Irene Smith usually begins by adjusting her breath, calming the room with her even exhales. Her job is to be present with the dying, to give them comfort and relief from pain. She has lost three clients in the past two weeks, but when she goes to work she must be fully present and completely at peace.
Smith, 65, is a massage therapist and the director of Everflowing, a program she founded to teach "mindful massage" or "skilled touch," as she calls it, in hospice caregiving. This is not deep-tissue massage for the stressed; Smith and massage therapists like her offer gentle touches to aid people who are overcome with the pain and fear of death.
"I ‘pet’ people in their most vulnerable times," said Smith, who began developing her techniques in 1982. "Hospice massage may be me stepping up to the bed, stroking your face, just looking into your eyes. It may start with a foot massage and end with my stroking your face."
Smith and other hospice massage therapists know they can’t give medical relief to someone dying, but Harvey Walters, 68, from Mariaville, Maine, said his sister Barbara took great comfort from Smith before she died in 2007 from lung cancer.
"Barbara’s energy and spirit and aliveness—her presence was just greatly enhanced by that section with Irene," he said. "She bounced back to where she was again."
Hospice massage is not covered by Medicare or insurance, and many providers are full-time massage therapists who offer hospice massage on a volunteer basis. That makes it tough to recruit therapists for hospice training, said Hanne Jensen-Male, the nurse manager at Zen Hospice in San Francisco. But she said the simple art of touching had great benefits, even if it doesn’t bring great profits.
"Just picking up and touching their hands is powerful enough to cause a reduction in pain," she said. "It’s so important that I want all my nurses to take the training."
Kristine Worden, 59, a former social worker who now works as a massage therapist and hospice volunteer in Grand Terrace, Calif., says she is amazed that there is only one hospice in her area that offers routine massage services for its patients. Though more and more people have begun to realize the benefits brought by the massage, "It’s not blossoming yet," she said.
The practice also bears little resemblance to other forms of massage.
"It’s really hard to classify it," said Lora Casey, 45, a licensed massage therapist in Rhode Island who participated in Smith’s workshop in 2005. "It’s more like when you were a little girl and you were sick, your mum maybe would come to you and kind of gently rub your forehead."
Smith said the real purpose of the treatment is to give support. She said she remembers a patient who suffered from cancer and just couldn’t stop vocalizing her pain, crying out even as she declined the offer of a nurse. She said it became clear the woman wasn’t looking for medical help.
"Pretty soon I learned that she wanted to be fully present in her dying process. She wanted to have the opportunity to express her pain," Smith said. "So for me, it was about touching her, massaging her, holding her and being willing to just be present during that expression. There’s nothing I could fix except to witness, to validate and to honor her pain."
Smith said serving the dying means overcoming one’s own fear of death and the diseases her clients suffer. She said she gave hospice massage to the earliest AIDS patients in the United States before the disease had even been identified. In June 1982, she said, she was called to see a man with a disease called "gay cancer."
"They said the only thing that you need to be aware of is that you need to wear gloves," Smith said. Later, when she was rubbing the man’s arm one night, a piece of news with the term "AIDS" flashed across the TV. "I said, ‘Oh my god, that’s what Michael has.’ And that was the first time I learned fear."
A simple, skilled touch can sometimes be the last bit of comfort a dying person feels, but not everyone is able to find such valuable massage service when they need it, said Jane Tatum, a 63-year-old volunteer who has provided massage for 11 years at Kaiser Hospital, a hospice in Oakland, Calif. In the hospice where Tatum works, there are only two parttime workers who can provide hospice massage. At her busiest times, Tatum said she could have 10 patients at the same time. "We always have a waiting list," she said.
The peacefulness provided by hospice caregiving is not only shared by the patients and their families, but also by the people who offer the service, she said. "Being with someone when they are close to dying is very powerful. It is not to cure the patient, but to help the patient ‘go through’ in the best way possible."