Death, Dying, and the Breakability of Us All

By Lauren Cates

We’re all broken. This is a fact for which we can be deeply and truly thankful. The wounds that make this true have made, and will make, you who you are. The J-O-B called “massage” is simple. Rub the knots out, agree sympathetically that, yes, these are the tightest shoulders you’ve ever felt, tell this person whose knots you just rubbed to drink water, collect some money from this person, and move on to your next client. Lather, rinse, repeat. Right?

Except that this story is a lie. Worse yet, telling this story and believing it is like forgetting to RSVP to what might be the most important invitation you’ll ever receive.
Touching humans for a living is a daily invitation to be real and present. It doesn’t matter how “healthy” you think those humans are or how much they do or don’t “need” massage. It’s not about their muscles, and it’s certainly not about that big muscle on top of your shoulders.
Personally, I make my living touching humans that would be deemed, by most standards, to be very, very sick and even dying. I have been lucky enough, since 2005, to do my work with people who find themselves in hospital beds either receiving care as they approach the end of their lives or who are being treated for severe and often complex symptoms from advanced disease. I go to their homes, I go to long-term care facilities. Over the years, even some of the “sickest” clients have willed themselves into their cars to come to my office. As a result, I’ve been invited to see massage therapy, and my own life, through a lens that makes it really hard to keep up the story. The story of “wellness”  and that of the “wellness practitioner” is one of invincibility, expertise, and control. Of course, I’ve also had plenty of “healthy” clients who believe that story and who like the way that it allows them to not think much at all about being sick or about dying or mortality or how incredibly breakable they are.
That’s pretty typical.

An Important Invitation
Humans are convincing storytellers. We are constantly telling stories about our spouses, our parents, our bosses, our clients, ourselves. Some are true stories, but most are just fabrications to make sense of things from a safe and comfortable distance. These stories help us pretend we are separate and that what’s happening to another could never happen to us, or that we’d handle it better or differently than they’re handling it if it ever did happen to us. Stories that let us believe we know things that will make someone else “better.” Stories that have never been fact-checked, but that nevertheless shape how or even if we see each other.
Massage therapists touch people for a living and, yet, we rarely see the people we touch. We want desperately to avoid the experience of having our own vulnerability mirrored back to us by the injured and malfunctioning bodies of our clients. We see pain and hear suffering as they tell us why they think they’ve come for massage today and, before they’ve finished their sentences, we are hard at work telling a story about how we’ll stop that pain—for them and for us. And by doing so, we’ve lost the most important aspect of this work, being truly present with another.

Pathology: I Do Not Think That Word Means What You Think It Means
The word pathology comes to us, as do so many good and co-opted words in the English language, from Greek. Pathos means “experience” or “suffering,” and the word pathology has been translated, in some texts, as “the study of emotions/passions.”
It’s reasonable to say that a majority of people seek out massage because they are experiencing some kind of suffering. The Buddhists define suffering simply as “dissatisfaction with what is.” In this definition, disappointment in the fit of those jeans you just bought is on par with starvation. There’s no hierarchy. Ill-fitting jeans and starvation are both experiences that inspire us to wish things were different.
That pretty much sums it up.
Most of the people we touch are not happy with their bodies. Their bodies are causing them pain. Their bodies are not letting them run as far, walk as fast, or even live as long as they want. Their bodies are responding to messages from a disease or an injury or some misuse that is making their joints ache or their guts rumble or their feet tingle.
They hate this, and so do we.
They pay us to join them in their dissatisfaction, and then to fix it.
In the West, we are conditioned to resist and avoid suffering at all costs. We feel pretty certain that any sense of physical or emotional discomfort is an indication that something is wrong. Very, very wrong. We have a hard time believing there is anything redemptive or valuable about being with our pain, with illness, or really, about being with any experience that isn’t one we have envisioned for ourselves. We stand, demanding to “see the manager,” when something other than what we have expected is what we see before us or, heaven forbid, feel inside us.
And if you’ve been taught that your job is to do things with your hands that help people escape from their discomfort, you will be both always busy and never successful.
Thanks to some uniquely raw and intimate encounters with a few profoundly ill people in my treatment room over the years, and thanks to some kind Buddhist and Buddhist-inspired folks who invited me to consider the possibilities inherent in simply feeling what I was feeling, I started to see, early in my practice, that all of my clients were frail and traveling around in breakable outfits that were mostly a mystery to both of us. The palliative-care patients, the marathon runners, the desk workers, the people in cancer treatment, the CrossFitters. Everyone. Every person I touched was supremely breakable and, in fact, as the second of the Buddha’s Five Remembrances suggests, they were, as am I, “Of the nature to have ill health.”

