Maneesha James Blog

Maneesha, Foot massage is a wonderful way to connect with another. It sounds so wonderful the openness with which you were able to connect in this way with the two patients described. I am one to love to give and receive foot massage from the time I was very young and my mother and I would practice foot massage on each other. Thank you for sharing this. : )

Dear Maneesha! I liked this article a lot. It sounds like many patients are not conscious during their last hours so all you do before that is very healing anyway. http://www.goldenbuddha.org/application/workfiles/resources/Aging.pdf Love from Dorset (UK) Zahira

  Found this when wandering through some of my files and can't recall how I founjd it; maybe by googling 'massage'  and 'research'. Below is just the first couple of paras, but it makes interesting reading.       



                                 Complementary Therapies in Medicine (2006) 14, 100—112

Evaluating CAM treatment at the end of life:

A review of clinical trials for massage and

meditation

Summary

Background: There is a pressing need for improved end-of-life care. Use of complementary and alternative medicine (CAM) may improve the quality of care but few controlled trials have evaluated CAM at the end of life.

Objectives: To determine the strength of evidence for the benefits of touch and mind-body therapies in seriously ill patients.

Methods: Systematic review of randomized controlled trials of massage and mindbody therapies. A PubMed search of English language articles was used to identify the relevant studies.

Results: Of 27 clinical trials testing massage or mind-body interventions, 26 showed significant improvements in symptoms such as anxiety, emotional distress, comfort nausea and pain.

I came equipped for my evening shift in the Palliative Care unit on Friday with a jar of foot balm! I wanted to offer foot and hand massage as an opener, this time. Over the previous sessions there I'd felt some patients, who were alone, actually weren't pining for company. I began to feel intrusive even asking if they'd like me to visit. So I decided on a different tack.
One of the patients, an elderly woman with a tiny frame but a lively pair of eyes, who had declined a visit last rime, really perked up when I asked if she'd like a foot massage. I suggested, as I massaged her feet, that she might feel so relaxed that, by and by, she drifted into sleep, and that if that happened that was perfectly okay. Though she did relax and clearly enjoy it, she was still awake to happily accept my suggestion that I do her hands next.
She lay there, eyes closed, her deeply veined hands held out to me, as I took them, one after the other, and gently worked on them. There was very little talk, and I enjoyed the silence between us, which felt like an easy, comfortable silence: the kind one falls into with someone with whom one is very familiar.
I felt a sense, too, of intimacy between us. The very gesture of her placing her hands in that of a stranger touched me: it seemed to indicate trust and a willingness to be vulnerable; and the fact that she was allowing me to be with her, and to give my own energy and time to her in such a deeply personal way, was lovely.

The second woman also enjoyed her massage, though she was sitting upright and was very chatty, so it was a totally different experience than with the first woman. Still, I enjoyed it, the sense of two humans sitting together, on a cold and dark winter evening....people who barely knew each other but who were consciously allowing a connection to grow.

At the 'handover' a nurse had informed me that a third woman, with whom I had done a guided meditation with on two previous occasions, was now close to death. The door to her room was closed, except for when relatives slipped in or out. My heart went out to her. I wanted to know where she was at; to connect with her, to remind her of the meditative space we'd visited together. Of course it would have been entirely inappropriate for me to go in; I could only be with her, silently, alone, in my own way. I was glad that, at least, we'd been able to spend two evenings travelling to the space inside....
 
I see that this is probably the way it will be in the Palliative Care unit: if a patient is not having things done to her by a nurse, not eating a meal or having visitors, she/he may or may not wish for a stranger's company. If she does, she might be open to meditating, or, might not be. And if we are able to meditate together, or perhaps have a conversation about dying, when she is passing through her last minutes, quite rightly, family and friends will always take precedence over me.

Seems intelligence not to focus on what I cannot do, given this particular context, but, rather, to see how creatively I can  use the opportunities that do present themselves.

