It was a routine I had repeated many times: drive to the home of my client, Pat, about 25 miles from my office, carry my table through her kitchen and into her bedroom, set it up in a narrow space between her bed and a window-side chair, and give her a massage tailored to the limitations imposed by her metastatic cancer. Over time, and inevitably, the routine began to change.
I had been visiting Pat for more than two years, starting when she was referred to a nonprofit program I founded that provides free massage to people with cancer. Pat had extensive and growing tumors in her abdomen and pelvis, so moving around was difficult and painful. Getting on the table became impossible, and I started working with her on her bed. The end of her long journey was getting close, and my massage visits to her home—which she shared with her daughter, son-in-law, and two young grandchildren—became more frequent. We’d had a lot of wonderful talks before, but in her last weeks she was often too tired to converse, and then she was not awake at all. She died shortly after my last visit; her daughter sent a note to my nonprofit later to express how the visits had helped her mother, and her.
“At the end of her life, Mom was agitated. She was frightened, sad, angry, and upset. Steve came to give her a massage, and what happened then was truly amazing! I was holding my mom’s tight hands, and I felt her completely relax. I relaxed with her, and it was as though we were transported somewhere, together, in a total state of relaxation and meditation. I have gotten to that state before on a couple of occasions, but to do it with my mom, at such a crucial time at the end of her life, was such a gift. She never tensed up again. She passed away very peacefully and left our house with a smile on her face.”
How do we end up with our particular massage careers? Not just the career in massage, but the one within massage: the focus that we choose, or that chooses us. Sports, deep tissue, relaxation, myofascial release, geriatric, pregnancy, and who knows how many more. In spas, on cruise ships, in doctors’ offices, and physical therapy practices. In home offices and airports. It’s all massage. If we’re lucky, we find the focus we want, maybe need. I have a regular massage practice I love, but much of what I do as a massage therapist is with people who have advanced cancer, often people near death, through that nonprofit program called The Hand to Heart Project. Pat’s story explains why.

A Winding Road
I came to this work unexpectedly. After more than two decades in newspaper journalism, I began a massage training program with no thought that I would do anything specific. Just massage. But within two months of starting school, three people in my life were diagnosed with cancer. That led me to a connection with a therapist who had been providing massage to cancer patients for more than 20 years (and is still doing it more than 15 years later). I began working with her once a week massaging patients, mostly oncology patients, at a nearby medical center. Eventually, I began thinking it would be nice to offer massage to people when they left the hospital to recover, or to continue their treatment from home, or to die.
One afternoon, I went to see a patient who was about to be sent home under hospice care. She was a single mom in her 30s, and she had painful bone cancer. After I’d done maybe 20 minutes of mostly neck and shoulder massage, she sighed and said, “For the first time in months, I don’t hurt anywhere.” She also said she couldn’t afford to have a massage therapist come to her home. That did it. The beginnings of The Hand to Heart Project can be traced to the days after that experience, and to the help of a couple of clients who had become friends, and who offered to provide invaluable support.
I have counted my blessings many times since then. My massage career is as varied as possible, but with a heavy emphasis on working with people who face enormous challenges. I have great faith in the power of touch and compassionate presence to provide comfort.
The number of people being trained in oncology massage today is increasing by leaps and bounds, it seems, which can’t be a bad thing, even if many or most of them don’t end up working much in that field. I went about it differently, though. The nearly 10 years I spent at the medical center seeing patients one afternoon each week amounted to an apprenticeship. Over the years, I saw people with every imaginable type of cancer—from the common to the unusual. Colon cancer that never showed up in the patient’s colon, but did produce a tumor in the woman’s right orbital bone. A rare eye cancer. Breast, lung, and brain cancers of all types. Ovarian and endometrial cancers. Melanoma in a young woman who was the first person I worked on who was dying of cancer and who was younger than my son—a sobering experience. Stage IV lung cancer that never appeared in the patient’s lungs, but was instead diagnosed because it had spread to, and destroyed, his left femur.
The patients varied even more than the cancers. A middle-aged woman who had lived a holistic, organic life, and who cried and cried because she felt she had no choice but to allow the poison of chemotherapy into her body. A young woman approaching her death who was incredibly grateful and gracious, never sounding bitter or angry, and generous of spirit to the moment she died. A new mother who was dying of breast cancer that had been diagnosed while she was breastfeeding, and who delayed treatment until she weaned her baby, but then it was too late to halt the cancer’s spread. A dying man whose wife told me he had been abusive throughout their marriage.
That last was a challenge to my efforts to be present for everyone I work with, but not as much of a challenge as another patient turned out to be. He was in his bed resting when I arrived in his hospital room, with a prison guard sitting in the corner. The patient was a Vermont inmate, serving a long sentence for rape, a sentence his liver cancer wouldn’t allow him to complete. I may have had less compassion in my heart for that session than I normally do.

