A Day in the Life

The Many Faces of Hospital-Based Massage and Bodywork

By Shirley Vanderbilt

Originally published in Massage & Bodywork magazine, June/July 2000.

Displayed in the hallway of the Health Center of Integrated Therapies in Longmont, Colo., adjacent to Longmont United Hospital, weathered photos of early 1900’s hospital wards depict a cold, spartan environment where patients sit in straight-back chairs at the foot of a row of metal beds, neatly lined up like soldiers at attention. The solemn countenance of the patients’ faces reflect the stark mood of these lifeless rooms. In this early, institutional version of the healing place, the only resources available for rehabilitation were the skills of the medical staff and the perseverance of the patient.

We have learned, or rather remembered, much about healing during this past century. Medicine as an art and a science is returning to its roots, that of the ancient medicine men and women who combined their earthly remedies with the power of touching body, mind and spirit. Ushering in this new age of enlightenment in health, Longmont stands as a paradigm of holistic care, focused on the patient’s comfort and human dignity. Here the emphasis is on a nurturing environment, encompassing not only the warmth of the decor but also the tangible curing power of human touch.

Longmont is one of an increasing number of hospitals based on the Planetree model, a revolutionary approach to health care founded in 19781. The Planetree model provides a humanized and personalized atmosphere attending to the heart, soul and spirit of the patient. Meditative gardens, family rooms with kitchens and home-style furnishings in hospital rooms exemplify the material substances provided in this setting. But far beyond these conveniences, the Planetree philosophy is reflected in a reverent respect for the patient’s spiritual and emotional needs.

It seems serendipitous that the growing demand of the Longmont community for increased alternative medicine choices would combine with the visionary leadership of Longmont United Hospital (LUH) administrators to create this haven of holistic care. Through the combined efforts of both, Health Center of Integrated Therapies (HCIT) was established in 1994. Beginning simply with massage therapy and t’ai chi, the center gradually added services and grew steadily with the support of the hospital and its clients to become one of the largest hospital-based alternative therapy programs in the country.

On paper, the program’s statistics of success are impressive. But the real energy of its accomplishments lies within the gentle, healing hands and hearts of the center’s practitioners and their relationship with patients. The therapists’ days are long, their patience enduring and their challenges sometimes overwhelming. Their rewards come in small, measured amounts — a smile from a cancer patient, a “thank you” from an exhausted new mother, enthusiastic verbal support from a staff physician. They work in a world of physical and spiritual energy, supporting their patients and each other as they strive to bring balance to the ill within this healing space. Their daily routine is not so much a “routine” as a constantly challenging symphony, the flow ranging from adagio to staccato and back again.

To gain some insight into the realities of life for these hospital-based therapists, Massage & Bodywork was invited to follow along for a day as the HCIT staff attended to their patients, juggled schedules and reflected on their work.

7 a.m. — The day begins as the sun, barely clearing the horizon, scatters a warm glow along large rocks in the Zen garden at HTIC’s entryway. I’m greeted by Lucy Gaspervich whose bright smile and radiant energy is enough to turn anyone into a morning person. A former pilot and engineer, she now offers her skills as a massage and Reiki therapist, in addition to handling scheduling and a host of other problem-solving duties at the center. Gaspervich’s non-stop movement, as she switches from answering phones to answering my questions, gives me my first clue as to how this day will proceed. Having attended to necessary paperwork and checking on the day’s schedule, she indicates we’re ready to begin seeing patients at the hospital, just one block away.

8:15 a.m. — Barbara Mallot, seated on the edge of a gurney in the pre-op area of Longmont’s surgical unit, is scheduled to undergo a myelogram for the fifth time. The procedure, a radiographic contrast study of the spinal sub-arachnoid space, involves inserting a needle in the spine to remove a measured amount of spinal fluid prior to the injection of contrast dye.2 Because spinal fluid is self-regulated, it will take her body a day or so to regain normal fluid volume and pressure. This procedure is invasive and uncomfortable. Mallot will likely suffer headache pain for a few days afterward, in addition to the discomfort of the procedure itself. In these final moments of preparation, she sits upright on the gurney, the pain of her spinal stenosis too severe to allow her to lay down.

