In this article, I will discuss how there is a place for acupuncture and complementary therapies in palliative and hospice care and how it can benefit patients, carers and families as well as nursing staff. I will also discuss how volunteering in hospices can provide invaluable experience and confidence for all acupuncture practitioners - whether they are a new graduate or a seasoned professional.
For the past two years, I have been volunteering in St Josephs Hospice in the Whitechapel area of London. The East End of London has a curious history. If tourists ever tire of the wealth and grandiosity of Big Ben, the Houses of Parliament and Buckingham Palace, perhaps they can catch the train over to East End and have a ‘butchers’ at Brick Lane to catch a different flavour of London life. In some ways the main Whitechapel road has probably not changed much in the last 100 years. Gentrification has not set in yet (although Spitalfields market has succumbed to it) and the main high street is a mixture of local business shops and street market stalls.
The East End has a bit of a sordid history. Whitechapel was immortalised in 1888 – ‘The Autumn of Terror’ when Jack the Ripper set off a reign of murder and mutilation in the East End. The pubs along Whitechapel road were often frequented by prostitutes passing from one to the next selling their wares. The Ten Bells pub where two of his victims were seen before being brutally murdered and their organs surgically removed - still serves pints. And a mile down the road, the Blind Begger pub is open for business. This is where the famous London gangster Ronnie Kray gunned down rival gang associate George Cornell for calling him a “fat poof” in a room full of witnesses. This incident proved to be the downfall of him and his twin brother’s empire which had taken London by storm in the swinging 60’s.
The East End also has a long history of immigration and a vibrant changing population. In the 17th century, the French Huguenots made their homes in the Whitechapel area. In the 19th century, it was the turn of the Irish. In the 20th century, Ashkenazi Jews made it their home and in more recent times it is clearly a Bangladeshi area. In another hundred years, who knows which people will occupy these shops and streets? The Tower Hamlets has traditionally always been a poorer area, but it is an area with character. I should warn tourists that it does not leave any great impressions, but it is nonetheless a unique part of London.
St Joseph’s hospice is a few miles down the road and is in a modern building. It has one of the most vibrant complementary therapy departments in the UK. It was set up in 1905 by seven sisters of charity with the support and financial backing of Father Gallwey and Miss Grace Goldsmith and some anonymous donors. Their objective was to offer a place where people could die in peace away from the poverty stricken, disease ridden conditions that the poor suffered from in the East End of London at the time.
At the time, the East End was a dire place to live. It was squalid and dirty. Poverty was widespread. There was overcrowding, workhouses and many women had to turn to prostitution to survive. It had a definitive ‘Dickensian’ feel to it. It was the area where the famous American author, adventurer and social activist Jack London chose to study poverty up close and personal by being a ‘down and out’ in the East End – the details of his exploits can be found in the book ‘The People of the Abyss’. It is notable that Jack has been a hobo travelling across America which had made him strong and hardy. But even the abject poverty and hopeless desperation of the East End was too much for him both mentally and physically and at times he had to escape from his experiment – a choice that none of the locals would have ever had.
Times have changed since then. With the establishment of socialised healthcare, the NHS, the welfare state and advancements in medicine - the desperate poverty of the early 20th century has thankfully been dramatically reduced. But the hospice has grown with the times and is still as important as ever. Today the hospice can offer more than just a clean bed and warm food. Patients also have access to the best medications, access to doctors, 24 hour nurse care, counselling, community events and a variety of complementary therapies including acupuncture. The hospice relies heavily on volunteers at all levels of operation. If at any time you were to call the hospice or visit it, it is likely that some of the people you speak to or meet will be volunteers.
As a volunteer there practicing acupuncture and reflexology, I have gained invaluable experience and confidence. It has also changed my perspective on life.
Acupuncture and Complementary Therapies in Palliative Hospice Care
A major part of complementary therapies in the UK is in hospices and providing palliative care. Complementary therapies encompass many kinds of therapies such as aromatherapy, reflexology, holistic massage and many others. Among these therapies, the practice of acupuncture is becoming increasingly popular in hospice care and in hospitals in the NHS.