Earlier this year a documentary was made at the Palliative Care Unit of Greenwich Hospital (where I now do volunteer work once a week). Titled, 'By Your Side,' it follows the journeys of 6 different patients. Its first screening will be at the Roseville Theatre, North Shore, Sydney, on Wednesday July 28th at 7:15.

Be there or be square, as they say!

The movie, 'Wit,' has been out for some years and, through a friend mentioning it the other day, I watched it for a second time. By Mike Nicholls, with Emma Thompson as the main character, the movie may not be favourite viewing for the faint hearted, especially those of us who are currently needing to visit hospitals for treatment or are hospitalised: the picture it paints of the dehumanising process is grim, even soul-destroying. Though, as I say, this was my second viewing, I was immensely moved by it -- outraged, stunned, and (on the upside!) strongly affirmed in pursuing the work I am doing. That is, supporting those people who have just received a diagnosis of a life-challenging illness.

Doctors typically neither have the time nor the skills to offer anything but the most cursory support. By that, I mean, emotional support at the time of diagnosis and at any time during one's illness, and/or helping patients in identifying their needs and accessing the appropriate resources. That's where I see a gap which I can fill: as a psychotherapist, I offer support for patients in dealing with the whole range of feelings that they might experience. As a former nurse I have a certain familiarity with the medical-hospital system, so can accompany clients to future doctor visits (often good to have a person with you, to hear things you might miss, to ask questions, and so on), to prepare them for/accompany them to chemotherapy and or radiotherapy, and to be available for general psychological support at my place of work or in their home.   

Would so welcome hearing from others who feel similarly...

The  palliative-care volunteers' team at Greenwich Hospital (of which I am now a part), headed by Daphne Robertson, has just been awarded winners of 'Best Palliative Care Volunteer Service in NSW' in the 2010 Palliative Care NSW Awards.

Daphne (who has trained and managed the team for the past 8 years) commented 'I think the main reason we won is that we have such a gerat team of volunteers. I put a focus on education, supervsiion and personal development. It is this reputation which allows us to attract an extremely high calibre of person, e.gg, lawyers, doctors, nurses, psychologists, journalists, teachers, business people, psych.students, cleray and many others' (and there are over a hundred of us).

The team has developed innovative ideas in growing and improving the service and has been very active in creating fundraising activities. Volunteers are recognised and valued as part of the multidisciplinary teams and, on a dollar-value-of-volunteer contribution, contribute services worth around $450,000 per annum.

                                                                                                   *
Meanwhile, I am learning lots in my new role as a volunteer on the pallcare unit. In response to my question, asked of her in my first week, a nurse agreed that it was true to say the nurses take care of the patients' physical needs, and volunteers, of their psycho-spiritual needs (with input from social workers and chaplains). Her comment reminded me of the main reason I left nursing as a career so long ago. I, like many others I am sure, was initially attracted to nursing because I enjoy people and love relating to them. Yet, as I came to understand fairly quickly, the more experienced you become in nursing, the further away from the patients do you move!

The nurses in pallcare ( as anywhere else in a hospital), provide essential services, but my interest -- indeed my passion -- lies in what I see as being equally essential: supporting patients in dealing with their other-than-physical needs. The fact that this aspect of one's care is catered for by unpaid, casual, members of the community is surely a comment on the value  (or lack of) that society places on our psychological and spiritual aspects.
                                                                                                   *

Dr Michael Barbato, 40 years in the field of medicine, with the past half of that time as a Palliative Care specialist, has just had released a new edition of his book, Caring for the Living and Dying.

 

 

 

In his opinion, “Western medicine offers a health care system that is evidence based, outcome orientated, and frequently dominated by technological and pharmacological interventions. It aims to cure and when this is no longer possible it seeks to prolong a person’s physical existence often at the expense of their spiritual and emotional well-being. This biomedical approach with its focus on the ‘fleshy envelope’ falls far short of the mark especially when directed to those who have a life-threatening illness or multi-system disease. Even with these illnesses, death is often considered an adverse event rather than a natural end to life.

