Ep 2 – Conversations in Quarantine – Interview with Cal Cates – Part 2

A person wearing full personal protective equipment

In Part 2 of our conversation with Healwell’s Cal Cates, Cates describes what it will look like for massage professionals to wear personal protective equipment (PPE) and the psychological aspect of giving and receiving massage in our new normal.

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Author Bio: 

Cal Cates is an educator, writer, and speaker on topics ranging from massage therapy in the hospital setting to end-of-life care and massage therapy policy and regulation. Cates is a founding director of the Society for Oncology Massage and current executive director and founder of Healwell, a nonprofit organization that works with children and numerous hospitals and clinical facilities. Healwell also trains massage therapists in sustainable caregiving, as well as partners with hospitals to conduct research about the effects of massage on people living with illness. Cal is also an author and columnist for Massage & Bodywork magazine, whose feature article “Death Dying, and the Breakability of Us All” won best feature article at the 2019 Maggie awards in Los Angeles. Cates is also the co-founder of the new podcast Massage Therapy Without Borders.

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This podcast is sponsored by ABMP.

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00:00 Darren: Our gift to you weekly free CE from ABMP as a way to give back to the profession during this challenging time of COVID19. ABMP is offering free access and CE for five courses in the ABMP Education Center each week for four weeks through May 6. Simply register online at abmp.com/ce for access to watch these video-based courses which are among the 200 plus available to all ABMP members in the ABMP Education Center. Please enjoy this courses and free CE while we look forward to resuming practice.

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00:44 Darren: Thanks for joining us for episode two of Conversations in Quarantine. My name is Darren Buford and I'm the editor-in-chief of Massage & Bodywork magazine and Senior Director of Communications for ABMP. Our goal here is to speak with luminaries and experts in and around the massage profession. To talk about the effects of COVID19 on bodywork practitioners and more importantly, to discuss next steps towards safely reopening our doors when the time is right. How to pivot now, how to prepare for the future, and discussing what the new normal might be. We're joined again by Cal Cates, Executive Director for Healwell and co-founder of the podcast, Massage Therapy Without Borders. Are there other things that you can think about that come to top of mind when you think about what that new normal might be?

01:27 Cal: You know I think that we're gonna need PPE and I watch people out in the world wearing their PPE and it's not pretty. [laughter] And they're just going to the grocery store, they're not trying to be like a care provider and unless something major happens in virus spread and containment, the question will continue to be, is this worth a human life? And it has to continue to be that. And I love my chiropractor. My body would be so much better off right now if I could see my chiropractor, but my chiropractor is one of the few it seems, from what I'm seeing online, who has said "I am not gonna do this. Until it's safe, I'm not gonna do this." And when I think about practice, one of the things that we express being grateful for in our call this morning is we've been wearing PPE for years. I got over my hurdle of does a massage feel the same when you're wearing gloves or not years ago.

02:20 Cal: And I got over the idea that, "Oh, a person's not gonna want a massage from somebody in a gown because when you're in the hospital, you want a massage from anybody who will give you a massage." So if they're wearing a gown great, mask sure, shield you name it, like bring it on. So I think I really wanna invite massage therapists who don't have that experience to stop coming from a perspective of what they're afraid people won't want. What people will want is a conscientious practitioner who's doing what's necessary to keep them safe. We're all gonna not like it, but we do crap all the time that we don't like because it's the right thing to do. And I think that we will probably lose some people in the profession who are like... I don't wanna... That's not what I signed up for. And I think that's sad, but I think that there are people who'll go, "Oh yeah, I don't wanna... I guess it's fine. I've been massaging people for a week now with gloves and nobody cares, they just want a massage." I think we're excellent at making things harder than they need to be.

03:17 Darren: I love that, to hear that you've already worn PPE and that you can tell people this is just a small bump, this is a hurdle that you'll get used to, that you were already doing this. I didn't know that, and that was absolutely the question I wanted to ask you because there's a clinical aspect of massage and clearly that is an aspect of the field. And then there's a spiritual component that many practitioners align with, and I'm wondering for those who line with that, if that, if that word gear is a... It's a moment where they might not feel comfortable moving forward to whatever that new normal might be.

