel in front of her and place a needle in Bladder 62, to open up her spine and GB 41 to open up her side and hip.  As I so often do now with my elder and dying patients,  I spend some time gently touching her hair and head and back of her neck, and then finish lightly touching her face.  I want my hands to be as soft as they can possibly be.  She then makes the tiniest of murmurs, and I trust that it is coming from a place of relaxation in her, and not discomfort.  

 I wonder if the reason we share such a closeness is from my work on her head and face, and the way it links us in an unspoken way.  I do not know.

Since the bed is up against the wall, and her back is facing that direction I decide to climb up onto the bed and position myself behind her so that I can cradle her a bit, and work on her back directly.  It is intimate, and yet I want to feel close to her, and I want her body to feel the caring that I have for it, and that it can lean into me.   She doesn’t seem to mind, and I just softly lay my hands on her back and right hip.  There is this instant where I begin to  move my hands just above her body, first along her back and then along her leg and hip, and finally over her upper body and face.  I have not done this before on her or any of my clients but I know it to be a medical Qi Gong technique and it is what feels precisely right at this moment.  This space directly on or right about the surface of the body is where our Wei Qi resides, it is a protective layer.  As i move my hands, her entire body begins to feel animated and then completely softens.   I feel very connected to Lillian at this moment, almost as if where she stops, I begin.

I often get uncomfortable at this moment.  I get scared that I will somehow disturb her being, her health, increase her pain, act irresponsibly.  It is hard to know if any of that will ever be an actual outcome but I do know for certain that the softness I felt happen in her body was real, and that my love for her is steady.

As I am gathering up my things to leave, Lillian awakens and is calling for her daughter to help her to the  bathroom.  She had fallen asleep and is surprised, i think, to see me still there.  She looks so beautiful and says with utmost tenderness, “ thank you for the divine break from my pain; it feels so nice, I wish i had started this so long ago.”

AN ACUPUNCTURIST'S REFLECTIONS IN HOSPICE CARE

 Visiting Mary in her trailer

I was called to help a woman who had just entered into hospice care the week before.  Her name was Mary Ann, and she was suffering and dying from liver failure.  She had a long history of substance abuse, and then some recovery time, but she was 54 years old and her body was breaking down.  She was confined to a hospice bed in her trailer since both her feet and hands were wrapped up in gauze.  She had gangrene in all of her limbs.    

She was only one year older than me and I felt that knee jerk reaction in me that wanted to believe somehow that even though she and I were so close in age, I was different.  I was healthy.  I was perhaps further from death. 

As I watched this all arise in me, I also noticed that I wanted to be very close to her.  I wanted to touch her face and lovingly rub her head and neck.  I wanted to press on acupressure points along her collar bone to help her breathing which I could hear was so labored.  I wanted to crawl into bed with her and cradle her, so that she would be less afraid.  I wanted to feel connected to her as she was leaving this life, and her body.

I am reminded of Marie de Hennezel’s exquisite description of touch in “Intimate Death”. “Sometimes there is no substitute for the touch of a hand. It embodies the sense of true meaning.  This contact of essence to essence is something that must be risked, essayed, lived.”

This is something I often wish that all caregivers realized.  We are all too scared to risk intimacy.

At one of my visits with Mary Ann, I was seated beside her and quite suddenly, she began to gag and struggle to breath.  Her niece, Becky, who was her primary caregiver, quickly came to her side with a basin. Mary Ann had been experiencing strong nausea with some vomiting that morning due to a medication change that was too hard on her stomach. For now, it was only the dry heaving that remained,  and when it passed, she rested her head back on the pillow.  Tears were running down her cheeks, and when she looked at me, her eyes held so much anguish and despair.  I reached out and touched her face, and we just sat and looked into each others eyes for what felt like a long time.   I tucked her damp, sweat- soaked hair behind her ears, so that her face could be free.  It was then, her features softened and a soft smile appeared.  My heart was so full of caring for this woman.

I fear that when I am dying I will no longer recognize my feelings.  I fear that I will somehow be unable to communicate as I have throughout my life.  What is becoming undeniable to me, however, is that other capacities begin to emerge as we near death and these traits hold tremendous expression. 

 Due to the illness and the strong medications Mary Ann was on, she was unable to speak, but as I sat there holding her gaze that day, I felt such a richness in her presence.  There was such a vitality she was sharing with me.  I was moved.

I wept in my car before I left the trailer park. I had so much grief in my own chest for her suffering.  And yet a gladness in my heart for the lovely meaningful connection we shared.

Note:  the names have been changed to protect people's privacy

By Gwen LoVetere, Licensed Acupuncturist with Providence Hospice and owner of Invisible Grace Acupuncture