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.