As with all pre-op patients, Mallot is offered massage to help her relax before the procedure. Although apprehensive — she has never received massage before — she allows Gaspervich to proceed. As the therapist opens her bottle of massage lotion, spreading it to both hands, the two talk animatedly about Mallot’s aches and pains and her hopes for better health. The patient’s apprehension seems to subside as she relaxes under Gaspervich’s skilled hands. As the session continues, I talk with Mallot’s husband who sits just outside the drawn curtain. He indicates it will be a long, trying day and expresses concern for the challenge his wife is facing. The session ends with Mallot’s enthusiastic approval of her massage, and an indication that this is something she may want to continue at the alternative therapy center.

As we leave the day-surgery unit, Gaspervich seems more energized than ever, taking me to task to keep up with her as we navigate corridors and move on to another section of the hospital. Sharing her thoughts on the benefits of massage for these patients, she says, “The anesthesiologists say they use less anesthesia, and the patient takes less pain medication after surgery.” Referring to Mallot, she explains that with each myelogram, the patient loses a little function in the spinal column. Gaspervich says she noticed that Mallot’s shoulder was pinched, and although it “came down” somewhat, there was not enough time in their session to completely loosen it. Using shiatsu to move energy back into the tissues, and gentle strokes for relaxation, she has done what she can to prepare Mallot for the impending procedure.

Recent research is validating what Gaspervich and other therapists like her have known for some time. Massage therapy is gaining in acceptance not only at the Longmont hospital, but in care centers throughout the country as medical staff become more aware of the inherent benefits to the patient’s lymphatic system and overall well-being. A recent study at University of Colorado’s School of Nursing reported that massage therapy provided increased relaxation and a positive mood change in patients within an acute care setting. These benefits contributed to more rapid recovery and increased participation by patients in their rehabilitation.3

At Longmont, patients are offered several options. If the massage therapist is not available during the patient’s scheduled arrival and preparation for surgery, a session can be arranged the day before. Some of the center’s clients prefer this, especially in the case of early morning surgeries. Massage services are also offered to patients during in-patient recuperation.

9 a.m. — Lynn Daniels’ assignment this morning is to provide massage to new mothers. Of the two in residence at the hospital’s Birthplace, one has declined services until she is feeling better. A soft-spoken woman, Daniels smiles and says she will offer the new mother massage services again tomorrow. The other new mom, Amanda Bridge, has delivered a baby girl just five hours earlier. The room is darkened and crowded as an exhausted Bridge is surrounded by family and friends. Bridge’s own mother, relishing her new role as grandmother, rocks the baby gently in her arms as Daniels and Bridge discuss the massage services. Although Daniels is ready to proceed, the treatment will have to be delayed. The baby is ready for her first feeding. Daniels agrees to return within the hour and quietly leaves.

Outside the room, Daniels explains that with new mothers, the massage is specific to the mother’s birth process. In her private practice in Boulder, Daniels uses a lot of shiatsu and sports massage, but here at the Birthplace the emphasis is on relaxation. She usually does a 12-minute session on each side, concentrating on the neck and shoulders. In some cases, ankles and feet are worked to counter edema from the pregnancy. The majority of Daniels’ clients have never had massage before, but it’s a rare event when her services are turned down.

9:43 a.m. — With the baby successfully fed and all visitors except the grandmother gone, the atmosphere in the room is quiet and low-key. Bridge has settled under her covers and the grandmother again cuddles the new baby as she stands at her daughter’s side. Bridge smiles slightly as she indicates she is now ready for her first massage. A few minutes into the session Daniels asks, “Is that a little tender in there?” as she works an area of the back. “A lot of women get this lower back pain,” says Daniels. Bridge’s response is barely audible as she sinks into relaxation. “She did a lot of work (labor) at home,” says the grandmother, “and the baby came within about an hour after she got here.” Daniels continues massaging the back and shoulders, checking with her patient about specific needs. As the session ends, Bridge has closed her eyes and appears to have dropped off to sleep.

Not all Birthplace massage sessions are this serene. “If the baby gets fussy,” says Gaspervich, “the therapist may have one hand on the mother’s back and the other on the baby in the cradle.” The therapist may also find herself in the heartbreaking situation of performing massage on a mother who has lost her baby, or whose infant is facing a life-threatening health challenge.

