Marianne Tavares rscj

My Work with Complementary Therapies in Healthcare

“Supportive and palliative” care are terms currently used to describe what has been known as palliative care. Palliative care is the active holistic care of patients with advanced, progressive illness, but many aspects of palliative care are also applicable earlier in the course of the person’s illness. Supportive care is that which helps the patient and their family to cope with cancer and treatment of it – from pre-diagnosis, through the process of diagnosis and treatment, to cure, continuing illness or death and into bereavement. St. Gemma’s Hospice is a specialist palliative care unit. This means that patients not only have advanced, progressive illness, but their symptoms are complex and require treatment from the variety of approaches that is within a multi-professional team.

My experience of working at St. Gemma’s reminds me of my work with people with HIV/AIDS. Working with people who live with a life-threatening illness puts me in touch with “what’s really important in life”. It is then much easier to let go of what’s been eating me! Patients often come into the hospice wary and full of fear, and it may take them a few days to settle down. It is part of good nursing care to help people settle in, while gently identifying key problems which are causing distress to the patient.

My own role is many-fold: I have been grabbed in the corridor by a nurse, saying: “So glad I’ve caught you! Can you come and help us with this patient who has just come in and who is in a total panic.” I ended up supporting /holding her sitting at the edge of the bed, and encouraging her to just ‘rock’ gently, while murmuring gently and repetitively that she did not have to stay still, that she was OK as she was, that she was not alone and was very safe. It was not immediately evident on admission, but the picture emerged that her panic was ‘terminal restlessness’, which happens with some patients. She died peacefully that night.

I was asked to see a 50 year old woman who norm ally takes great pride in her appearance, and who had undergone radical and disfiguring surgery (tongue and voice box removed, tracheostomy fashioned). She was waiting for radiotherapy to her head and neck, and was being fed via a permanent tube in her stomach. When we first met, she was smoking, had a scowl on her face, and I thought she was going to tell me to “f… off”. I held her jaw which was where she had pain, and gave her a Reiki treatment, then gently massaged her head and shoulders. She was sitting on a chair and gradually relaxed enough to lean her head against me, which told me that something had changed within her. She lay down on her bed afterwards, smiling, less aware of her pain, and mouthed “thank you”.

I was asked to see a man who was fed up and wanted to go home. However, his sister needed him to be able to transfer from bed to chair before she could manage to continue caring for him at home. He told me that he wanted to be more independent, and was outwardly cheerful, yet had not made any attempt to engage in rehabilitation activities. I massaged his legs, and encouraged him to simultaneously visualise himself at home, transferring from bed to wheelchair and back again – and see himself somewhat more independent. I heard later that that afternoon he started to work with the physiotherapist and occupational therapist.

I have massaged a woman who had had a relapse, and who asked specifically to see me as an outpatient. She did not know what she was feeling when she came, just that she could not pray and was just generally ‘down’. At some point in the massage I noticed that her eyes were blinking rapidly. This continued for some time, so I asked her gently what was happening. She told me about feeling afraid, and I can’t remember what my response was, but when we continued the massage, what came to her, through visualisation, was the parable of the storm in the sea and Jesus calming the storm. She was fine afterwards; once she knew the feeling was fear, she knew what she needed, and no longer felt depressed. She only needed to see me one more time, then she saw the acupuncturist to help her with anticipatory nausea during chemotherapy.

I have massaged carers who have then become open to receiving counselling support for their emotional needs. As a complementary therapy team, we have been known to massage and support very stressed carers (and patients) over the last 2-3 years of a patient’s life.

I used to offer staff massage regularly, now it’s “whenever we can”. Like most other hospices we are dependent on volunteer help, and staff massage now depends on the availability of volunteer therapists.

The terms “skillful touch”, “essential touch” and “the art of aware communication using touch” are used to describe touch as sensory education, in which the practitioner is the facilitator. Skillful touch is said to stimulate self-awareness, re-awaken the sense of self that is beyond the physical, and restore in the person some sense of control in a seemingly powerless situation. In my experience, when a person responds to touch and relaxes deeply, they go into a space within themselves where something happens – some things are processed, inner strength or energy for their journey is renewed, peace is found, and/or they are enabled to gradually let go of what they need to let go of. Most of this is done non-verbally and, more often than not, they cannot articulate what has happened. Transformation happens at many different levels and, for me, it is always a privilege and very rewarding to witness it.

In the last three years, the other part of my work has been research, writing and lecturing on the same subject as my clinical work. The development of the National Guidelines for the Use of Complementary Therapies in Supportive and Palliative Care lead to a small project to develop a Guide for Writing Policies, Procedures and Protocols – a very dry topic, quite a conversation stopper, but I’m afraid my brain also works that way! I loved researching and writing it, and it is currently going through the publication process at Hospice Information.

I am currently writing a chapter in a book on massage and bodywork in cancer care. My chapter is entitled “Integrating Massage and Bodywork”. I will focus mainly on the key roles and different perspectives within the many professions that make up the multi-disciplinary team. The decision to focus on this comes from my reflection on the specific and overlapping roles in multi-professional teamwork, but it means sticking my neck out again! I am learning so much - my research has already shown that no one profession has a monopoly over the physical, psychological, spiritual and social care of the patient: this may not go down well with some people! I can risk sticking my neck out, when necessary and for something important, because I am an rscj; when I am able to act with integrity and compassion, it is also because I am an rscj – and have all the spiritual, emotional, practical and financial support that goes with being one. So … thank you to all of you.