Romane Aymé never separates from her bottle of sweet almond oil, nestled in the pocket of her blouse like a gri-gri. “I use it to massage patients as soon as I have a little time”, says the 26-year-old nurse. Here a sore calf, there dry elbows. Even when time is short, the young woman warms a few drops in the palm of her hand then rubs what needs to be. “We are not only there to give injections or change protections”, insists the caregiver, very attached to these “Moments of sharing and pleasure”, unfortunately too often relegated to the background. Indispensable to avoid bedsores linked to prolonged bed rest of patients, massage is for her a form of language. “I worked in a neurology department for three years, with cerebral-injured or aphasic patients, she says. Taking their hand, caressing their face, it was a way to communicate with them, but also to soothe them, especially after painful treatments. “
→ READ. Medicine: touching the patient is no longer automatic
And then the coronavirus arrived, imposing barrier gestures and physical distancing. Mask, gown, glasses, “We turned into cosmonauts”, remembers Eve Rizzotti Donas, midwife at Strasbourg University Hospital, very hard hit during the first wave. So much so that the caregiver had come to be wary of her own hands. She who had always considered them as allies, now she looked at them with suspicion. “We didn’t really know how to do our job anymore, she testifies. We midwives are manual workers. It is impossible not to touch the patients. During childbirth, our whole body is engaged. And I can tell you that we are pushing too! “
“The first and the last meaning that we develop”
So we had to adapt. Wash your hands even more often, compensate for restrained gestures with words that comfort and smiles that soothe – smiles that pass through the eyes, mask obliges. “But there are situations in which there are no words, says Eve Rizzotti Donas. I accompany women in medically assisted procreation, waiting for a child who does not come. Others have had miscarriages or are going to have an abortion. What to say in such moments? We cannot be satisfied with technical gestures or with prescribing this or that treatment. Putting a hand on a forearm, wiping away a tear, is sometimes the most useful thing you can do. “
“If touch is the first sense that we develop, it is also the last that remains when the end comes”, notes Mélanie Matz. For this nurse in an Ehpad in Sarrebourg, in Moselle, reaching out to the patient is to consolidate them in their humanity, to anchor them in the present moment. “Many of our residents suffer from Alzheimer’s. Touching them brings them back to reality ”, she emphasizes.
This young mother has had a very bad experience of the sanitary measures imposed in her establishment. “The mask complicated communication with the residents, but I think the hardest part was the gloves”, she says. Usually confined to private toilets – “We put them when we are in contact with biological fluids” -, they had become mandatory for any relationship with residents with Covid. Instructions from the regional health agency. “Touch has been considerably impoverished, deplores the caregiver. A gloved hand does not diffuse heat, it is not soft. The contact becomes cold, mechanical ”, observes the caregiver, still upset at not having been able to “Accompany with dignity” a resident who died this winter.
Éric Girardot is convinced of this: you can die from the lack of a tactile connection. “This emotional touch is extremely important, especially for people weakened by age or illness. In nursing homes, people who were deprived of physical contact lacked essential food and left faster ”, he laments. Specialized in comfort and well-being care for the elderly, this practitioner has set up several training courses for nursing home care workers or geriatric services and carers of dependent people. Because we do not knead the skin of an octogenarian like that of a thirty-something or a teenager. “The skin of older people can be thin and mark very quickly”, points out Éric Girardot, who speaks rather of “Touch-massage” or from “Touch-contact”. “The pressure of the fingers, the pace are not the same. The touch must be reassuring, containing, but not heavy or restrictive ”, describes this practitioner, who ensures that demand from establishments has increased in recent weeks.
As if the crisis, by putting the touch on the spot, had reminded of the importance in the relationship between caregiver and patient. “In Antiquity, the image of the doctor is that of an old gentleman seated on a chair and who feels the patient, recalls the historian Stanis Perez, co-author with Patrick Berche of Pandemics: from the origins to Covid-19 (Perrin). Until the XVIIIe century, all his senses are involved, including taste, because it is by tasting the urine that he can diagnose diabetes, he continues. With the arrival of instruments, in particular the stethoscope, the place of touch has declined and the patient’s body has gradually been put at a distance. The Covid has generated a hygienic surge which could accentuate this trend, but as often in crises, we can expect a pendulum effect ”, analyzes the historian, for whom touching will not come out lessened but undoubtedly with “New gestures”.
With an increasingly important place given to consent. Clearly, the need to be touched, whether purely medical or more emotional, does not allow all manipulations. “For example, some people hate being cracked, remarks Léa Gay, osteopath in Hauts-de-Seine. In this case, it is necessary to adapt the techniques and to go to the rhythm of the patient ”. Otherwise the painful area risks making him suffer even more.
“In the profession, it is customary to say that if a person does not want to let himself be touched, it is not worth insisting, because the defense mechanisms that he will put in place go into the opposite direction of a relaxation ”, abounds Dominique Blanc, president of Ostéopathes de France. To rush the patient is to risk closing all access to his body and his emotions. Gold “It is only by touching the skin that we can understand what is happening, including at the psycho-emotional level. Because fabrics have a memory ”, affirms this practitioner who practices in Villeurbanne.
The delicate moment of the toilet
Eric Girardot speaks of a “Taming phase”, beginnings for building a relationship of trust. “The people we deal with are sometimes very isolated, they don’t have visitors and are not used to being touched. We must not rush them, he indicates. Not to mention that in these generations the culture of touch was not the same, many did not receive this form of affection. “
Hence the apprehension that is often felt during the toilet, a moment often feared by patients. “I fight to be systematically in pairs with a caregiver, because it is very difficult not to be mistreating when you are alone, regrets Romane Aymé. Being in pairs ensures that the patient is in a good position. Above all, he can hang on to one of us rather than the bar of the bed. Patients are often afraid of hurting or falling when lifted. Skin to skin secures them. ” Just like rubbing them with the soap he used to use at home. “It’s a familiar smell that reminds them of home”, she adds.
Smell, a sense intimately linked to that of touch. “I am often asked if I don’t mind touching bodies that are not necessarily clean or may be sweaty at the end of the day,” has fun Léa Gay. But I don’t even think about it. What I see are bodies in pain and that through my hands, my only little hands, I can manage to relieve. I find that very beautiful. “
→ Find episode 1 of this series: “We are beings of skin”: touch, our essential link to the world
A word that touches: “massage”
More or less expert hands that squeeze, pinch … people more or less skilled in this contact, which is light, fluid, or more tonic. In the imagination, the art of massage – from the Arabic massa “to touch, palpate” -, recounted in the stories of travels in the East, summons the exotic and sweet sensations. In the West, the word refers to “kneading” the skin and all the manual techniques applied to the body. First empirical, massage was practiced in France from the 19th century.e century in specialized establishments – the masseur-physiotherapist diploma was created in 1946. Slamming, effleurage, friction, tapping…, as many maneuvers used, whether the massage is for hygienic or therapeutic purposes. Sedative, stimulating, relaxing, it can be abdominal, facial, plantar, palmar. As many touches as there are regions of the world exercising it, each bringing its share of variations and mastery – Swedish, Californian, Thai … There is also the saving gesture, cardiac massage and its chest compression movements in case of heart failure.