How ‘The Pause’ Became a Resounding Call to Honor Life

Jonathan Bartels started in health care in 1986 and has worked as a registered nurse in trauma care, palliative care, oncology, medical/surgical care and post-op organ transplant. He’s currently working as a palliative care nurse liaison. He created “The Pause” in 2009, a practice that has spread throughout the world. This is his story.

It was 2009 and I was working at the University of Virginia Trauma Center.  It was after sunset when a trauma case rolled through the door, a person who had “coded” at the scene of an accident after being struck at high speed by an SUV.  She was really messed up.

As a teaching hospital, we had about 15 people in the trauma bay and everyone was working furiously to resuscitate and stabilize her. The energy in the room was frenetic. At some point her blood pressure started to drop and we were rapidly infusing packed red blood cells as quickly as we could.  In twenty minutes we had infused 10 units of blood.  Her pelvic area had been fractured in the accident and she was losing massive amounts of blood, despite trying to tamponade.  She eventually lost her pulse again.

We did CPR immediately and worked for at least 10 minutes continuously, but despite our efforts, she died forty minutes after arrival.  She was naked with blood and tubes everywhere.  She was lifeless and the monitors were stopped and silent.

The time of death was pronounced. I could now see in my coworkers’ faces that exhaustion had replaced what was just a few minutes earlier their focused energy to save her. The motion in the room slowed and the focus was now no longer her body in the middle of the room.  All eyes were now looking down at the ground or up at the ceiling, everywhere but on the lifeless body.

I had seen this many times before. The frustration and disappointment of a team who tried all they could to fix an untenable situation.

This time, I wanted to make it different.  That’s when I asked out loud if we could all stop for a moment and honor this human in the bed. I asked that we recognize her life lived prior and also honor our own efforts to save her — to do this in silence and in whatever way gave that moment meaning.

We stood around the bed, all 20, and just held that honoring silence for 60 seconds.

This was the birth of what we now call “The Pause.”

The first time I did The Pause, people thanked me.  They felt it was good and seemed to appreciate being given permission to honor in a way that is open and not necessarily religiocentric.  The greatest compliment is imitation, and many started to apply the practice into their own way of providing care.

Since 2009, the practice of The Pause has spread to hospitals across the United States and on at least six continents around the world.  The Cleveland Clinic is among those hospitals that have found it helps both families and staff. I no longer can even guess how many actual hospitals utilize the practice, nor how many individuals have simply adopted it into their own practice.  It has been identified by many leading agencies in health care as “best practice” and encouraged by one of the biggest nursing organizations in the world (The American Academy of Critical Care Nurses).

During the worst of the NYC pandemic, I read that while patients were pouring into emergency rooms and dying in hallways alone, many care providers were instructed that if the patient died, to stop and say their name and honor them in silence.

The Pause takes place in a variety of settings, not just after a difficult attempt at resuscitation.  It is being done in nursing homes after a patient dies.  You will see it after a hospice death, an expected death or after life support is compassionately removed in an ICU.  You will see it after EMS arrives and tries to save a patient in the field or after a patient is found dead.  You will see a whole team hold that space, or just a few who are present.  You see that if families are present, they too stand with the care team and share in that practice, or if they are not able to be there, they are told that the patient was honored after death. You even see it done for pets by veterinarians.

The staff respond differently based on who and where they are.  Some shed silent tears, others hug and still others stand motionless in reverence.  Some look directly at the person that has died while others look deeply downward, while others close their eyes.  All hold that silence with reverence.

In pausing, we are offering a “mini-inoculation.”  It is not meant to be a cure-all, more a first step in self-care.  Pausing allows us to hold that space and for a moment and sit with the brevity of this last right of passage. It happens in real time. It allows us to honor that life instead of cursing the loss. It invites us to feel rather than to suppress our feelings and shut down.  It brings awareness to the fact that we must take care of ourselves in order to care for others.

It is a reintegration of ritual back into the sterile scientific environment that medicine has metamorphosed into.

If you’re curious about using “The Pause” and want to know more, visit thepause.me website and download ‎The Pause App on the App Store (apple.com). You can also reach me, Jonathan Bartels, through The Pause Facebook page.

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