The Pause

Sirens have become part of civilization’s background noise; most people carry on with their routines as the sound wails by. For me, having served as a trauma nurse for half my career, the sound is a call to action. Someone’s life has changed.

If a patient in the emergency room requires aggressive care, we are always ready to give it our best efforts. If CPR is part of the scenario, our team dives in as quickly as possible. Time is brain: The sooner we can get the heart pumping, the longer the brain will remain functioning. I have tasted the glory that comes with being part of an emergency team that saves lives. But I have also experienced the pain that accompanies the loss to which we bear witness.

Television dramas portray great success with CPR; the reality is much different. Two percent of adult CPR recipients fully recover, and only up to 16 percent will be discharged from the hospital. That leaves roughly 84 percent who either die in the emergency room or die within days or weeks after such a cardiac crisis. During these times of interventions we briefly enter a patient’s narrative. When a death occurs, we see how time stops for all those intimately connected with that person’s life.

Time does not stop for us. There is another patient waiting to be seen. There is another person needing to be helped. Often we detach and walk away, pushing the loss into the depths of forgetting.

A few years ago, after a retreat on resiliency, I came back into the medical field with a new mission. Detachment, I realized, can be an unhealthy course. A patient’s death should not be forgotten. It is a shared experience and needs to be honored and recognized.

Soon after the retreat, I found myself caring for a man who had been found outside his home. In the night, he had apparently walked out of his house and tripped down stairs. In the fall he knocked himself unconscious, choked and died. He was found by his housemate in the morning. An ambulance was called and CPR was initiated.

As the man was rolled into the trauma bay we continued to attempt to resuscitate. His core temperature was low so we worked on him for over an hour; the theory in resuscitation is that a person is not dead until he is “warm and dead.” We warmed him and continued CPR, but his heart never restarted. All the while, his family stood by, watching and hoping. I had seen similar scenarios play out many times throughout my career. This case was particularly difficult because of how long and hard we tried. By the end I was physically, mentally and emotionally drained.

After his death was pronounced, I decided to take a risk and ask the room if it would be acceptable to pause and, in silence, honor both our efforts and this patient’s life. No one objected, and for a moment we stood and silently honored his life and passing. In that moment we were present for this death with the reverence it deserves.

This practice is now called The Pause. It is a means of ritually marking the importance of this moment. It is simultaneously a shared and private experience. In silence, it allows people of all faiths and beliefs to participate. This practice brings back the humanity that has somehow been lost in the technology of modern medicine.

Others who participated have started to apply this as part of their own practice, and it is now being performed in hospitals across the United States and in other countries across the world.

One moment can make a difference.

Jonathan Bartels is a palliative care liaison nurse at UVA.