 

“Human suffering is multi-dimensional and often beyond the reach of curative medicine, yet this approach to care remains the dominant paradigm for the majority of people who die within the hospital system, diverting attention away from the hard but real issue of life and death. Timely and appropriate preparation for death is rarely countenanced, leaving little if any time for the ‘patient’ and family to make the necessary journey towards wholeness and inner peace. Hospitals are not good places to die and will remain so until those who provide care reflect on their actions and agendas, and see a person’s death not as the end of their life or as a failure of treatment, but as a profound transitional experience.”

 

Dr. Barbato arranged my first workshop on ‘A Meditative Approach to Dying’ here in Australia in May of this year (and provided a testimonial about it; See Testimonials on my site). As I discovered at our first meeting and had reaffirmed at the workshop that followed, Michael is an intelligent, compassionate, open man, with a refreshingly straightforward approach to life. These traits are evident in his book.

 

There is a ton of books and articles out now on various aspects of death and dying, and I’ve barely scratched the surface! Written primarily for carers, Dr. Barbato’s book would also appeal to anyone interested in the subject. That it is based on his experiences here, in Australia makes it particularly attractive to me.  It is comprehensive (chapter titles include: Living with pain; Symptoms other than pain; Day-to-day care; States of consciousness; What happens around the time of death; Care of a child; Care of the elderly), grounded, and compassionate. I appreciate his providing in the Appendix, Palliative Care Associations, a Bibliography and an Index by subjects.

 

Among the comments the book has garnered is this, from the NSW Society of Palliative Medicine: ‘This is a book that deserves fanfare and promotion…. It is beautifully written with a strong thread of sincerity through it that can only be drawn from years of experience of dealing with people at the ends of their lives.

                                                                       

BTW: Dr. Barbato has written a second book, Reflections of a Setting Sun: Healing Experiences Around Death, which is equally well written.

 

To purchase his books and/or learn more about Dr Michael Barbato: http://caringforthedying.iinet.net.au

I’ve just completed a 2-day training as a volunteer at a local hospital. Some of the group want to work in Rehab., some in the Psychiatric Unit, but the majority, like me, are interested to work in the Palliative Care Unit.

I’ve only recently come to learn that not all those in ‘pallcare’ (as it is chummily known as at Greenwich Hospital!) are expected to die within the next weeks. However, by and large, it is with those whose death is imminent that I should like to be.

To date, I have only worked in the US and Europe with the dying; and those people with whom I did work were all meditators (specifically Osho sannyasins).I am curious to know if the kind of people I meet in an Australian hospital context, are interested in/open to my meditative approach and the using of meditative methods.

I’d be interested to know if there are other meditators who are already working in a similar way? – either here in Australia or anywhere else in the world.

That so many people do offer themselves as volunteers in palliative care units and hospices in so many countries is terrific. I know that it is they – not the doctors, not the social workers, not the chaplains nor even the nurses – who tend to spend the most time with patients, and so their role is incredibly significant.

On the other hand, I would like to see the whole status of caring for the dying being upgraded – to at least the equivalent of midwives (though, as we all know, nurses are shamefully underpaid and undervalued). See the articles on my website under Doing Dying Differently (especially Way to Go and Home Deathing).

Dying is as significant an event as birthing. Those wishing to offer truly meaningful support to the dying should be trained accordingly – in listening, in being-there-with, and, when appropriate in counselling (the dying person as much as their family and close friends), as well as being able to guide them through their final moments.

And, BTW: There is a fantastic article ,' Mindfulness in Hospice Work , ' by Anne Bruce and Betty Davies . The online version of this article can be found at: http://qhr.sagepub.com/cgi/content/abstract/15/10/1329 . It looks at the impact on the staff of their being meditators, in this instance, zen practitioners.