Patients in hospice care may suffer from a variety of health conditions, but by far the most common conditions tend to be Chronic Obstructive Pulmonary Disease (COPD), Multiple Sclerosis (MS) and Cancer. Of which, cancer is the most predominant. Patients dying from cancer experience heavy symptom burden – in particular the physiological and psychological effects of pain, which at times can be severe. Other common problems that people are affected by in palliative care are muscular skeletal pain, internal pain, breathing problems, nausea, oedema, vomiting, stress and anxiety. Family members and carers also suffer from stress, anxiety, grief and muscular pain especially if they have to lift the patient often. Stress and anxiety can also lead to sleeping problems, fatigue and depression. Complementary therapies can help people deal with all these problems and I have treated many patients and carers for these problems. This is important because it takes the strain off other medical staff – doctors and nurses and it means less suffering for the patients and their carers, which in turn creates better wellbeing.
WHO Definition of Palliative Care
The World Health Organisation (WHO) laid out a definition of what palliative care should encompass. In particular, palliative care should:
- Provide relief from pain and other distressing symptoms,
- Integrate the psychological and spiritual aspects of patient care,
- Offer a support system to help the family cope during the patient’s illness and in their own bereavement,
- Enhance quality of life.
It is my experience that acupuncture and complementary therapies can help satisfy these objectives, especially the aim to “provide relief from pain and other distressing symptoms”. To back this up, clinical research and studies have been carried out which have shown the benefits of acupuncture in hospice care and cancer treatment especially for providing relief from pain and other distressing symptoms.
Clinical Research and Studies
In one study in the American Journal of Hospice and Palliative Medicine, – ‘Acupuncture is underutilized in hospice and palliative medicine (2008)’, research showed that acupuncture was more established in the UK than in the USA. Researchers studied 27 randomized trials of acupuncture and found that in 23 of these trials; acupuncture was effective for treatment of dyspnoea, nausea, vomiting, pain and xerostomia. They also found it safe and cost effective and good value for palliative and hospice care.
In the Pub-Med Journal - ‘Acupuncture: role in comprehensive cancer care--a primer for the oncologist and review of the literature (2005), a review of acupuncture in cancer care was carried out. In this review of studies, it was found that acupuncture significantly reduced vomiting episodes for patients receiving chemotherapy and that acupuncture was observed by several researchers to be just as effective as or more effective than antidepressants. Studies on breathlessness also showed that acupuncture had a significant positive effect on chronic obstructive pulmonary disease. Patients with hot flushes due to hormonal imbalance may also benefit from the use of acupuncture. One pilot study also showed an improvement of chronic post chemotherapy fatigue following acupuncture treatment.
In another Pub-Med paper – ‘Acupuncture as palliative therapy for physical symptoms and quality of life for advanced cancer patients (2010).’ A trial was carried out to study acupuncture treatment on patients with ovarian or breast cancer.
In this pilot study, patients with advanced ovarian or breast cancer received 12 acupuncture sessions over 8 weeks with a follow-up after 12 weeks. Among all 32 assessed patients, there was self-improvement reported immediately following treatment in levels of anxiety, fatigue, pain, and depression. Psychological distress, life satisfaction, and mood states also showed improved scores during treatment with some of these benefits still being sustained after 12 weeks. This improvement in psychological distress and life satisfaction seems to indicate that acupuncture can satisfy the WHO definition of palliative care - that treatment should integrate the psychological and spiritual aspects of patient care.
The WHO definition also recommends that palliative care should ‘offer a support system to help the family cope during the patient’s illness and in their own bereavement’. It has been my experience that acupuncture treatment does offer a support system to help the family cope during the patient’s illness and in their own bereavement. This is because In St Josephs, therapies are offered to family members and their carers. It is often the case that the family member is also the carer which means they must go through the difficulty of seeing a loved one suffer but must also hold themselves together to look after their family member which includes things like dressing, preparing food, lifting them up and transporting them as well as other duties. The acupuncture session with the carer or family member provides a much needed quiet time and the opportunity to take some guilt-free ‘me-time’ for a change. Family members and carers may also have their own health problems and acupuncture provides the opportunity to address these problems and alleviate their own suffering. From treating family members and carers I have found that acupuncture is especially helpful for dealing with stress, anxiety and sleep problems. It also provides a reflective space – where they have some space to talk freely.