Good luck with that
Being a massage therapist in the modern world is a total setup. It doesn’t matter where or with what population you practice.
• “I’ve had pain in my low-back for the last six months. I’ve come so you can fix it and reverse it in the next 60 minutes. Go!”
• “I have multiple sclerosis. My joints ache, and pain and anxiety keep me awake most nights. I’ve made a 45-minute appointment. Fix it, please.”
• “I am exhausted as I head into week five of radiation therapy for ovarian cancer. I’d like to have enough energy to be able to go home and clean my guest room for my sister’s visit this weekend. You can do that in 60 minutes, right?”

Take a minute to notice what’s happening inside you right now.

Maybe you’re exhausted because this is what your job is like, and you feel like you don’t help anybody.

Maybe you’re thinking, “Yeah, I can do that. What are you talking about? Piece of cake!”

Maybe you’re like, “Nope. This doesn’t happen to me. I love my clients, and they all feel great when I’m done with them.”

Or, “My aunt/uncle/boss has/had low-back pain/MS/ovarian cancer. I know exactly what will help.”

I wonder if we could notice the habitual responses these scenarios elicit inside us. Just notice, without judgment. Notice ourselves. Notice this person we’re touching. And let whatever we notice just be true.
This is not a quiz or a measure of your skill or goodness. This is just information.
What would happen if we considered that these are very human requests and expectations from very real and individual people who are facing realities that are disappointingly different from the ones they mapped out for themselves? I wonder what would happen if we could take a deep and compassionate breath for ourselves and for them before we tip over into how we’ll fix them, fail them, or treat them like someone we’ve decided is similar.
Being with humans is hard.
If you’re a massage therapist, that is your job. Being with humans. Most humans hate that change is the only constant in this life. Our reality as humans is impermanence and, yes, suffering. We’re hardwired for dissatisfaction. “Boo!” we say. “Let’s look at something else. If I just learn more stuff and master more techniques, I can fix it. I can fix it all.”
Stop. Breathe.
This would be another great opportunity to take a moment and just notice what’s happening inside you.
Are you feeling some resistance to what you just read?
Are you feeling angry that I’ve drawn attention to change and pain as standard aspects of all human experience?
I wonder if you’ve just decided that I’m talking to “other” massage therapists.

“That’s not my life. I have a lot of joy, and I keep a gratitude journal.”

“I love humans, and I totally see every person I touch.”

“I give my clients hope. That’s why they love me.”

“I’m a healer.”

Noticing any tightness in your body now? Any increase in heart rate? Mild agitation?
What if I told you that you and I are not fighting here?
I’m not suggesting any of what you might be feeling is false. I am, however, inviting you to notice how tightly you’re holding on to any of it.
When you walk into a session or a hospital room, how important is it to you that you change what’s happening for the person you’re about to touch? How important is it to you the person on your table feels “better” when you’re “done”? Are you invested in how smart, skilled, or expert your clients and colleagues think you are? (Hint: If you’re not, you might be malfunctioning because it’s really, really human to find these things important.) If you are, that’s great. Now, I am going to ask you to notice your attachment to those stories and then to decide if you have the grip strength to keep that up for the next 20–30 years of your career as someone who touches humans who live in breakable, mysterious, constantly changing bodies.

Thankfully, None of Us Is Getting Out of This Thing Alive
My friend and mentor Tracy Walton is fond of saying, “There is nothing unnatural about dying.” And so it is. Similarly, there is nothing unnatural about limited range of motion, a hamstring strain, a sprained ankle, neuropathy, swelling near the end of life. Inconvenient? Definitely. Painful? Probably. Unplanned? Most definitely, but very, very natural. And certainly, if we’re going back to the root, pathology.     
These experiences inspire strong emotions. We get frustrated and impatient when our parts aren’t working. This is a completely natural response.    
As massage therapists, these are beautiful moments in which to remember that “Angry is sad’s bodyguard.” When we remember this, we can glimpse the tenderness that lies underneath the emotions most salient in so many of the people we touch. We can remember, if only inside ourselves, the person under our hands is scared. So many of the people we touch find themselves receiving massage because they’re not willing or able to tell a story in which their body is breakable and will someday stop. They are sad because their body has changed or is changing. Their experience is different than it has been. This is not what they ordered. Their plans have been altered, interrupted, maybe destroyed by this noncompliant but natural body. They have been reminded, in this inconvenient (but, they hope, fixable) way that they are fragile and that they have existed, all this time, at the will of their bodies.     
The wisest parts of you know that your job is to be with this person. But this person thinks your job is to help them forget all this inconvenient information and all these uncomfortable sensations. What a lonely place for us each to be.     
Let me be clear. This is not something a majority of the people you touch are consciously aware of. This realization, for most of us, is deeply and safely buried, and when our time touching a person is over, that time ends with them often feeling better enough that they can go back to their old stories of health or expected function or immortality for at least another hour, another week, another month.    
The rub is that humans are breakable, and every single one of us will get weak or sick or old and every one of us will die. When you are honest about that as you’re touching a person’s body, it changes what happens. You don’t ever have to tell the person a thing about it with your mouth. In fact, often it’s true that the less you say, the better. The person under your hands doesn’t have to “believe” in their breakability for your awareness of it to matter.

