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 

 

Death and Dying: An Acupuncturist’s Reflections

By Gwen LoVetere 

Anything and all I have learned, as an acupuncturist, that is good, gentle, sensitive and healing, has come from my work in hospice care.  It has carved me out.  It has shined light on the ways I have refused to see my arrogance and terror, and in the ways that I have hidden, it has found me and called me out.  Recently, I have felt compelled to share the stories of some of my hospice experiences, ones that broke my heart and moved it to open in ways that are bigger and bolder, and with a sense of wildness gained in that expansion.  Here are two.

In the fall of this year, I had the good fortune to work with an 87-year-old man who was dying of aortic stenosis.  He had just started on hospice care, and I was called because he was interested in receiving acupuncture treatments for pain in his right leg.  Jerry had moved in with his daughter and was staying in one of her downstairs rooms, as it was increasingly difficult for him to manage anything that stressed his heart.  The wall facing his bed was covered with pictures—of his youth, of his years raising five children with his wife, of him as a grandfather, smiling the lovely grin of someone who is proud of his life, and of what he has been a part of growing. 

One afternoon, we talked about his early years, back in the ‘40s, when he started his own construction company.  He remembered them with a glowing smile, yet there was also the stress of those growing responsibilities as he went on to own the company and overlook its expansion.  Jerry went on to tell me that he regretted working so hard.  He regretted all the busyness.  Then, with a long, full pause he went on to talk about his wife.  She had died twenty years ago, and he still grieved her immensely.  For five years in a row he visited her gravesite daily.  He could not fathom that when he turned his head toward her, she was no longer there.  He felt gravity around it, wished he hadn’t added to her suffering by not doing more for her.  His heart, he said, while pointing at his chest, was broken with the loss of her.  The doctors wanted to do surgery to correct the stenosis, but he told them, No, enough, I don’t want any further intervention.  He looked at me with complete transparency and said, ‘This is my heart, my heartbreak, and no one will take that away from me’.

As an acupuncturist, you learn to take in information; it is part of the training.  You listen, you notice smells, you check pulses and palpate the skin.  I have done this a long time, long enough that I don’t necessarily notice I am doing it anymore.  Laying my fingers on someone’s wrist and feeling through the pulse what is going on inside them has become so natural to me.  Hearing this and feeling my heart as he was sharing his history, his ‘thread’—as former palliative care physician Stuart Farber termed it—connected me deeply to myself and my own mortality, my own heartbreak, my own sensitivity.  And although I am continuously fortunate in the encounters I have with hospice clients, in this case I was completely dumbfounded by what I learned about myself, about the nature of loss, and about love.  It was an exceptional experience. 

Around Thanksgiving, I met a 41-year-old woman, a commercial-airline pilot, dying of a brain tumor.  Cicely had gone through multiple surgeries as well as two rounds of chemotherapy and was just starting hospice care.  She had several scars on the back of her head and neck.  The first time I visited, I was welcomed into the house by her sister, who led me upstairs to the bedroom.  What I noticed right away was a very small person under a heaping pile of blankets and comforters.  She looked up at me with big eyes ad I remember thinking, ‘Wow, there is so much light in her eyes!’  She told me she had never had acupuncture but wanted to try it.  She was nervous about the needles, and I told her I—rarely—used only one or two, and that mostly I practiced acupressure, which she liked. We talked some about what came before hospice for her, all the tests, all the surgeries, the experimental chemo’s, etc., and it was so sweet to just be there with her, pressing on some acupuncture points, mostly on her abdomen and legs, nothing more.  

The last time I visited, I was greeted by her husband who, with shaky hands and red-rimmed eyes, led me upstairs to Cicely.  She was much quieter on this day, and although she did open her eyes and greet me with that soft, bright smile, she was clearly close to transitioning, which is when those who are dying shift their focus more within and less on the external environment, including loved ones.  It is said that it’s best not to try to call them back at this point, but to let the process unfold as it is—even though that can be hard on the ones being left behind.  After checking her pulse, it felt right to work on her back, and as I helped her onto her side, I again noticed the long, jagged scars along the back of her head.  At that moment, I was nervous and awkward; it felt so intimate to work on areas of her body that had experienced such trauma and pain and loss.  Would it be okay to just move in and touch those parts of her that might hold the most intense feelings of injury and grief?  

As I sat there on the bed beside her, I paused and asked myself, what would it be?  Would I do what felt right and natural and guided?  Or would I choose what I so often have—safety?  I would have been playing it safe based on fear—fear that I would mess up, cause harm.  I reached out and touched her neck, her head, her scars, and, lastly, her face with as much love and gentleness as I could.  And I felt connected to her, just as one being deeply caring about another.  She seemed to beam as I did this.  It looked as if it offered her the support needed to relax even more deeply into herself.  This is what I hope.

 

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

 

Gwen LoVetere is an acupuncturist with Providence Hospice.