Enhance the Quality of Life
Aside from the fact that we are all going to die… sometime. When considering hospices, there is a misconception that patients in hospices are in an immediate terminal condition. In the U.K. this is not true. People may be referred to hospices to recover after having operations or undergoing treatments. The hospice can also serve as a drop in. Some patients will come in for a few weeks during the year and then return home. I have seen some patients return throughout the years. The hospice also has an outpatient service. St Joseph’s hospice organises many community groups for people to join as well as offering seated acupuncture groups, multi-bed sessions, free talks, tai chi lessons and even training courses to anyone who is interested. Acupuncture treatment is more than pin-sticking. Listening and counselling skills become essential and more developed. Often the session with a client becomes a much needed ‘time out’ for the patient – a chance to de-stress and release some tension.
Cancer
Volunteering in a hospice I find that 80% of the patients I see have had or have various forms of cancer. There seems to be a universal fear of cancer. It can be a devastating disease. The advantage of treating many people with cancer is that the fear of treating patients with this disease can be reduced. Western science has shown us that cancer has multifactorial causes – a combination of different things. According to Cancer Research UK, Some of the factors that increase the chance of cancer are:
- Carcinogens - cancer causing substances like tobacco smoke. Also there are some indicators that diet may be a cause of cancer - particularly an excess of red or processed meat.
- Age seems to make us more susceptible. For example, a large percentage of the elderly patients in St Joseph’s hospice - particular in their 80s or 90s tend to suffer from certain types of cancer. This may indicate that resistance to disease is reduced and there is an increased susceptibility to cancer with increasing age.
- Some genetic factors, for example the BRCA1 and BRCA2 genes have a higher correlation with breast cancer.
- An impaired immune system – caused by AIDS, HIV or people who have had organ transplant and have to take drugs to suppress their immune systems
- Also some viruses may lead to certain cancers. For example, the human papilloma virus (HPV) is linked to cervical cancer. Hepatitis B & C has links to Liver cancer. The Epstein Barr virus has links to Lymphomas.
- Even some bacterial infections may lead to cancer. Research shows a connection between helicobacter pylori infection and stomach cancer.
- Environmental factors. For example, excess exposure to the sun may cause skin melanomas.
Cancer and Stagnant Qi
In TCM, cancer may be seen as an accumulation of phlegm or damp. There may also be Spleen and Stomach deficiency and the non-transforming and transporting of fluids and food. There is almost definitely a form of Liver Qi stagnation and I suspect the involvement of strong emotional factors either in the present or the past. As there are many types of cancer – it is worth looking to the area that is affected. For example, if it is lung cancer, consider firstly of course obvious environmental factors like whether the person is a long-term smoker. After that, it may be worth considering if there has been an excess of unresolved or buried grief in the past which is the emotion related to the Lung and metal element.
I have treated several women with breast cancer and have found that treating the Jueyin channel (Pericardium and Liver) seems to help open up and release past issues - hurt and anger that was especially strong before the cancer appeared. The Pericardium channel also flows through the breast area and is strongly influenced by emotions. From an oriental perspective and from my own experience, I feel that the concept of ‘Liver qi stagnation’ as used in TCM theory has some relevance. If applying a five elements point of view, emotional stress leads to excessive Liver energy which overacts on the Spleen and Stomach hindering its transforming functions and causing phlegm. Whichever way you look at it, cancer is an indicator of stagnant energy which has accumulated and solidified. It probably involves the disharmony of several organs and channels. The answer is never straightforward especially if there are other disease processes and disharmonies occurring.
With some of the people I have seen, there is some history of strong emotional stress which have been repressed. Sometimes, there is overwork in a stressful living and work environment. It can be a difficult childhood or bad relationship or bullying at school. Either way, the energy is heated up internally and then repressed causing an internal imbalance. Although, these are just my own thoughts, I have come to appreciate how important it is for us to remove stress and deep emotional hurts from ourselves in any way possible whether it is regular gym exercise, yoga, tai chi, adventure sports, shopping, drinking and talking openly with close friends, counselling, or even setting up illicit fight clubs in order to burn off all that stuck internal heat. It’s better out than in.
One final point that is important to stress. As an acupuncturist in the hospice, I see the primary role is in relieving suffering. Although I may suspect that some patients may hold strong emotional hurts within themselves, it does no good to bring these up or to try to open the patient up to this. To do so may cause more suffering. Stirring up a muddy pond only makes the pond worse until it settles down again – but the mud is still there. If you saw the hospice patient five or ten years earlier, maybe you could remove the mud, but in the hospice after they have a serious illness, it is no longer the time to remove it. Some things should be left well alone - until the next life perhaps - especially for the older patients and those in a more diseased state. However, for some of the younger patients, if they seem to want to open up more - indicated by crying during the treatment and by them openly volunteering information about their life, then the acupuncturist can become the facilitator to this process by letting them open up and let it out.
