Some years ago, I was trying to explain to my grandmother what I do for work. She knew that I was a massage therapist, but knew little about The Hand to Heart Project. So I told her about providing massage and the comfort of touch to people who are sick, in many cases people who are close to death. She gave me one of her familiar curmudgeonly looks and said curtly: “What’s the point?”
I don’t remember what I said in reply. It seems obvious that touch and presence can be powerful and helpful when someone is approaching the end of life – so obvious that I can struggle to explain it. But the truth is that we do get asked the question – less grouchily, as a rule – by people wondering why they might welcome us in when a loved one is dying. Is there any point? Does it really help?
One challenge in trying to answer those questions is that it can be difficult to know what people who are dying feel. “The way death is talked about tends to be based on what family, friends and medical professionals see, rather than accounts of what dying actually feels like,” Jennie Dear wrote in a 2016 article in The Atlantic. (Accounts that can be hard to come by, admittedly.) For instance, a person near death often appears to be laboring to breathe. “The sound can be deeply disturbing, as if the patient is suffering. But that’s not what it feels like to the dying person, as far as doctors can tell,” Dear wrote. “In fact, medical researchers believe that the phenomenon – which is commonly called a death rattle – probably doesn’t hurt.”
But because it is disturbing to witness, and because it can be accompanied by apparently anxious movement and vocalizing, caregivers might be inclined to be “protective,” even to the point of keeping away someone who is offering quiet and comforting touch. Or maybe they think that because the dying person no longer appears conscious, it wouldn’t be worth the trouble. In the same Atlantic article, though, Dear quoted James Hallenbeck, another palliative care specialist, explaining that people at the end of life tend to have their senses disappear in a particular order. “First hunger and thirst are lost,” Hallenbeck wrote in a guide for end-of-life care, according to Dear. “Speech is lost next, followed by vision. The last senses to go are usually hearing and touch.”
It’s likely, then, that someone will feel the touch offered by a massage therapist (or a loved one) even in the last stages of life, even when they don’t appear awake. Still, does it help? Hand to Heart has plenty of anecdotal evidence to support an enthusiastic yes.
I once arrived at a client’s home to find his distressed wife waiting for me. Her husband had had a bad night – not awake, but not resting peacefully. He appeared anxious, was moving and vocalizing. She left me alone with him, and I set my stool next to his bed. I spent most of an hour with him, doing very light massage, sometimes just resting a hand on his shoulder. He was quiet when I left, and he remained quiet until his death seven hours later. His wife later wrote to us: “I am convinced that (my husband’s) passing would not have been so peaceful if the massage therapist had not come over under the auspices of this wonderful program, and I and my family will be forever grateful for that.”
Another case involved a woman I had been visiting through Hand to Heart for a few years. When I showed up one day very near the end of her life, she was lying on her bed with her adult daughter, both on their sides with their heads together. My client was not very awake, but she was tense. Her body was stiff, her rigid arm resting on her daughter. As soon as I put my hands on her, she softened. Her body seemed to sink into the bed. Her arm dropped. Her daughter later wrote: “I was holding my Mom’s tight hands and I felt her completely relax. I relaxed with her, and it was as though we were transported off somewhere, together, in a total state of relaxation and meditation. I have gotten to that state before on a couple of occasions, but to do it with my Mom, at such a crucial time at the end of her life, was such a gift. She relaxed more than she had in weeks. … She never tensed up again. She passed away very peacefully, and left our house with a smile on her face.”
Often, the people who least need convincing that end-of-life massage can be helpful are the clients themselves, as long as we start working with them while they are still alert and aware. When they know how much it helps, they are open to having it continue when they are no longer awake. But because they won’t be making the call at that point, I encourage them to be sure that their family and other caregivers know of their desire. That helps to avoid “gatekeeper syndrome,” or someone acting with the best intentions but keeping their loved one from receiving the comfort of touch by an experienced massage therapist.
There is, by the way, a secondary benefit from massage at this stage of life. Caregiving in that situation is extraordinarily stressful, and we’ve often been told that just seeing a dying loved one receive the gentle touch of a Hand to Heart massage therapist is a great comfort. One family member even told us that watching her mother relax during a Hand to Heart visit freed the woman’s adult children to begin touching her more themselves. They hadn’t been sure that it would be OK, or that she would like it.
Hand to Heart has several massage therapists with a combined 75 or so years of experience. We have often been with people who were in the last weeks, days and even hours of life. We know it can help, and that touch is not only a great comfort, but an important means of connecting not just with another human being, but with all other human beings. As Thich Nhat Hahn once wrote: “If you touch one thing with great awareness, you touch everything.”
Poetry, and the Tree of Life