04:03 Cal: Yeah, well it won't surprise you to hear that I have a lot of patients for that because I just actually had a wonderful opportunity to talk with some massage students at a school here in Baltimore County and by Zoom, of course. One of the slides that I use a lot in my presentations when I'm trying to invite students in particular about massage therapists, in general, to think differently is I use this example from there was a guy named Giordano Bruno who came after Copernicus and basically kept saying no, for real. This is a thing and you know, you're not the center of the universe and if you can't welcome this new information, he is quoted as saying, "Your God is too small." If you're thinking is that I can't have a spiritual encounter with this person because I'm wearing gloves or a gown or a mask, you might wanna work on your spirituality. I get it, I get feeling that and I get the tendency and the habit of wanting to go, "Oh, this is gonna be between me and them."

05:07 Cal: It's only between you and them if you let it be. So I have been working in hospitals at the bedside of dying people and sick people and recovering people for years in gowns and that is definitely where I have had some of my most spiritual experiences, and I do this work because of the spiritual aspect. I get out there and get all cranky about the need to respect the clinical and the value of that. But without the spiritual, the clinical doesn't matter. If you don't wanna be a massage therapist anymore, hats off, I get it, but don't say that you're not gonna do it anymore because it's gonna somehow be like wearing a spiritual condom. It's not a thing. [laughter]

05:46 Darren: Because of the asymptomatic nature of COVID-19, you're seeing there are talks about conversations about temperature checks.

05:56 Cal: Yeah.

05:57 Darren: Even though that may or may not do anything, that may be a comfort... Part of this is a psychological aspect that we mentioned before of the practitioner and the psychological aspect of it for the client as well. And temperature checks are one of those things that kind of check a box, it's kind of a temporary light check of a box, but it's one of those things that established a comfort level that... Well this is different, this is a little different than what it was like.

06:21 Darren: And another thing that we've talked about as well is waivers that there may be... The intake process could be completely different, especially if there's a slow roll, especially if there's a slow roll. There could be a situation where the intake process says, "Okay, there's not a vaccine, yeah. I have not had an antibody test. And you have not had an antibody test but we would both like to proceed with this thing called massage and in order to do that, this liability waiver that we're both gonna sign is going to suggest that we're both okay, we both understand this, and this may be our new norm for a while until those other things occur. But let's still, let's still practice massage together."

07:09 Cal: Yeah.

07:11 Darren: Are there other things that you can think about that come to top of mind when you think about what that new normal might be?

07:18 Cal: Well, you know, I feel like... I have said to so many of my clients over the years, "I'm really glad to meet you and I'm sorry that I'm meeting you because you have cancer," or because I mean, when people wind up meeting me, it's typically because things have gone poorly in their life and from a health standpoint, or crossroads is a place of challenge for them. But I do feel like this is really going to require massage therapists to think like healthcare providers. And every time we establish a new contract with a hospital, we have to sign a thing that says, "I am going to be in the land of germs, and I am accepting responsibility for the inherent risks of being in a place that's full of germs that could maybe even kill me. I promise to wash my hands, wear PPE, follow the signage, blah, blah, blah."

08:09 Cal: But it's basically on me to do what I understand or what I know to be safe. In the same way that herpes has been around forever. HIV has been around forever. There've been all... Scabies and cellulitis. We could go on forever talking about the stuff that's already coming into your practice. MRSA and C. Diffs that can't kill you... Well, but it can kill you. So I think that it's really, in a way COVID is just kinda juggernaut in the tail of massage therapists who have thought that these weren't already risks and to just really get serious about. People are germy. We're all carrying stuff around that we really shouldn't be sharing with each other. It's just that this has a much shorter trajectory toward possible death and so, we're like, "Oh. Huh, maybe we should do something about this."