How Volunteering benefits Acupuncturists
A well structured training course, good teachers and apprenticeship (if you can find one) can set a practitioner well on his or her way to becoming a good acupuncturist. But the real lessons will always come from the patients themselves. In China and to a limited extent in Japan, it is possible to work in hospitals or pain clinics where you will be exposed to hundreds of patients and supervision. In the West, the majority of us will have to make ‘our bones’ in private practice, which in many ways is the ultimate challenge – because, unlike working in state hospitals or as salaried employees in private clinics, our income is directly correlated with our success in obtaining results with our patients. Although there are a lot of factors like how well we market and promote ourselves and our business, ultimately, the key factor is simple. If we get good results, patients come back and we earn money. If we get no results, patients don’t come back and we starve. With this motivation, we must become experienced and effective as quickly as possible and in order to achieve this level, regular patient practice will take us there. Basically the more people we see - the better acupuncturists we become. Volunteering enables you an opportunity to speed up your progress by giving you the chance to treat many people in a clinical hospital setting. However, it is not a complete substitute for private practice and practitioners must be wary of falling into the belief that it is. There will be important lessons, that volunteering cannot teach you.
Working for free
This was an issue that I had to go through. You are offering a professional service for free. Other healthcare professionals are paid, why shouldn’t complementary therapists? What is sometimes missed is that there is a trade off going on. It is not monetary. On the contrary it is far more valuable. You are providing a professional service and in return, the hospice is providing you with hands on practice, supplies, support and quick experience. There are other less obvious benefits. For example in the UK, in order to work with what are classed as ‘vulnerable’ adults or children – for example, people with serious illness or learning disabilities - you must undertake a police or ‘CRB’ check. The hospice should arrange for you to get one and once you get it, the certificate will last you for 3 years and will be looked upon favourably by other employees. A well organised hospice should also give many opportunities to develop other skills - for example to give talks, set up your own courses, give lessons or arrange any other activities. There will come the time when you will outgrow the hospice and decide to leave. Most desirable is that your own personal practice is becoming busier and you have no more time to volunteer. But, the benefit is that it is always there and you can always come back later on.
Patient Contact and Experience
In acupuncture, there is no substitute for hands on training. In Japan, the success of an acupuncturist is not based on how much money he has or how famous he is – but on how many patients he treats a week. Multi-bed clinics are not uncommon and some clinics run on a casual waiting room process where you just turn up without appointment and wait in the waiting room with other people until your turn is up. In the UK, acupuncture is not as well established and is generally more expensive so this kind of setup is quite rare.
Acupuncturists in the West must undergo training, and participate in follow up courses, seminars, workshops and read many acupuncture texts, but ultimately it is the patients that will be the greatest teachers. Think of every patient as a teacher with their own unique lesson. The more patients you see, the more teachers you have. One of the problems for all new acupuncturists is building up a practice. It is a process that can take years. It requires determination, perseverance and self-forgiveness. Some practitioners at the beginning may see only one patient a week. Gradually, that number will increase. The downside to this is that development is slower. This is one of the advantages of volunteering in a hospice for new practitioners. If the department is well developed, you may be able to see 4-8 patients a day, sometimes more – and many will have serious diseases. It can be a way of speeding up your skill development and can really help with hands on confidence.
Exposure to different people
As well as needing to get your hands on as many bodies as possible it is useful to get your hands on as many different types of people in order to develop your skills. The hospice will introduce you to a variety of people – men, women, young, middle aged, elderly, different ethnic groups, nationalities, religious backgrounds, different socio economic and professional backgrounds. You’ll notice that despite our outward differences, we all have one thing in common - we all can get sick.
You will notice that different people will often carry attitudes with them that reflect their life experiences. For example, a number of patients at Saint Joseph’s are older generation East-Enders. The elder generation were born during or after the war, and lived through periods of rationing and scarcity. They tend to have a no complaining keep it to yourself attitude and in the past may well have joked about the idea of having a massage or meditating. But in the hospice, they are curious and more open to it. Some of them will have never had any type of complementary therapy before let alone acupuncture, so it can be quite interesting to share the ‘deflowering’ process with them and provide their first acupuncture treatment - especially if they enjoy the treatment and it helps with their symptoms.
