This past September, NPR ran a story about a new practice being taught at the nursing school at the University of Virginia Medical Center, called the pause. This term describes a moment of silence taken by a medical team after losing a patient. Originally, the pause occurred after losing a patient in the trauma care setting, when the hospital chaplain asked the group to stop and stay for a moment of prayer. After that, health care workers reflected on that act of pausing. Then, after losing a subsequent patient, they asked everyone to take a moment of silence. And the practice continued.
The unfortunate truth in medicine is that there will always be other patients in need of care. Thus, as heartbreaking as the loss of a patient may be, the day cannot end in that moment. One’s instinct is torn: There is the human side that wants to honor the moment, and there is the working provider side that needs to move on and care for other patients.
The reasons for enacting the pause are numerous. The most obvious and identifiable reason is because the practice satisfies the human desire to acknowledge the loss of another human being. But second, and perhaps more easily overlooked, is the fact that the pause affords time to recognize the effort the health care team has put into caring for the patient’s life. For health care workers, it can be difficult to accept that in spite of trying everything, a patient can still be lost. The pause allows for reflection on the effort the team put in, and it lets the team re-gather strength to focus on subsequent patients.
During my training, I discovered there is no real way to prepare for the experience of death. Each loss is different, and while it can be difficult to change how we emotionally respond in the moment, creating a culture of reflection allows for managing loss in retrospect and preparing oneself for subsequent patient care.
The pause is not just for the patient; it is for the team. It is for the well-being of the providers. Regardless of whether this practice spreads to other institutions, the underlying principles of togetherness and reflection promise great humanity moving forward through the rigors of day-to-day medicine.