The average stay for new mothers is 48 hours. Massage is offered here every day of the week, 9-11 a.m., for the duration of the mother’s stay. In addition to services offered within the Birthplace, each new mother receives a coupon for $10 credit at HCIT for a full-body massage or baby massage instruction. In some cases, the whole family joins in to learn simple massage techniques for the infant, taught by the center’s baby expert, Karen Martin. For babies less than 30 days old, the procedure involves 12 simple strokes, and for older infants there are more than 40 strokes and stretches that may be included. Plans are underway to provide newborn massage while babies are still under care in the Birthplace. For boarders — those babies held beyond the mother’s discharge date because of complications — massage will continue throughout the baby’s stay. The Longmont approach to infant massage is backed by hard data. In research centers like the Touch Research Institute in Miami, Fla., massage has been shown to increase newborn weight gain and contribute to the baby’s overall health and development.

10:08 a.m. — Cecile Hoff comes to the Hope Cancer Care Center five days a week for treatment for her cancer. It’s a grueling schedule, but a necessary one. To ease the strain of the regimen, and to help her body recover from the invasion of the cancer and radiation, she also receives treatment of a gentler sort. Today is her third session with massage therapist Cynthia Swan. The session takes place in a small office which has been converted to a treatment room, outfitted with a massage table and a supply of linens. Soothing music fills the air as the warm glow of a candle dances along the low-lighted walls.

Hoff, completely clothed, lies relaxed on the table as Swan talks in low tones, directing her client to focus on specific body parts. Swan uses Comfort Touch in which a gentle palmar touch is applied along acupuncture sites. She combines this with craniosacral therapy and Reiki. “The intention is to go toward the center of the body, using the whole palm,” says Swan. Continuing her work on Hoff, she moves down to the feet and back up, then to the head. “I like to do a little craniosacral balancing. It calms everybody down,” she adds. When asked how she feels, Hoff looks up, her mouth curling into a soft smile: “I could do this every day.”

Gaspervich explains that bodywork is essential to this population while their bodies are being bombarded with radiation. “We want to help them be back into their body before treatment,” said Gaspervich. “They are in such an empty place. It is too painful to be in their body. When you see these cancer patients, there’s a blank, empty look. We try to help them reconnect by giving them the space and atmosphere to bring their body and spirit back together,” she concludes.

Hoff is an out-patient at the cancer center, but Swan’s clients may also come from the in-patient unit. Therapeutic bodywork is offered at the center two days each week with Swan scheduled on Mondays and Mary Minor, an experienced hospice nurse, providing Healing Touch on Wednesdays. The treatments are gentle, with the patients remaining clothed either in their street attire or hospital gown, and usually last no more than 30 minutes.

Working with cancer patients can be emotionally challenging for the therapist. “I make sure I’m aware of who I am and where I am,” says Swan, explaining the necessity for boundaries. “I have to remain clear and not drown in the other person’s emotional space.” By remaining as a “presence” for the patient, Swan feels she acts as a conduit for the release of energy. The Comfort Touch approach used by Swan was developed in the late 80s by hospice therapist Mary Rose. Derived from the Oriental bodywork of shiatsu, the technique is focused on relieving pain and providing deep relaxation for the patient.

11:10 a.m. — We stop for a visit at the hospital’s rehabilitation unit. No patients are being seen at this hour, but the unit’s medical director, Dr. Phil Barr, lets me pull him away from this moment of quiet for a few questions. Barr is one of HCIT’s strongest supporters, automatically writing orders for massage, so all that’s required is for the patient to request the service.

“I prescribe for all in-patient and out-patient,” says Barr, who also practices in nearby Boulder. “I make massage therapy available. There is more time and less encumbrance here,” he states, noting that the average patient stay in the unit is 11 days and for the most part, his patients are free of attached tubes and other paraphernalia. Describing the treatments patients receive in this program, Barr says, “It’s not dissimilar to an athlete receiving massage for trauma during the sport. Surgery is controlled trauma.”

“Massage enhances the work of the physical therapists,” adds Gaspervich. “It lessens pain and stiffness and increases the patient’s range of motion, decreasing their rehabilitation time.”