08:57 Darren: I'm wondering about the intake process and practicing and the thing I equate it to is, we're very comfortable when we go to the dentist or we go to the doctor's office where we'll see the poster on the wall.

09:13 Cal: Yeah.

09:13 Darren: And the poster... Oh yeah, I'm in a doctor's office, and the sheet is pulled down over the table. And it sets this tone and it sets this mindset, and I'm wondering if practitioners may be doing and transitioning to a similar type thing and cleaning might need to occur in front of the client. And I almost think about the doctor who comes in and washes her hands before your check-up, right? There's a comfort like, "Oh yeah. Oh yeah. Yes, okay. Yes, absolutely. I feel comfortable now." I'm wondering if some of that visibleness of the antic process could ease some of that comfort level as well.

09:53 Cal: Yeah, it's certainly possible. I think about in the hospital, we train our therapists and when you go through hospital orientation, they say, "As much as possible wash your hands in front of the patient." There are signs all over the hospital encouraging patients, "Ask your provider to wash their hands if you didn't see them wash their hands." And very few patients actually do that, but I think there's real value in just making that a habit. And where it takes me is sort of, is it gonna change regulations for practice space? And do you have to have a sink in the room? Do you have to have sort of like a holding space where a person can wait? Do you bring a client into the room and have them watch you change the sheets so that they know... I mean, I don't know.

10:37 Cal: And I was talking with some of my colleagues about... In my private practice, I don't wash my blanket after every client. I just don't. And I have a little memory foam face rest cushion with a fleece, blah, blah, over it. I don't change the fleece after every client. I change at the end of the day. I put a different cover over the fleece but the fleece and the cover are both very porous. And so, yeah, what kind of equipment are we gonna need? And Massage Warehouse donated this huge package three or four months ago to Healwell with cream sheets that we used for my son. They're just sort of plastic table covers and face rest covers. "Oh my God, who the hell is gonna use this? It's terrible." "Oh, I guess we're gonna use this." You know? "Oh, way to go Massage Warehouse."

[laughter]

11:21 Cal: So yeah, I think we're really gonna have to be... It's another place we're gonna have to shift our mindset from, "Oh, this is annoying," to, "Oh, this saves lives." If I want to be a massage therapist, I have to be serious about how germs spread, how I prevent the spread of germs and what is my responsibility now as I am a healthcare provider or at least I have to act like healthcare providers act.

11:45 Darren: There is another aspect of this that's a financial impact of this, one that we haven't had to deal with before, and that means time increase between clients for cleaning. That means potentially fewer clients in a day. That also means the potential of purchasing things in abundance that have not had to occur before.

12:15 Cal: Yeah.

12:16 Darren: More sheets, more blankets, or not using blankets or transitioning out of that cleaning equipment that we've never had to purchase before. And I think about the financial impact of that as well and practitioners. It's not only signing on for gear. It's not only signing on for that. That's one thing. There's a financial impact which is like, "Oh, I didn't sign up to clean. I didn't sign up to do that much cleaning. I didn't sign up to do that, to launder that much." And I wonder about, it's one thing for us to talk about it and then there's that first week where you go back to practice again, and there's new reality. And I've been thinking about that and I don't know that. I don't have stats in front of me that say, "This is the average amount it costs to launder for a practitioner." But I just... It's hard for me to believe that those things wouldn't increase and change the fundamental nature of the practice.

13:07 Cal: Yeah. It's funny, as you were talking, I was thinking about... We always have our students read this article about how little hand washing takes place in the hospital and all of the different things that the infection control officers at the world hospitals have tried to do to get people to wash their hands. I do think that's probably gonna change a little bit in the immediate at least, we have a really short memory and it's really easy to sort of de-sensitize ourselves. So I think a couple of things will happen. I think that, I think a lot of sole practitioners just won't bother, or they'll do a little more than they used to do, but they're not gonna actually do everything that they should do. And I know, I bet my face just made like a judgy thing about that. I don't actually, I get it. If I'm me, seeing clients in my basement while my kids are at school, I'm not gonna buy an autoclave, I'm not gonna... That just doesn't feel worth it to me, so I'm gonna see clients who are comfortable with that. My practice might shrink, whatever. I think we're gonna have an underground emerge because I think that probably regulations are gonna emerge that is gonna push things in different directions. I think they'll do their best and they'll find clientele and they'll remain a small vector for spread.

