Shannon, 41, had been admitted into in-home hospice in July of 2017 after a long battle with endometrial cancer. She fought hard to stay alive, accepting every clinical trial offered to her after several rounds of chemotherapy and radiation. She had come to me two years prior for acupuncture to ease some of the side effects of her treatment. She was a devoted patient, impressed by the relief it gave her, and convinced it was helping her body's immunity, because she felt better after her treatments.
Indeed, with all of her constancy to her various treatments, in March I had written in her medical notes that Shannon's blood work was moving in a promising direction, and for the first time since her diagnosis, her CT scans were showing that her aggressive form of cancer had not progressed. When she optimistically delivered this news, I wrote in quotations that she said, "I have to give credit to acupuncture since it's the only thing I have changed." In the same notes, it was written that she was about to begin hormonal treatments as a part of a new clinical trial.
The Acupuncturist & Patient Relationship
In the two years I treated her, we had formed an endearing patient-practitioner relationship that I find is common amongst acupuncturists and their patients, as treatments are more frequent and personal than most forms of modern medicine. I was really rooting for her, though my optimism was cautious, as I had already witnessed how volatile cancer could be in other patients. I knew intricate details about her life, as aspects that seem irrelevant in Western medical paradigms are in fact crucial to the execution of effective treatment in Chinese Medicine. She confided in me after she met with the new doctor who was leading the clinical trial that she really didn't care for him, that she felt his interaction with her was very impersonal; she felt like a number in his eyes, and this raised flags.
In late June, her new scan results showed her two tumors had gotten bigger and there was a new one as well. Her oncologist encouraged her to get documents in-order while she was feeling well and to stop working in order to have meaningful time with her daughter to whom she was a single mother. Shannon's prognosis had taken a grave turn and indeed, she was facing death.
After early July, she began missing appointments without notice. I reached out with an email and expressed that there was no pressure to come in but that I was thinking of her. She responded within a few days and asked if I might be willing to pay her a home visit. As it turned out, she lived down the street from me and I wanted to help her in any way that I could. We arranged a phone call and looked at our schedules to book a time. She sounded surprisingly well and astute; one would never think they were speaking to a person who was dying, though she had been informed she had six months to live. We agreed on a date and time one week from then.
Shannon's Treatment
I arrived at her home prepared to see her as I knew her, but a different woman answered the door. I told her I was Shannon's acupuncturist and that she had requested a home visit from me. She leaned close and told me she had taken a bad turn in the past few days and that I might want to go in and assess the situation to see if I could still treat her.
I entered and found Shannon in her living room on a hospital bed. She appeared unconscious except for slight movements in reaction to her loved ones. I approached her and saw that her eyes were open, her pupils drawn upward, the crevices of her eyes surrounded by a yellow crust, and many eye lashes had fallen out and rested on her cheeks. Her eyes appeared stiff and lacked luster. Her mouth was open and her teeth appeared blood stained. There were strands of short hair all around her pillow.
I have faced a fair amount of death in my own life, but I had not been expecting this so it took me by surprise to see her on her deathbed when I had arrived expecting to have meaningful conversation with my patient. I noticed that my hands were shaking slightly as I leaned in to tell her I was there and that I was so happy to see her. I told her family that I was happy to treat her to make her more comfortable if they could tell me what her complaints had been before she stopped talking. She had complained of pain from being bedridden so I planned to do points for pain relief. When I lifted her sheet to expose her lower legs, I saw that this very petite woman was extremely swollen with edema.
I used points to increase circulation and she shifted slightly with the needles and then settled. I massaged yin- tang and her hands and spoke to her softly. When I left, I thought I would never see her again. I felt moved to have had the experience and opportunity to say goodbye to a patient who had trusted me until her last days.
An Effective Treatment
The following day, I was surprised when her mother called me and told me that she had been markedly less restless after the acupuncture. She asked if I could return and I happened to be available and drove down the street to her home. Knowing what to expect this time, I felt more collected and prepared. I gave her a treatment again and then sat by her bedside as her daughter ran around the home ostensibly unaware of the gravity of what was unfolding.
I held Shannon's hand and leaned in. She appeared completely unconscious now, so I told her that I knew she could not see what was going on, but that I was witnessing her entire village showing up for her and that it was evident they all loved her daughter so much and would take great care of her. She squeezed my hand very slightly and shed a tear. As she lay with the needles in, I taught her grieving mother how to apply gentle pressure on a few pressure points that would have a relaxing effect. She passed away the following day.
I love that Chinese medicine is applicable in just about any situation that merits healing. It is phenomenal for pain and sports injuries and depression and fertility, but it seems we forget that healing is still relevant in somebody's last moments of living, that if we can aid one another to die with dignity, the human race is collectively better off for that tiny show of compassion.
I was moved to witness that her death was not chaotic at all compared to living; her body shut down in a very methodical fashion wherein acupuncture was still a functional option to offer her comfort and relief. While I am aware that hospice work does not call to all practitioners, to those for whom it might, I would urge you to offer your gifts in this way. My presence for Shannon and her family was a simple offering from me, but it taught me unforgettable lessons that I will carry forth for the rest of my career.
As modern medical standardization continues, the field of traditional Chinese medicine has the advantage of comprehensive personalization. For rare or complex cases, deeper consideration of constitution is invaluable. Proper constitutional assessment, especially with first-time clients, can guide desirable and predictable outcomes. This leads to a higher rate of return, and greater trust between you and your patient.
Though the creation of a financially sustainable, health-promoting model feels far away today, we are casting a vision for a full return on health, believing that this compels us to keep one foot firmly rooted in caring for the sick and the other foot firmly founded in maintaining health. Shifting from a fee-for-service model to value-based care using a phased approach is paramount.
Laser therapy has emerged as a powerful tool in the realm of traditional Chinese medicine (TCM). This new modality fits beautifully into the toolbox of the modern acupuncturist, as it can be used as a hybrid form of stimulation to acupuncture points, meridians, organs, nerves, and symptomatic areas in a new way that blends both moxa and energetic needle-like responses.