Barr views all hospital services as contributing to the progress of patients in the rehab unit and is enthusiastic about incorporating alternative therapies into his team approach. Before rushing off to meet the demands of a hectic schedule, Barr suggests that in addition to massage therapy, he’d like to see acupuncture made available to his patients.

12:15 p.m. — After a short break for lunch, we’re back at the home base of HCIT, with Gaspervich fielding the staff’s questions and discussing schedules with Michelle Bowman, the center’s program manager.

Bowman, a driving force in the center, is herself a student of acupuncture and will add practitioner services to her current duties once studies are completed. At the moment, she has her hands full in a dual role as manager of the alternative therapies center and PrestigePLUS, the senior membership program. She has watched the HCIT program grow from a single treatment room and a few t’ai chi classes to its current role in providing alternative health throughout the hospital.

“We are laying a foundation for massage as a professional modality in the hospital,” says Bowman. “It is important to have massage therapists on staff, not as contract laborers.” With Bowman’s persistence and the hard work and dedication of the staff, the program is now 100% funded by the hospital and expected to produce revenue in the year 2000. Approximately 20% of the in-house massages result in patients returning for continued treatment at the center; the majority of those are seniors. In addition to massage, the center offers a variety of alternative therapies including acupuncture, Reiki, reflexology, t’ai chi and herbal medicine.

12:50 p.m. — As patients begin checking in, rooms are readied for treatment and therapists prepare for their afternoon sessions. Gaspervich explains that the therapists’ schedules are staggered so that they are available on certain days for in-patient work, and others for sessions at HCIT. Additionally, everyone on the staff is in private practice, which gives them a well-rounded range of experience.

We join Sally Nibbelink in what I call the “mirror room,” as she arranges lotions and adjusts equipment in readiness for her next client. A serene panel of angels displayed on the wall reflects from mirror to mirror, creating a feeling of sacred space. Leaving Nibbelink to her work, we continue our tour of the center. Soon Gaspervich is called back to administrative tasks, fielding calls and questions and consulting with Bowman. My behind-the-scenes look reveals there is more to running the center than simply providing nurturing touch to a client.

1:40 p.m. — With some of the administrative duties cleared out of the way, I have an opportunity to speak with the staff about their personal balance. “How do the therapists stay grounded?” I ask. Each therapist has her own rituals, her own way of clearing, Gaspervich and Bowman explain. For many of the HCIT therapists, a washing ritual following the treatment session — rinsing hands and arms up to the elbows with cold water — is used to clear their energy field. Journaling is also a popular release. For Swan, when working with cancer patients, balancing herself involves using a mentor to help her work through the energy demands of dealing with life-threatening illnesses. “I work with my mentor on my emotional state, my countertransference, clearing out my own thoughts and perceptions,” she says. Swan also uses Reiki symbols to facilitate her clearing process — “To release my energy field from the other person’s energy field. And I do a lot of breathwork at the end.”

Gaspervich, whose heritage is Native American, uses her own form of indigenous ritual to find balance. “Everything in life is a circle,” she says, “layered like an onion.” Noting the physical, emotional and spiritual aspects of life, she continues, “The physical is housing for the soul. And like our car, it needs to be maintained properly to run. I combine the emotional with education, like working on relationships with people. This is why I’m so concerned and deeply involved in being clear. When we work with people, we get into their core. And they’re always connected. You can’t really separate any of it.” Gaspervich believes that “we are all spiritual residents of the earth.” Everything is connected and there is a reason for all, everyone and everything, she explains. In preparation for treatment sessions and to balance herself afterward, Gaspervich meditates and performs rituals which seek the assistance of helper spirits. But her inner work also includes using the medicine wheel and meditating with sacred objects she feels connect her to the Universal energy system. Each sacred object, she explains, has come to her through a spiritual experience with nature or an important relationship with someone in her life.

3 p.m. — With treatment sessions underway, the clinic has taken on the hushed tones of the hallowed place it is. I’ll be leaving soon, but Gaspervich and the other therapists will remain for hours, meeting with clients, sorting paperwork and doing what they do best, providing the healing touch that brings health and balance to others — and themselves.