14:16 Cal: I think that home-based practice might be a thing that doesn't happen legally anymore because I think maybe health inspectors are gonna be coming into massage practices the way they do into restaurants and waxing places and spas, and say, "Show me your practices, what materials are you using, how often, where are your procedures?" And if I'm just me massaging people in my house, I don't wanna do that. So I'm not gonna stop practicing. Just gonna tell anybody. So I think there's gonna be a solid underground that's gonna emerge. But I think if we try to pass the cost of PPE on to clients, I think that's not gonna go so well either. I feel like it's the cost of doing business. I don't know what the market is like in other places, but I could probably increase my hourly rate by maybe $5, maybe $10, but this is what it costs for me to do my work safely. You as the client shouldn't have to pay for that.

15:11 Cal: And I think, again, that's gonna drive some people to leave the profession because it just is gonna look different, it's gonna cost more, it's gonna take more time and I'm not gonna get to touch as many people. And I think there is a sense of like there's such a beautiful flow or at least there was four months ago to like person leaves, wash my hands, peels sheets off, change everything out, I've got a minute or two to sit, have a little sip of tea or something, and then the next person comes in, but if I'm frantically spending 20 minutes between clients cleaning everything and maybe changing my clothes or changing my PPE, or whatever, it's gonna feel different, and some people aren't gonna like that feel.

15:52 Darren: There's also another aspect of PPE, if that's where we go. If that's where PPE goes.

15:58 Cal: Yeah.

16:00 Darren: And there's an interesting aspect of PPE as well that I wanna talk about here that I wonder if there's a psychological shift, a way for the... If there's a chance here for the profession, something that's been hanging over the profession forever are the nastiest word ever, massage parlor. And PPE has this clinical nature to it. And I wonder if it starts to benefit our profession at all. Is that something that... What do you think about that?

16:33 Cal: Never has, never will. I love that you think that and maybe... And I will buy you a six pack of your favoritest beer to be wrong. If I'm wrong, I'll be so glad about it. MT show up on our classes all the time in scrubs, doesn't make you a healthcare provider. It just means you're wearing pajamas. So you can wear scrubs. And honestly, I feel like they make you look more like you don't fit, if everything else you do is still what you used to do. Maybe, and maybe it will create a little internal shift for therapists and they'll go, "Oh, I have a greater responsibility." And maybe that will open doors for actual practitioners and the type of continuing ed they seek out or the way they think about what they do, but I don't think that this is sort of like a fake it till you make it situation where because we look like doctors, we start to be respected like doctors. I don't know, I've been wearing PPE in the hospital for years and I feel like I am respected, but it's not because people think I'm another kind of provider.

17:35 Cal: And I think that... Yeah. And I also think that massage therapists are gonna pull masks down so their noses are sticking out 'cause it's too hot in there and they're gonna not tie their gowns in the back. And we spend a lot of our time in our hospital classes teaching the students that once you're gowned and gloved, you can't touch things. I think that it's gonna be people at the grocery store, they're wearing gloves, but they're touching everything with the same pair of gloves. Like I said, I'd love to be wrong and I hope I am, but I'm cynical that a different outfit is gonna somehow transfer a different level of respect or understanding about what we do or how we do it.

18:14 Darren: Because you teach that and you have been wearing PPE. What was that hurdle like?

18:18 Cal: Oh, men.

18:18 Darren: For you.