Technical skills
Pulse taking
I often take the pulse, but with some of the patients with severe diseases, I would rarely base a treatment based on the pulse. The reason is that pulses are not always clear. Regardless of the season, a patient may be thin and frail and yet the pulse will be rapid and bounding. Other times, a patient may appear healthy at first impression – they may have recovered from surgery and treatment and yet the pulse will be weak and thin. Generally, the rapid pulse and the weak pulse tend to be encountered a lot. The interaction of advanced illness, surgeries and cocktails of pharmaceutical drugs will affect the pulse in ways that were not predicted in the Huang Di Neijing. Drugs have different energetic qualities and the interaction of disease processes and surgery leads to various imbalances of Qi and blood stagnation and the Yin Yang balance in the body. Nonetheless, the hospice does provide the opportunity to feel many types of pulse qualities – albeit from people with severe disease.
Learning about strength of treatment.
Adapting treatment
Due to advanced disease states and medications, treatments need to be adapted to the patient’s condition. Sometimes treatments should be light – with few needles used and sometimes can be slightly heavier with more needles used. For some patients, I use a Chinese TCM approach and for other patients I use a more Japanese Meridian Therapy approach. At times, I feel that TCM needs to be toned down – as it can be a little too aggressive, with less needles used and Meridian therapy needs to be jacked up a level - as the focus is symptomatic treatment and I never know just how many times I will see that particular patient.
If patients are extra sensitive or have had a lot of hypodermic injections, then it may be a good idea to use thinner gauge needles and guide tube insertion. The less is more approach can be a consideration because many hospice patients are in a weak depleted state and you may not want to risk over stimulating or leaking qi. I met one acupuncturist who simply needled yintang on one patient to good effect because she deemed her condition was too weak for any further needling.
With some patients taking steroids, I prefer to keep needle insertion shallow and to not use too much needle manipulation. Steroids thin the skin and make it easier to bruise so deep massage techniques and strong needle stimulation should be limited.
But generally, I feel it is important to keep needling as painless as possible so I tend to favour the guide tube on the more sensitive patients. However, the hospice does provide an opportunity to practice and develop painless free handed needle technique but if a person is especially sensitive, than I will use the guide tube. The reason is that we want to create a positive association with acupuncture. We don’t want to give any more suffering. Most patients new to acupuncture assume needling is going to be painful. After all they have probably had numerous injections with hypodermic syringes so when acupuncture needling is painless, they are often pleasantly surprised and it helps them relax. In the Toyohari system of acupuncture, painful needling technique is said to disperse the qi. As many patients will be deficient in some way, we want to preserve the qi as much as possible.
Many patients are very immobile. Many have to lie down on their back and cannot move, which makes any form of back treatment difficult to perform. This is all the more worse when a patient has back pain – the area you want access to. Back pain can sometimes be exacerbated by lying on your back and not moving around as the energy stagnates. But with some patients it really is not possible to move around. Treating patients requires that you become inventive. Using distal points or extra channels becomes necessary.
In the Meridian therapy system of acupuncture, there is the principle of treating the healthy side of the body. This principle can be useful for patients with inaccessible body parts. For example, in one instance I treated a patient with a painful arm. Unfortunately she had bandaging over her arm and I could not treat the affected limb directly for local treatment. However, by following the principle that the channels are a mirror of each other, I treated the corresponding acupoints on her other arm. Of course, I had to explain why I was treating her opposite side.
Trying out and testing
The hospice setting is also a great place to try out new techniques that you may have been taught. For example, recently there has been some interest in a system of ear acupuncture called ‘Battlefield Acupuncture’. As the name implies it is a system of ear acupuncture designed for relieving pain presumably on the battlefield where the medical centre may be many miles away. This can be ideal for patients suffering severe pain from operations or caused by tumours in the hospice - especially when conventional painkillers are not effective.
It can be a great place to try out certain point protocols. For example, after re-reading Miriam Lee’s book – ‘Insights of a Senior Acupuncturist’, I went through a phase of trying out her standard points protocols –Liver 3, Lung 7, L.I.-4, L.I.-11, St-36 and Spleen-6, to test how effective it could be. The Mox Africa charity also had a moxa protocol for patients with tuberculosis, which involves a pattern of moxa cones around the region of BL-25 which I tried out in order to boost the immune system. Although, I had to use smokeless stick-on cones as typically most hospices will have smoke alarms – and it is highly advisable that you do not risk setting off the alarm as otherwise the entire hospice has to be evacuated, which won’t make you any friends.