Training Versus Feeling
I’ve been asked if people need to be trained in oncology massage before offering massage to oncology patients, and most people probably assume that answer is yes. But it depends on what you mean by trained. As I mentioned, an unprecedented number of massage therapists are going through oncology massage programs now. But as it happens, none of the massage therapists I currently have under contract in The Hand to Heart Project have had oncology massage training, although one is a licensed practical nurse who began her nursing career in oncology before transitioning to providing massage to cancer patients. However, they all have life and work experience that makes them well-suited to the task.
I’ve talked with people who have had oncology massage training whom I would have confidence referring a cancer patient to; I’ve met others who seem to be more focused on the technical side of oncology massage than the human side. There certainly are important things to learn about working with people with cancer, but the question brings to mind a realization I had some time ago: when I work with people through The Hand to Heart Project, the skills I draw on are less about working on a person who has cancer, and more about being with a person who is suffering. It’s the suffering part that is so important. We are all suffering, even if the suffering can appear uneven from person to person. Everyone we touch is suffering. Every massage is a connection with someone else’s suffering—a connection between theirs and yours. It’s in that space between that important work is done.
Working with people facing illness has changed my relationship with my own mortality; I think I’m more accepting, even while I hope my life is a very long way from ending. I have had relationships of profound depth that I never had—never could have had—in my years at newspapers. Some of the most amazing relationships I’ve ever had have been the shortest.
It’s also true that I have found myself in many situations that didn’t come up in my massage training. I have lost a lot of people I came to care a great deal about, which can weigh heavily. Even though there have been hundreds of such deaths, I almost think I could name them all. I couldn’t, I know—it just feels that way. And there have been lesser challenges. Twice I have had to help people up off the toilet before a session because they didn’t have the strength to stand. And we didn’t cover picking people up and placing them on the table in any of my classes. I’m pretty sure it would have been discouraged. (It’s possible I have an advantage there, in being 6 feet, 7 inches tall.) I remember being told never to work on someone diagnosed with deep vein thrombosis. I’ve since learned that it’s fine, under the right circumstances, with appropriate touch, and I have done it many times. I love seeing clients’ dogs and cats when I visit homes, but I wasn’t prepared when a man’s golden retriever jumped onto the table, only a week or two after he had been in surgery to put a rod into his leg to stabilize a cancer-eaten bone. Or when a woman’s seven Pomeranians all yipped and scurried around the table during a massage.
Because of The Hand to Heart Project, I found my way to an integrative health center in Hanover, New Hampshire, where I have my private practice. That led to a collaboration between me and a psychotherapist at the center in developing a three-day NCBTMB-approved workshop called “Trauma, Cancer, Presence, Touch.” The Hand to Heart Project also led me, rather circuitously, to cowrite a book with a Dartmouth College professor titled Let’s Talk About Death: Asking the Questions that Profoundly Change the Way We Live and Die (Prometheus Books, 2015).

More to Learn
The book and the workshop, though, are secondary benefits. I do this work because of the relationships—the stories I get to witness and become part of. A few years ago, I began what turned out to be a short series of visits with a man who was fast approaching the end of his life. He’d never had massage before, but his wife encouraged him to try it when a hospice nurse suggested it. He took to it quickly. For the first few visits, he was able to get on the table. After that, he would stay in his bed, and eventually he wasn’t very awake for the massage. His wife wrote this note after my last visit with him, which came just several hours before he died.
“[My husband] had a very restless night and couldn’t get comfortable, and in the morning his breathing was very labored and noisy. Amazingly, Steve appeared on our doorstep to give him a massage. Steve worked on him for quite a while, and when he was finished, the difference was remarkable. [My husband’s] breathing had eased and he was able to fall into a quiet sleep. Such a relief! Our hope was that he could stay in his home and pass away peacefully, and that is actually what happened. Early in the evening, he just fell into a deeper sleep and we were all able to be there as he quietly just stopped breathing.”
Here is another thing I realize over and over again as I go about this work: the amount that I know will always be dwarfed by the amount I don’t know. There is always more to learn from every person I see. I can be surprised at any turn, which is a great thing in a career choice.
In his novel The Notebooks of Malte Laurids Brigge, the 20th-century poet and philosopher Rainer Maria Rilke provided a brief passage that I carry in my mind constantly: “I am learning to see. Why, I cannot say, but all things enter more deeply into me. Nor do the impressions remain at the level where they used to cease. There is a place inside of me of which I know nothing. Now all things tend that way. I do not know what happens there.”
Life, death, and mystery. What more is there?

Steve Gordon (contact@handtoheart project.org) is a licensed massage therapist in New Hampshire. He is the founder and executive director of The Hand to Heart Project, which provides free massage and compassionate touch to people with advanced cancer (www.handto heartproject.org).
He is coauthor, with Irene Kacandes, PhD, of Let’s Talk About Death (Prometheus  Books, 2015). He is also coleader, with Erica Zinter, LICSW, of the massage therapy workshop “Trauma, Cancer, Presence, Touch.” For information about the workshop, contact Gordon at gordons.cornish@gmail.com.