Love Yourself and Get Out of the Way
Irene Smith, a pioneer in compassionate care and end-of-life work, says, “This work is not about healing others. We can’t heal another human being. We can only heal ourselves until our presence is healing.”
When your presence is healing, that’s not a thing you’re doing. You’re just being. Unvarnished. Agenda-free. Vulnerable. Nonstriving. Broken, beautiful, wretched you. This version of you is the best mirror any other human could wish to gaze into.
The best work we can do is to find and cultivate that version of ourselves and to stop reserving it for people who “really need it.” YOU. NEED. IT. The world needs the you that has the courage to be honest about how truly irrelevant your “expertise” is and about what’s really happening in front of your eyes. The world needs the you who is more interested in what might be next than in what you can make happen next.
My friend and colleague Kerry Jordan teaches that massage is essentially a relationship in which “I’m pressing the surface of my brain to the surface of your brain.” That’s probably about the most intimate you can get with another human, but intimacy does not show itself to expertise. When we think we know what happens next, when we’re expert, there’s nothing intimate or connected about that. There’s only anticipation, a serious limitation on the number or shape of satisfying outcomes, and the likelihood of disappointment.

Work Kinder, Not Harder
I suspect that much of what you have read here you have read or heard in other places or even come to in your own way and time. And yet, much of it probably struck you as new or at least as something worth remembering. That’s always been my experience when I have “learned” things that are essential, simple, and true. Things I swore I’d never forget ...
And then?
I forgot them.
I have been blessed by an army of incredibly generous and sometimes ruthless teachers. Clients, meditation instructors, fellow therapists, doctors, nurses, social workers, my own son. They have taught me how exhausting it is to need to be the smartest or funniest or most skilled person in the room. It’s exhausting to be a helper, to be the one who shows up to heal others. It’s exhausting to be too busy or too scared or too special and important to feel things.
These teachers invited me (and keep inviting me) to stop.
To be still and to be honest.
Early in my career, as I tried to make sense of why I felt so “at home” in massage, I told a story about how I was called to help, but that was just a story. Another lie.
The call was actually something I never could have imagined. The call was to be authentic and present. Humble and curious.
Today, I can look back and know that I was led to massage therapy in 2003 by a deep sense of my own worthlessness. (Yes. You read that correctly.) I was not and would likely never be enough, but maybe I could be good. If I could be good, I could qualify. For love. To be seen. To be valuable.
Massage also just seemed like a job I could do. I like people. I like touching and being touched. Typically, people tend to like me. How hard could it be?
Really, really hard.
I know now that while it looked like an accident, some deeper wisdom probably propelled me to pursue massage therapy. I don’t go in for all that “everything happens for a reason” malarkey. I’m just saying that, in hindsight, I know there was a deep longing inside me to be so truly myself that, as spiritual teacher and author Adyashanti says, “All that will be left of [me] will be a tendency to shine.” Massage school was the first step on that path for me.
I feel lucky to have learned early that kindness is, and will always be, my primary tool, but that was just the beginning. Poet Naomi Shihab Nye removes our romantic notions about kindness and reminds us of the cost of its cultivation in her poem “Kindness.” “Before you can know kindness as the deepest thing inside / you must know sorrow as the other deepest thing.”
Kindness does not come from our desire to help, nor does it come from politeness or manners, nor is it one of the trappings of good customer service. Kindness is what’s left when you’ve plumbed so many of your own depths that you know them well and intimately. Kindness is what grows up in the place of the stories you used to tell about how “I’ll be better after …” and “If only I could …” when wisdom invites you to stop telling them. Kindness is deep. It sees through appearances, and it lets you work and live from a place of truth that’s not up for grabs.
The assertion that one is a “healer” or someone who can fix the unfixable or know the unknowable—these are prevalent and dangerous stories in the massage therapy community. No matter how many specializations I have, no matter how many fancy-pants massage celebrities have taught me their magic tricks and copyrighted modalities, every body in every moment is unique and worthy of kindness before and above anything else I can offer. When people come to me for massage, they’re coming to be seen and to be loved. Even if they have a rotator cuff injury. Even if they have plantar fasciitis or diabetes or IT band “issues.”
Humans are aching for other humans to touch them kindly and without agenda.
When you are open to the mystery of being human—of bodies and their breakability—dying and death are no more sacred than living and life or health and illness. You see through the stories you tell that hold up your beliefs and ideas about who you are and how you fit into it all. You get honest about how most of what you’re doing is not influencing, but simply witnessing. Another friend and mentor, Gayle MacDonald, says, “Love needs fewer or no words and silence can be as supportive and welcome as conversation.”  

