[Written while listening to this because we’ve all been there. Comments are welcome below.]
When we become massage therapists, there is a set of moral guidelines we vow to adhere to. “This is okay to do but that is clearly not okay; this is permissible if you do x,y,z first but, under NO circumstances whatsoever is that allowed”. Our code of ethics is not to be violated at any cost. It isn’t always so black and white, but for the most part I’ve stuck to the code staunchly.
A few questions to ask after reading this (please feel free to reply in comment area):
- What would you have done in this instance?
- What would you have done differently?
- Have you ever encountered a challenging circumstance you felt unprepared for and if so, how did you handle it?
The following is a true story. It brought up many emotions as I recounted it and for the first time, I felt compelled to put it out there. 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 live peacefully with myself:
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 “Paul” (not his real name). Paul was referred to me by another trusted client I worked with for a couple of years, until he moved out of state. One day, 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, Paul called and we set up an appointment. General relaxation. Stress relief. Good phone vibe. “See you next week.” Business as usual.
Paul was staying in a hotel in Soho in New York. One of the more “elite” (I hate that word in reference to anything but athletics) expensive hotels. He was staying there as if it were his apartment. Paul was clearly financially well off in life and the concierge knew exactly who I was going to see. It appeared he made a distinct impression on the hotel staff 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 like he was in his early 60s and in relatively decent shape. He was SUPER tan. You could tell he spent all of his free time bronzing 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 and emanated the warmth of one, too… like the uncle who always gives the best advice in the fewest words, followed by a firm pat on the back with an unspoken you’re gonna be ok, kid. If I could pick one word upon first impression, it would be kind. This man was gentle and kind. We shook hands upon meeting and his handshake affirmed my first impression. He smiled like someone who would be proud and accepting no matter what you may or may not do in life. I moved in to set up my table.
The room definitely looked lived-in. 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 was a hot summer day and it is also a huge pain in the a** to transport a massage table through NYC). I was annoyed but got over it. He apologized then I felt bad for getting snappy. He hurriedly filled out the intake, we did the informed consent thing, and I went to wash up in the bathroom while he lay down on the floor “mat”.
Moment of truth
Paul was in the prone position and I was about to begin the massage 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 alcohol was what I was smelling. It undeniably was. I was taken aback and wasn’t sure how to proceed because he did not appear drunk and I wondered if my brain was making it up. So, I began doing warm-up compressions on his back while trying to formulate how to handle the situation. Then I 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 but I’m not drunk”. It was around 3pm at the time of his appointment. I believed him, but the smell of alcohol rising from his skin told a different story. After another long pause he said, “My medication is on that table”, and pointed at a plastic orange pharmaceutical container that was next to some Motrin or Advil or something like that. I asked what the medication was for (it was not included on the intake form). He said it was for his addiction. Paul was a high-functioning clinical alcoholic.
For the first time in a very long time I was confused about what to do even though the words contraindication contraindication contraindication kept popping up in my mind. I took a deep breath and removed my hands from his body and admitted, “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’s the best I could come up with.
Paul replied, “I totally understand”, and put cash for the session in my hand. Then he apologized. I noticed he apologized a lot. And without thinking about it, I blurted “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 do much gentler work that can calm your nervous system. But there will be little to no pressure”. He said “That’s fine”. I placed my hands on his back again with less pressure than I am 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.
Paul was not creepy at all. If I sensed an iota of shadiness, I would have copped a serious attitude, demanded payment like a mafia enforcer, and darted out the door (something I’ve had to do on more than one occasion in my earlier years, before I developed the massage-therapist’s-6th-sense-creeper-radar). Paul was, however, clearly in pain. I won’t get esoteric here, but ETHICALLY I did not feel I could abandon my work at that moment. Maybe it was counter-transference, but something 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, being there felt like the right thing in this unprecedented circumstance. Damned if I do, damned if I don’t… who knew there could be irony in ethics?
I proceeded down his back with light and steady pressure and he continued to breathe deeply and rhythmically. Then I instructed him to turn face-up. I put both hands over his feet and noticed he was sniffling, which you know almost always happens when you flip someone over. But they were different kinds of sniffles and his body was tensing again. Paul was starting to cry. “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 Paul effected some part of me. I kept hoping he was o.k. A couple of hours later, I called and left him a voicemail saying, “just want to check in and make sure you are o.k.” and left it at that.
A week or so went by and I got another call from Paul. He wanted to schedule again and said that the light pressure work would be fine. I agreed with the caveat 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 chose to believe 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 took the form of a pain medication (although a poor choice in one) and I knew I was no one to judge him. Nor would I deny him of a service he may benefit from on some level because my job is to provide comfort. 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 already have. I knew it was not my business or my responsibility, but again it gnawed at my gut. I decided 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.
I saw Paul a few more times before he left the city. He took to calling me “kiddo” a lot, 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. Most of his stories were followed by pearls of wisdom he picked up as a result. He never spoke about Vietnam. 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 felt calm with me and like he could really relax. He once said he trusted me and that felt huge. I knew this had nothing to do with my technique or skill because what my hands were doing was minimal. I was merely being present with him. That may be all, but it required a lot of ego-checking-at-the-door from me before every visit. If he was able to feel some modicum of relief for 60 minutes at a time, it was likely because I never judged 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.
May I never see in the patient anything but a fellow creature in pain.” – The Oath of Maimonides
Paul set one last appointment before leaving NYC. I arrived as usual to check in with 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”.
I walked into the restaurant and looked around. Again, it was about 3pm so the restaurant was pretty empty except for a man sitting at the bar and the bartender who was still prepping for his shift. I walked up behind where the man was sitting. “Paul?” 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 was what I almost wanted to order.
I couldn’t believe it. I was so angry I think I clenched my hands. I was disappointed. Furious. 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. Like, RIGHT NOW.”
He answered by pulling out a stool and gesturing for me to have a seat. I reluctantly obliged the war hero. He said, “I probably won’t be coming back to the city for a while and just 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 a little and hopelessly chuckled. I will never forget it.
He motioned the bartender over, then looked at me and asked, “Pellegrino?”. 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. He insisted I take the payment for the session, although I felt weird about doing so. I said “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”. I’ve never been one to hold a grudge.
It was the last time I ever saw Paul.
My only regret
Months went by and I was travelling through the south with some friends (we were in a band together and on a tour– I used to play a lot of gigs in a former life). My bandmates went in a store somewhere and I stayed outside enjoying the air. I went into the van for something and noticed there was a missed call on my cell phone.
I played the voicemail. It was from the client who introduced me to Paul. He called to tell me Paul had passed away. Organ failure. He also thanked me for helping his friend and added there was nothing more that could be done. “Paul was very fond of you. Thanks for being there for him.”
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 all meant. Looking back if I knew the moment at the hotel restaurant bar was to be the last time I ever saw Paul, there is only one thing I would have done differently: I would have ordered a scotch on the rocks, too. Then I would have raised a toast to him and clinked his glass. And I would have said thank you for your service, Sir, and thank you for trusting me.
Rest easy, “Paul”. Enjoy your peace.
This post is in honor and memory of him and a reminder that although nobody is perfect, everyone deserves a moment of respite.