My friend recently died of breast cancer. She was an amazing woman who lived fully until the end. Everyone who knew her loved her, she made everyone feel special. I hadn't known her all that long or even that well but she had an impact on my life out of proportion to our time spent together. When her cancer recurred, I wanted to do whatever I could to help. One of the things I was able to offer was massage.
Our first massage was a general full body relaxation massage. She loved it. She had been having trouble sleeping and it left her feeling so relaxed that she felt as if she could fall asleep. I told her I would come and give her massage whenever she wanted. She stayed pretty busy in spite of the illness and so several weeks passed before I gave her massage again.
Before our second encounter, she had sent a message asking if I could teach her any pain management techniques; the medication she took for pain was not always effective. The question gave me pause. I spend a lot of time reading about pain science, discussing it with other manual therapists, and working with clients with injuries or chronic pain. This, however, was different and I wasn't exactly sure how to approach it. I knew there was a little research that showed that massage could help lessen pain in patients with cancer but I had no experience with it personally and wondered if I had anything to offer. If part of one's approach to lessening pain is to reduce the threat level, how does one do that when there is, in fact, threat?
A day or two later I saw a physical therapist friend at a social event and asked if he had any words of wisdom. His answer was that he would first assess whether the pain was musculoskeletal or from the cancer and proceed from there. Well, duh, of course! I was so distracted by the cancer that it had not occurred to me that her pain might be independent of it.
When I arrived at her home, we sat and talked about what was bothering her. My friend had gotten to where she was unable to lie on the table and we agreed that lying on her sofa, where she spent most of her time, would probably be easiest for her. She showed me where it hurt. Two weeks prior, she had been repositioning herself when she felt a sudden stab of pain in the area of her lower ribcage and it had nagged her ever since. She wasn't sure if it was from the cancer, which had invaded her lungs, or fluid in her lungs, or if it had occurred because of strain during repositioning. I gently palpated with the pads of my fingers, found an area of tenderness, and placed my hand flat over it, exerting a mild, sustained stretch on the skin. She said it felt good. As I sat there holding this and occasionally replacing my hand in a different place, I told her how I'd been thinking a lot about exactly how to approach her pain or what kind of pain management strategies I might have to offer. On one hand, pain is pain and the same principles should hold true for pain from cancer as other pain. On the other hand, if one goal of manual therapy is to reduce threat, how does one do that in the face of actual threat? I wasn't sure if what I usually told my clients about pain would be very helpful but she was curious to hear it anyway, so I explained how pain works. She found this interesting and thought it could be helpful. Meanwhile, she said the skin stretching was doing a lot to relieve her pain and generally made her feel relaxed.
There was something unique and sacred about those moments we sat together, her lying on the sofa, which had become her home, and my hand on the skin over her ribs, exchanging quiet conversation. We both knew her time on earth was not long and it made our moments together that much more meaningful. There was nothing sad about it, it was calm and quiet and focussed. She said she found my voice soothing; I found her peaceful and honest nature inspiring. At the end of our session, she was amazed that her pain had completely gone and asked me to write down what I had done. As simple as it was, the cancer had also invaded her brain and she could not count on remembering. With it written on paper, if the pain recurred and I was not available, she could have someone else do it. Driving back to my office, I felt transformed by the experience. I walked in thinking I had little or nothing to offer; I walked out knowing I had made a difference in my friend's life and she had made a difference in mine.
About a week later I returned. The pain in her ribcage had left and did not come back but this time her low back ached from lying on the sofa and she had also been getting headaches. Positioning her on the sofa proved unworkable, so I got a straight-backed chair, had her straddle the chair so she could sit facing backwards, and placed a pillow in front of her that she could lean against. This worked. I did the same sort of skin stretching as before over her lower back, which she enjoyed immensely. One of the things I love about the skin stretching is that it is very uninvasive and so it is pretty safe for a variety of situations. I worked around her lower back and then moved up her back and onto her shoulders. She loved it. When it seemed her back had been sufficiently addressed, I turned to her neck, head, and base of the skull. Even though she did not have a headache at that moment, she said it felt really, really good. She marveled at what I was able to do with my hands and how good it made her feel. She was an enthusiastic recipient of massage and it was a pleasure to work with her. Later, I received a message from her that her back felt completely better and when she returned to the sofa, she could see how her position had been creating some strain. Getting some relief from the ache allowed her to feel the strain and then find a less stressful position.
I left feeling a profound sense of gratitude for the privilege of working with my friend. I felt I had learned something very important about the power of touch and being fully present for another person, especially one who is facing the end of their life. Not every massage therapist has the inner resources to do this kind of work and there is no shame in admitting one is not cut out for certain types of work. It would be better to recognize that than walk into a situation where one's own anxieties interfere in being fully present for one's client.
I learned again that bringing even temporary relief can have value and that small interventions sometimes have an effect greater than we would imagine. I was reminded of how valuable honest, caring human interaction can be. There was no sadness in our time together but, in fact, a quiet joy. My friend was not dying of cancer, she was still fully living every day with enthusiasm, gratitude, grace, and humor.
That was the last time I saw her. She passed away sooner than expected. At the end of our last session together, I asked if she would mind if I wrote about our experience and she gave her permission with enthusiasm. I hope that by sharing this experience, it might help others who are living with cancer or facing the end of their life to find some comfort and ease through massage therapy. Studies have shown that massage can reduce the pain of cancer and improve quality of life. I'm glad we have the research because it may make massage more accessible for those who could benefit. This one very human story, though, is what I really want to share.
In memory of Elaine Goble Dandridge, who wanted us to remember her by finding laughter wherever we can.
For more information about studies on massage and cancer patients, see the section on cancer in the Classified Massage Therapy Research database.
Massage therapist, author, and instructor Laura Allen generously offers her online 1.5 credit hour course for massage therapists, the Ethics of Working with People with Cancer free of charge. Thank you, Laura Allen!