The time has come to be quiet.

Break up with your inner-fixer. (That relationship was never good for you anyway. Ask any of your friends who love you.)

Listen more than you talk.

Stay open.

Be curious.

See the people you touch with new eyes and beginner’s hands.

They want your presence more than your expertise.

And, for cryin’ out loud, please be kind to yourself along the way. Resist the temptation to pile more and more capital letters behind your name or to chase CE credits and specializations to try to fill your holes. Learn and keep learning, absolutely. Just notice what you’re after and do it all with your eyes and your heart wide open. Get to know yourself. Become friends with all the stories you tell and why.
Getting to the ease I now experience with most of the people I work with is hard, and some days I still miss the mark entirely, but my work and my life are more human than I ever knew they could be or than I ever thought I wanted them to be. More real and fragile and vulnerable and nuanced than my limited ideas of helping and loving and touching could have held in those first months and years of “doing massage.” And I wouldn’t trade any of it.
Being with humans is a good gig if you can get it.
That’s your job and that’s plenty. Stop wearing yourself out making it anything more than that.
Bodies do what bodies do. We know so little about what they really do and why, it’s mind-blowing. Get honest about that and you might be on to something.

Massage Therapy in a Hospital Setting

Healwell, a nonprofit agency that trains and then connects massage therapists with hospitals, hospices, and rehabilitation centers, is a natural outgrowth of my own journey. When I graduated from massage school in 2005, I had the good fortune to meet and work with a visionary massage therapist and businesswoman named Brenda Teal. Brenda had just been invited to open a second location of her business, The Teal Center, on the campus of one of the local hospitals in Arlington, Virginia. I wanted to work in a hospital. Brenda and I both wanted to make a value-added contribution to health care.  
Voilà! We started figuring out what it looked like to bring massage therapy to the hospital.
I think it’s safe to say that none of us really knew what we were getting into at the time, but like the evolution of so many things that ultimately prove to be good or successful, we just paid attention and followed where opportunities could be leveraged or created, and beautiful things happened. The right people came along (thank you, Lucille Eddy!), we made way for the right circumstances, and the ball started to roll.
Through lots of trial and error, we began to see and create what was needed. We established a standard of training and experience for the therapists we would hire. We educated and educated again and educated once more hospital administrators, nurses, social workers, and doctors about who we were, what we did, and why it was important.
It’s a long story, but over time, we observed a few interrelated factors that made it hard to bring massage into the hospital.  
• Massage therapists are not trained to be health-care professionals. Most leave massage school as minimally trained tradespeople who provide a service to healthy humans.
• There is a woeful lack of well-conducted research about massage therapy of any kind, but specifically about massage therapy’s effects on the lives and bodies of very sick people.  
• The massage profession has set itself up, through years of well-meaning volunteerism, to be welcome in health-care settings as long as we don’t expect to get paid.
This was a big, mangy mutt chasing its own tail. These were problems that could not be addressed in a vacuum. Each fed the other, and we knew we had to address them simultaneously with an eye toward elevating not only the level of practice of massage therapy, but the profession as a whole.
We had to tackle all of it to create real change.  
We saw, firsthand, that making a meaningful contribution required highly skilled and self-aware therapists. Creating trust in a health-care facility required humble but knowledgeable practitioners who could speak the language of health care. Commanding appropriate compensation meant that we would have to bring something to the table that wasn’t already there.
Healwell bridges the gap between foundational massage training and the essential skills necessary for integration of massage therapists in a clinical setting. Our courses cover not only the specialty practice areas of scar tissue mobilization, oncology massage, and hospital-based massage, but also research, ethics, and the presence and self-awareness that are essential to bringing all of these skills and knowledge together.  
For more information about Healwell, visit

Lauren Cates is an educator, writer, and speaker on topics ranging from massage therapy in the hospital setting to end of life and massage therapy policy and regulation. A founding director of the Society for Oncology Massage from 2007–2014 and current executive director and founder of Healwell, Cates works within and beyond the massage therapy community to elevate the level of practice and integration of massage overall and in health-care specifically.