18:19 Cal: Yeah, yeah, well, it's funny because I notice in myself, we just launched the first module of our typically two module hospital-based course right before all this happened. And I dread it. Like inside me I'm like, "Oh, I don't wanna do this." And it's really... But it's still important, and it's so easy, you just get used to it, so it's hot, it's not comfortable. I think one of the things is... I'm sure that there are massage therapists out there right now figuring out how to make PPE that's not ugly, PPE that's not hot. I think it is gonna create a whole new industry of products for massage therapists who don't actually wanna look like nurses and PTs and OTs and whatever. But, yeah, it's for sure a hurdle. And I think it's the 21 days thing, again, the first month of practice is gonna feel tedious and exhausting. And then you're just gonna forget that this is even a thing that you... You're just gonna do it, you'll be like, "Oh, look at me, I'm in a gown."

19:16 Darren: The final thing I wanted to ask was, because we are fortunate enough to work for an association that represents a lot of massage therapists throughout the United States, we also have social media channels and we also have comment areas in our articles and blogs and news items that we release. And there's a lot of division right now, more than I've seen in a while. I can't remember it being this... There's a level of hostility, that's a little uncomfortable, especially, because the nature of the work that massage therapists and body workers do. There's a little in-fighting going on. And a lot of it could be the fact that they're 250, 300 modalities out there and everybody is is right or everybody is is the way that you should practice. And there's... I don't see that bonding happening. Are you seeing the similar type thing?

20:11 Cal: Humans are at their worst when they're afraid. I feel like you can just kind of in a way boil it down to that. But I feel social media is a great place to float ideas. But don't die on that hill. I get tagged regularly, multiple times a day in fights that have emerged because I'm somehow a subject matter expert, and somebody's spewing something that sounds untrue and somebody who's taken one of our classes or knows Healwell, says, "Oh, get in there, Cal Cates." And I'm like, "Nope." I can spit in the wind right here in my living room. I don't have to... And that's not to say that I don't use social media 'cause we put stuff out all the time and we have a blog and we share our opinion, but we just let people comment, we don't rebut the comments. If you're gonna put it out there, you gotta put it out and walk away because you're not gonna convince people by all caps and exclamation pointing them. And I think this is a great place where it's not about you, and it's all about you. It's all about your unexamined fears and about your tenuous self-awareness and about your dissolving stories, about who you thought you were when you thought you'd get to massage forever and the discomfort of, I don't know who I am right now, I don't know what I'm gonna do, I don't know how I'm gonna pay my bills. We're all in some version of that.

21:33 Cal: I feel like there's no hierarchy of suffering is one of the things we talk about all the time 'cause we invite people to come to our courses who have cancer so that we can teach students how to massage a person who has cancer, who has a cancer history. We would joke because people would sign up, to come be a clinic client and they would have skin cancer, and we'd be like, "Skin cancer?" It's still cancer, it's still scary, it's still real, it's still often requires surgery or treatment. So yeah, I'm not currently worried that I can't pay my rent next month, but I've got plenty of other crap that I could put out on the table that you wouldn't want. So I feel it's a great opportunity to just chill out and to just read the stuff if you want. Definitely take a break, but don't post a thing and then keep going back to it. And looking, "Oh yeah, see that person's there." And then pile on. And it's like, "Wow, you guys." Remember and live the rule that you should never say anything online that you wouldn't say in person. If you're using a whole bunch of exclamation points or caps probably you need to go for a walk, maybe go to the bathroom, take a nap, and then see if you still wanna go on that same, on that same tag.

22:47 Cal: Yeah, I think we need to use social media. It is definitely keeping us connected. Thank God for Zoom, and all the things like it that are allowing us to stay connected. We've really gotta notice that none of us is our best right now. We just kind of really have a lot of compassion for ourselves and each other virtually and actually. [chuckle]

23:07 Darren: I think that is a beautiful message for us to close our conversation today. I wanna thank Cal Cates for joining us. This is our Conversations in Quarantine and we will have future guests that we will be speaking with. Thank you so much, Cal, and thank you to the listeners. And I'm wishing everyone health and safety and well-being out there. Thank you so much.

23:29 Cal: Hear that wish. Thanks so much, Darren.

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