Massage, Ethics, and the Pain of Addiction

May 8 / Tania Velásquez
Originally published on May 8, 2017


When we become massage therapist's, we have a set of moral guidelines we vow to adhere to. "This is okay, but that is clearly not okay; it is permissible if you do x,y,z first, but under NO circumstances whatsoever is THAT allowed". Our code of ethics are not to be violated at any cost. And for the most part, I've adhered to them staunchly. Some might say I'm a square when it comes to work.

The following is a true story. Though it creates some internal conflict, I would not have done anything differently. My problem is, if I did take the textbook "ethical" course of action I likely would not be able to be at peace with this.

Jim

This is about a particular client I had 10-ish years ago (a little over 1/2 way into my career). We will call him "Jim" (not his real name). Jim was referred to me by another trusted client I had worked with for a couple of years until he moved out of state.

One afternoon, my steady client called and said, "Hey, I have a really good friend staying in the city for a while and he needs some work done. I gave him your number because I think you'll be able to help". I said, "Sure!" and Thanks!", and assured him I would do my best. Nothing seemed out of the ordinary.
A couple of days later, Jim calls and we set up an appointment. General relaxation. Stress relief. Good phone vibe. "See you next week." Business as usual.

Business as usual

Jim was staying at a very well-known, high end hotel in Soho. He was staying there as if it were his apartment. He was clearly financially well off in life and the concierge knew exactly who I was going to see. It was clear the hotel staff was fond of Jim and I thought "Wow, he must be a really fun and nice guy!" Up I went.
I arrived at his room and he opened the door with a warm hello in a deep, mellow, radio DJ voice. He looked about 60 years old maybe and in relatively decent shape and was SUPER tan- you could tell he spent all of his free time on beaches.

Clean haircut, fashionable jeans, pastel collared-button shirt. I don't know why I remember the details of his outfit, but I do. He looked like the nicest uncle anyone could ever have -the uncle who always gives the best advice in the fewest words then gives a firm pat on the back with an unspoken "you're gonna be ok, kid"- and he emanated the warmth of one, too.

If I could pick one word upon first impression, it would be "kind". This man was gentle and kind. We shook hands and his handshake affirmed my first impression. He smiled like a proud uncle who is proud of you no matter what you may or may not do in life. I moved in to set up my table.

There wasn't much room for the table and the hotel furniture was immovable. So I improvised a floor set-up and mildly chided him for not letting me know there wouldn't be enough room for the table (it is a huge pain in the a$$ to transport a massage table in NYC on a hot summer day).

I was annoyed but got over it. He apologized then I felt bad for getting snappy. He filled out the intake and we did the informed consent thing and I went to wash up while he lay down on the floor "mat". 

Alcohol

He was in the prone position and I was about to begin when I noticed the faint smell of alcohol. It was not coming from his breath, it was coming through his skin (kind of like how a heavy smoker wears the smell of smoke). I actually leaned over him a little to make sure that's what I was smelling. It undeniably was.

I was taken aback and wasn't sure how to proceed because he did not look or appear drunk and I was wondering if my brain was making this up. So I just began doing warm-up compressions on his back while trying to formulate how I was going to handle this situation. Then I suddenly asked, rhetorically, "Is it me, or do you smell alcohol?" 
At that instance, his body tensed enough to answer my question. There was a long pause and he replied, "I had a drink earlier today (it was around 3pm at the time of his appointment), but I'm not drunk". I believed him, but the smell of alcohol emanating from his skin told a different story.

After another long pause he said, "My medication is on that table", and pointed at a small orange pharmaceutical container that was next to some Motrin or Advil or something like that. I asked what the medication was for. He said it was for his addiction. Jim was a highly functioning clinical alcoholic.

The moment I stopped being a massage therapist and became a human being


For the first time in a very long time I was very confused about what to do even though the words contraindication contraindication contraindication reflexively kept going through my mind. I took a deep breath and took my hands off of his body and said, "I'm not sure how to go about this, but I can't work on anyone who's been drinking because it's a (yes, I said the word) contraindication". That was the best I could come up with on the spot.


Jim replied, "I totally understand", and moved to reach for his wallet on a table and said he would give me cash. Then he apologized. I noticed he apologized a lot. And without consciously thinking about it, I added "I won't be able to give you the bodywork you wanted (which would have been a Thai-style hybrid on the floor), but while I'm here I can offer much gentler work that will just relax your nervous system, but there will be little to no pressure".

He said "That's fine". I placed my hands on his back with less pressure than I'm using to type on this keyboard, and invited him to take a deep breath. He did and the initial tension that sprung into his body began to dissipate. 

Jim did not give off a single red flag. If I sensed an iota of shadiness, I would have copped a serious attitude, demanded payment like a mafioso, and then bolted out the door (something I've unfortunately had to do before in my earlier years). Jim was, however, clearly in pain. I won't get meta here, but ETHICALLY I did not feel I could abandon my work at that moment.

Maybe it was counter-transference, but it was gnawing away at my gut and I made the call to alter the treatment plan and continue anyway. Contrary to all I've learned and even teach, that felt like the right thing to do. Damned if I do, damned if I don't...


