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Aromatherapy Triggers Memories and Relief for the Dying

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Aromatherapy Triggers Memories and Relief for the Dying

This Is Terminal is a series dedicated to opening conversations around death and dying. In this interview, we learn from the unique perspective of Nikki Hernandez, a certified clinical aromatherapist who works with hospice patients. She uses essential oils to bring relief to patients who are in pain or distress. Aromatherapy is not yet widely used in end-of-life care, but Hernandez thinks it should be in every hospice across the nation. 

Tell me about what a typical visit with a hospice patient might involve.

I will go to the patient's room or house and explain to them and the family what aromatherapy is and what it does. I usually bring two encyclopedias that talk briefly about what the oils are. I let the patient smell the oils that I think will be good for their condition, and then I will make a blend for them and massage them. I do body washes and soaps.

We had a patient in one of our hospices who had really bad COPD (chronic lung disease). I made a "Breathe Easy" soap, and I would have him bring it in the shower and make it warm – and the patient could actually breathe. He loved it. He kept on saying, "Nikki, don't forget to make my soap!" He was always worried that he was going to run out.

It just brings so much relief and relaxation. I also use them to give some patients a whirlpool bath if they are agitated. Or I will give them a massage or soak their feet. I do different things in different situations.

What are some of the specific oils that have therapeutic benefit for these patients?

I use a lot of eucalyptus for respiratory issues. I use peppermint for pain. I use frankincense and myrrh for terminally ill patients. Gosh, I use so many oils, but those are the main ones. Lavender and geranium: At the hospice in Denver, we would actually clean wounds with essential oils. We close a lot of wounds with essentials oils. My blend for just a regular, simple wound is lavender and geranium. For a more complex wound, that blend will have about 10 different oils.

Is there an emotional component to this work as well? We know scents are important memory triggers. Does that become a part of hospice aromatherapy?

I think so. Sometimes, when I brought my lavender and the person was agitated and smelled the lavender or the rose, they would feel an automatic calm. It made such a big difference. I always remember my grandmother using rose hand lotion, and I love that smell. It makes you feel good when you smell something and it triggers a memory of a loved one.

Can you talk about a few scents that are particularly evocative as memory triggers?

When I use lavender – for some reason, lavender must be a very common smell – lavender is one of the biggest triggers for childhood memories.

Cinnamon is another one. I like to use cinnamon when a patient has cancer, and most people have a really positive response to cinnamon. The three biggest ones are rose, lavender, and cinnamon. Peppermint is another, and it also clears the mind. It brings some clarity to the patient.

Is aromatherapy ever used in combination with other types of hospice therapy, like music therapy?

Yes, it is used in combination with other therapies. At the hospice in Denver, we have a really good integrated therapies program. The music therapist will come and play music while I'm doing massage. It's so peaceful when both of the therapies are involved. They relax, and they can let go. We use that a lot, especially with patients who are having a really hard time. We'll combine a couple of therapies.

Are there any other types of therapies you use in conjunction with aromatherapy?

I'll also use prayers if the family asks for prayers. There are others, too – I'll use reiki.

What sort of feedback do you get from patients and their families?

Most of them think it's wonderful. I always receive letters afterwards, telling me how grateful they were because we made it so much easier for the patient and the family. When I would go to the funerals, the family will tell me that if it wasn't for the aromatherapy, they wouldn't know what to do for the patient.

Most people are afraid to touch a person that is dying. But I encourage that in my therapy. I'll leave a lotion, and I'll say, feel free to rub their hands or give them a back rub. That seems to make a huge difference with the families.

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I was really surprised – I'd never thought of that. The Spanish, we're very huggy, we're always touching, we don't put distance between people. In hospice here, I see a lot of people who are afraid. But because they had that lotion, they were able to actually make the patient feel loved and made it easier for that patient to go.

Have you ever had a patient or family feel skeptical about aromatherapy?

Oh, quite a bit. Some people don't like the strong smells, and they don't want that. Sometimes I go there and present the essential oils, and it's something that they don't want. One, they don't think it works, and second because the smell may bother them.

Have you been able to change some of their minds?

A couple of times, I have. But quite a few times, we couldn't.

How did you get involved in hospice aromatherapy? What's your background?

I am from Colombia, and I was always interested in natural medicine. My mother used a lot of herbs and natural stuff to treat us when we got colds and whatever else we got, so I was always more into natural healing.

In 1990, I started working for a hospice in Florida, and in 1995, we had a doctor who was a patient at hospice, and she was very knowledgeable about aromatherapy and the integrated therapies of hospice. She asked me if I would help her rub the oils on her, and we got to be good friends. She donated money for that hospice to establish the aromatherapy program, and for me to go to school to learn the practice of aromatherapy.

So this was a pretty new thing when you started doing it, right? There were not established aromatherapy programs in hospice?

Right. The interesting thing about it is that when I started working with the aromatherapy, all my patients would be quiet and relaxed. So they started to realize that aromatherapy works.

Do you find this to be emotional work for you?

Yes. I get very attached to my patients, and I always have. At the beginning of my career, people would say, Nikki, you cannot get attached to the patients. But you can, you're human, and you see this person for maybe a year. How can you not get attached to that patient? And when you think about aromatherapy and massage therapy, you think about giving patients a bath; it's a very intimate relationship that you develop with the patient. You get very close to them, and they get very close to you.

How do you handle that emotional side? Do you think about how to take care of yourself so you can still provide good care?

That's really important because you come home and you're thinking about your patients who are dying and suffering – it's very hard. It's very draining. So, yes. I always try to stop and eat out before I come home if I'm too stressed, or I'll come home and take a long walk with my dogs. I always do something. In Florida, I would go to the beach and take a long walk.

It is very important to take care of yourself. Otherwise, you can't do it. If we didn't think about ourselves, I think nobody could do the job. It is a hard job. At the hospice in Florida, the director of the hospice was always making sure people were taking care of themselves and providing different activities for us so we didn't get burned out. If we had some issues, we could always go to her or to the director of nursing and talk about it. They really made it possible for everybody to be comfortable and to be able to talk about what issues they were having. It is important. You don't want to take your work home, but you do need somebody to talk to when you're really down.

Is hospice aromatherapy common? Is it used around the country, or is it still too new for that?

It's really sad because most insurance will not pay for aromatherapy. And it's costly. For aromatherapy in a small hospice, it's at least $10,000 a year. So they sometimes don't have the money for it. I've seen it used, but it seems like a hospice will start using aromatherapy, and they then stop because of the cost.

If there's a way for a hospice to afford it, what would you say to encourage them to make aromatherapy a priority?

When you think that you don't have to give so much pain medicine, and therefore the patient is going to be more alert and in less pain because of the aromatherapy, for the facility, they won't be spending as much money on medication. The other thing will be that when you use it on one patient in the facility, because the smell flows through the hallway, you're actually benefiting everybody that is in that particular hallway. You're not just taking care of one patient; you're taking care of many patients.

I would say that all hospices in the nation should think about using aromatherapy. It doesn't have to be a full program, but even if they do a little bit, a little bit is better than nothing. And it benefits the patients so much.

Can you sum up what you do in one sentence?

I love what I do, and I love the results.