As mentioned before, treating patients in a hospice requires a more flexible approach. Primarily I practice a form of meridian therapy with a great emphasis on meridian palpation as well as hara or abdominal diagnosis and evaluation of the back shu points. Unfortunately, often I may not have access to these areas. Many patients are relatively immobile. They cannot turn onto their fronts. Some may have had abdominal surgery making that area out of bounds. Some patients can be extremely sensitive especially if cancer is widespread so that even gentle palpation on the torso can cause severe pain. Sometimes, I consider myself fortunate if I am able to palpate the five phase points. You must work around all these limitations and more importantly, be light-hearted and reassure the patient. It is a great chance to sit and talk or hear about their life if they are willing to talk. Because even listening and joking becomes part of the treatment and sometimes can be more important that the acupuncture.
Other Clinical Observations
In the hospice you will encounter many kinds of clinical signs you would not often be able to see in private practice or at least not in such an extreme way. Muscle wastage can be common. If you palpate, certain muscle groups, some muscle areas may have a weak feel to them as though they are lacking qi and blood and can be an indicator of which channels are affected by the disease process. I have noticed the area around and inferior to SJ-14 to S.I.-10 can be an area prone to muscle wastage. There may be noticeable depressions or weak spots on key acupuncture points such as ST-36 or L.I.-4 and I have followed the Neijing recommendation that when depressions are found along the course of the yang channels – apply moxa. Oedema is a common occurrence and along with internal or external pain. Another finding, I have observed is the hard as a drum distended abdomen in patients with cancers of the intestines. There is a reference to the drum-like abdomen in the Neijing in respects to blood-letting treatment. Generally, the healthy abdomen should be relatively soft and pliant with some elasticity, a balance of top and below the naval, no tight or hard areas and with an even temperature – not with cold or hot patches. As the hara corresponds to the ‘dantian field’ and is effectively the power centre of the body, the health of the body can be reflected in the abdomen.
Adapting Acupuncture treatments to the Hospice Setting
Interdisciplinary working
Firstly you will work alongside other therapist of other disciplines. This is absolutely essential, because, it gives you a chance to learn new techniques or other ideas from other practitioners by exchanging treatments or attending socials. Being an acupuncturist in private practice can be very isolating and so being able to meet up with other practitioners can be beneficial. Secondly you will be working alongside conventional medicine practitioners – nurses, doctors as well as admin, cleaning, catering staff and other volunteers. You will find that having friendly relationships with all is essential. The cleaning staff will ensure the treatment rooms are cleaned and you have fresh towels and sheets. The receptionist and transport teams will be necessary for when patients are being brought in and need help to find your department. Doctors and nurses will refer patients to your therapy. At times, you may even treat nurses or other professional staff which is essential for better interdisciplinary relationships. Acupuncture is classed as a ‘complementary’ or ‘integrative therapy’. That means it complements conventional medicine – it works side by side. I don’t see any benefit to taking an antagonistic approach to conventional medicine as some practitioners do. I would prefer to see further integration and acceptance of complementary therapies especially acupuncture into mainstream medicine similar to the Chinese healthcare model, whereby hospitals would offer both conventional surgery and pharmaceutical drugs, but would also have herbal medicine departments and classical or TCM acupuncture and massage departments where patients would be referred to. And in this model, practitioners are salaried workers.
Advanced illness - death and realistic expectations
I have read and heard instances of acupuncturists who have been able to heal people completely of cancer. For example, there was an account of how the Japanese acupuncturist Kodo Fukushima healed himself of his own cancer with self treatment and after receiving regular treatments from a colleague and how later on he also had a patient come all the way from America to be treated by him for cancer. I heard also a story from a lady in London who told a compelling story of how a Vietnamese acupuncturist in England was able to clear her cancer. Such stories are not so common and have almost a mystical feel to them. The ability to heal advanced diseases like cancer is something for all of us to aspire to. Such acupuncturists clearly have powerful healing abilities but they also have a duty of care to humanity to pass on this healing knowledge to other acupuncturists.
In Veith’s translation of the Neijing, there is this passage –
“The sages did not treat those who were already ill, they instructed those who were not yet ill. To administer medicine to diseases which have already developed is comparable to the behaviour of those persons who begin to dig a well after they have become thirsty and of those who begin to cast weapons after they have already engaged in battle. Would these actions not be too late?”