I proceeded along his back with light and steady pressure, he proceeded to breathe deep and rhythmically, and then I instructed him to turn face-up. I put both hands on his feet and noticed he was sniffling, which as you know almost always happens when you flip someone over. But they were different kinds of sniffles and his body tensed again. Jim was starting to cry. Not full on crying, but for a very heteronormative male, it may be considered as such. I asked, "Are you o.k.?"

He said yes.

But I stopped anyway and got him a glass of water and suggested he sit up for a moment to drink some. He was looking down and said "I was just remembering something". And there he sat and I just sat next to him on the floor, eventually placing my hand on his shoulder to let him know the time of the session was nearly over. "Would you like me to call someone for you?" He said he had a sponsor he could call and I suggested he do so ASAP. 


I packed up and left, but Jim affected some part of me. I kept hoping he was o.k. I called and left him a voicemail a couple hours later to say "just want to make sure you are o.k." and left it at that. 

Rebooking

A week or so went by and I got a call from Jim. He wanted to schedule again and said that the light pressure work would be fine. I agreed, however, stating that he must not drink beforehand. He agreed. Business as usual.

I showed up and set up on the floor (did not lug my table this time). His body still had the faint smell of alcohol. I asked him if he drank earlier. He said no. Jokingly/not-jokingly I asked him to pinky-swear. He did and I believed him.

He was very talkative during this session, where I learned he was a Vietnam veteran. I was working on a war hero and it allowed me to empathize with his addiction. I understood alcohol was his pain medication and I was no one to judge or deny him.

My only job was to provide comfort in the only way I knew how. He fought for my freedom and at that point I told myself I would not turn my back on this client. From what I gathered, many people have. I knew it was not my business or my responsibility, but again, it gnawed at my gut and I decided that as long as his condition did not get worse, I would continue to see him as a client and offer therapeutic touch. The session ended.

Relapse

I saw Jim a few more times before he left the city. He took to calling me kiddo, even though I was in my 30s at the time. He told me many stories that contained the phrase "I was so drunk I...", which isn't exactly funny but he was able to laugh about it and in turn so was I.

I learned he had a daughter he was working on his relationship with. At one point he confessed he didn't feel comfortable with many people but he felt calm with me and like he could just relax. I knew this had nothing to do with my technique or skill because what I was "doing" was minimal. I was merely being present with him, unconditionally. That's all, but it did require a lot of ego-checking-at-the-door from me.

I think he was able to feel some modicum of relief for 60 minutes at a time only because I did not judge him. Transference, counter-transference, label it whatever you want. I genuinely cared for this client as a person, as a human, and yes, as a friend. 


The last time I saw Jim before he was set to leave, I arrived as usual at the concierge. But instead of pointing me to the elevators he directed me to the swanky restaurant on the lower level and said, "He's in there".

What? Ok.


I walked into the restaurant and looked around. Again, it was around 3pm so it was pretty empty except for a man sitting at the bar and the bartender who was still prepping for his shift. I walked up to behind where the man was sitting. "Jim?" He turned around and said "Hey, kiddo. What are you drinkin'?" On the counter in front of him sat a scotch on the rocks, which is what I almost wanted to order.


I couldn't believe it. I was so angry. I was disappointed. I felt betrayed. I said nothing and just stood there for a moment sifting for the right response. I finally came up with, "What the hell are you doing? We have an appointment." 


He answered by pulling out a stool and gesturing for me to have a seat. I obliged the war hero. He said, "I probably won't be coming back to the city for a while and I wanted to say thank you". And in what I am sure was a pissed-off tone, I said he could thank me by not drinking anymore. To which he kind of dropped his head and chuckled. I will never forget it.

He motioned the bartender over, then looked at me and asked, "Pelligrino?". I half-heartedly said "sure". We chatted for a while. He said he was going boating somewhere in Central America (he loved it there). We finished our drinks and I stood up and gave him a big hug. And he hugged back like family. I said "thank you" and "take good care of yourself", "be good", "be in touch", "don't do anything I wouldn't do haha", and "see you when you get back".

It was the last time I ever saw Jim.

A voicemail

Months went by and I was traveling through the south with some friends. We were in a band together, on a tour (I used to play gigs in a former life). They went into a store somewhere and I stayed outside enjoying the air. I noticed there was a missed call on my cell phone.
I played the voicemail. It was from the client who introduced me to Jim. He called to tell me Jim had passed away. Organ failure. He also thanked me for helping his friend and there was nothing more that could be done. "Jim was very fond of you. Thanks."
I collapsed into tears. I've lost clients due to illness and disease before, but this was different and I'm not sure how. It has stuck with me and I am still learning its lessons and attempting to articulate what it might have meant, here.

Looking back if I knew that would have been the last time I would have seen Jim, there is only one thing I would have done differently: I would have ordered a scotch on the rocks too, and raised a toast to him and clinked his glass and said "thank you, it's all good". 
Rest easy, Jim.
This post is in honor and memory of him, and a reminder that nobody is perfect and everyone deserves care.
Questions: What would you have done in this instance?What would you have done differently? Have you ever encountered a challenging circumstance, and if so, how did you handle it? 
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