This somewhat unforgiving statement emphasises the importance of preventative treatment and following a healthy balanced lifestyle in tune with nature (or the Tao). Many diseases take some time to develop and obvious symptoms may not show up until some time into the disease progression. This sums up very well – the problem of patients with advanced disease. By the time we see them, it may already be too late. The disease process is far more advanced and in many cases the best we can offer is symptomatic improvements such as reducing pain, digestive discomfort, and improving anxiety and stress or dealing with the side effects of pharmaceutical drugs like chemotherapy or post operative recovery. Perhaps, the best time would to have started treating these people at least one to five years before the cancer appeared. Of course it is easier to say this with hindsight and no guarantees that acupuncture can prevent cancer. However, acupuncture treatment and indeed many complementary therapies can enhance life, reduce stress, improve bodily function and boost the immune system and has the potential to be a good preventative measure. This is the reason why acupuncture needs be promoted more and to become more of an accepted mainstream medical system because one of acupuncture’s strengths is that it has the potential to keep a person in balanced health if taken frequently. However, proof of this is still dependent on more scientific studies being carried out.
Conclusion
We’re all in this together
As I mentioned before, practicing acupuncture in a hospice has changed my perspective on life. I realise that there is no difference between me, the patients, family members or carers or anyone else there. One day, I am treating a patient. Maybe sometime in the future, that patient will be me. One day, I am treating a family member who is suffering from stress as their partner is dying and I realise that it could be my mother or father or spouse that I could be treating. There is a certain awareness of the ‘fragility of life’ – of how life, dying and death are all so close together. It can be depressing, but it also makes me realise that we must try to fulfil our lives as much as possible in the time that we have.
And the final point - Why are complementary therapies effective? Healing is as much the body as the mind and the spirit. A patient can be treated with the best medicine, the best surgical procedures the best foods but if the spirit and the mind are still troubled; if the person has had enough and they don’t want to try any more, then healing is so much harder and suffering is worse. Acupuncture offers a chance to improve the physical state of the body by reducing pain, nausea, sickness and digestive function but it also improves the mind and the spirit by reducing stress and anxiety for the patients, the carers and their family members. And this is why the usage of complementary therapies is growing in palliative care in the UK.
The Future – Acupuncture and hospice care
It is my hope for the future, that complementary therapists and acupuncturists will become an integral part of hospital and hospice care and that the number of paid positions will increase in the NHS. For this to happen, it is important that complementary therapies continue to grow in popularity and become more in demand. It is vitally important that more scientific trials and research are carried out to prove their efficacy.
But there is a real humanistic reason why acupuncture should be incorporated more into hospice care:
Imagine that you are lying in a hospital bed in a weakened state and suffering from a serious disease. You have pain which keeps you awake at night and you’re feeling very tired. Your appetite is weak and you’re feeling a little distressed to see your weight dropping. You’ve got a catheter in your arm and you’re taking a cocktail of drugs which gives you an upset stomach. And even though all the nurses and doctors, cleaning and catering staff are friendly and caring and the environment is warm and comfortable, you’re still feeling anxious and depressed.
But then suddenly a friendly man or woman with a gentle manner comes into the room and after introducing themselves, offers you an acupuncture treatment. What have you got to lose? You say yes.
And then, as that person lays their warm hands on you and inserts a needle, a wave of relaxation comes over you and you are taken to another place. Suddenly you have a different awareness of your body and a feeling like a sense of tension has just been released - a tension that you never knew existed. Perhaps you feel excited that you are having something new, something mysterious for the first time in your life. Up to now, you've been poked and prodded, wheeled around, injected with drugs, had blood taken out or fluids pumped in. You’ve had your whole way of life turned around. Perhaps you feel relieved that someone is spending time with you for the express purpose of taking away your suffering.
You fall asleep during the treatment to be awoken and told that the needles have been removed and the treatment finished - but that feeling of relaxation remains with you for the rest of the day. A few hours after the treatment, the pain in your back has improved and you didn’t need to ask for that extra painkiller. The next morning, you also feel that your sleep was deeper - meaning you didn’t need to press the bell to ask the night nurse to assist you. And you may not realise it yet, but something else has been unlocked in you. That simple encounter of having needles put inside you has changed you. That is acupuncture for the hospice patient.
