What is it?
The medical Pause is a practice implemented after the death of a patient. This practice offers closure to both the medical team and the patient. It is a means of transitioning and demarcating the brevity and importance of this moment. Through silence this shared event is able to be honored and marked by a multicultural medical staff. Silence allows individuals to personalize their practice while not imposing onto others. This act is a means of honoring a persons last rite of passage. To bring an element of the sacred back into a profane world of medicine.
Who can ask for a Pause?
Any member of the team can request a Pause.
When do I perform this Pause?
In an attempted resuscitation situation, it is preferable to perform immediately after death is called. This allows for all involved in the care to be present and share in the practice before leaving room and becoming dispersed.
After an expected death it is also preferable to be done soon after patient’s death has been identified.
If circumstances do not allow for an immediate Pause, this can be done at a later time. (Preferable to include all team members involved in care).
If family is present, by all means allow or invite them to be present during the practice. This increases the shared experience and is a way to acknowledge their own loss.
A Pause can be performed for a Donor prior to harvesting organs.
A Pause can be performed for a recipient prior to and/or after an organ transplant.
How is The Pause executed?
Anyone can ask to do this following a code/death. At first it may feel awkward because we are standing in a vulnerable place and asking for a moment of respect. After it is done, it becomes easier to repeat because everyone involved understands how important it is.
“Could we take a moment just to Pause and honor this person in the bed. This was someone who was alive and now has passed away. They were someone who loved and was loved. They were someone’s friend and family member. In our own way and in silence let us stand and take a moment to honor both this person in the bed and all the valiant efforts that were made on their behalf.”
45 seconds to a minute of silence.
“Thank you everyone.”
Things to avoid:
- The Pause is not a venue in which to proselytize. It is an attempt to allow a group of people with diverse practices and beliefs to share an experience of honoring both the life lost and the care teams efforts. The language chosen is meant to universalize this experience.
- Allow staff who are not comfortable with this practice to opt out of the actual Pause. (This is a silent moment of respect and if a team member has difficulty with this, further exploration may be warranted in order to facilitate support of that person either through employee assistance or peer counsel).
- I would recommend avoiding making this a policy/procedure; allow it to become naturally integrated into how things are done in your place of work. Once staff is empowered, the practice will grow organically.
The Pause | Jonathan Bartels 
i am more then happy to take part in this.
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My first experience with this concept came in nursing school when a patient died an hour into our clinical day. The nurse joined us in the room and quietly told my two classmates and I who this man was; she told us about his family and his work, his illness and the peace he found in accepting his impending death. I’ve never known anything other than pausing to honor a person’s passing from this world and I’m happy to see this exercise in basic human decency spreading.
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I have recently introduced the pause into my emergency medicine practice. It has created a brief but powerful space after the intense efforts of a resuscitation. A moment to breathe, reflect, and regroup. It gives recognition to the power of the moment when another’s life has ended. It has been universally well received thus far. Thank you for introducing this concept, and helping bring a moment of healing for my colleagues and myself.
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This is a wonderful idea. With a few exceptions, I challenge anyone not to find 1 minute to do this. Spontaneity may be the key.
Shifts are so busy nowadays that recently I have felt we have been missing something – perhaps it is the time to pause.
I shall definitely talk to our managers in the Hospice where I work.
Thank you for sharing.
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Dear Jonathan, I too am in the medical field. I found my most rewarding work in oncology. I used a journal and would write down the name of every person that passed away that I took care of and go to know. I wrote a little note about a special moment–happy or sad, maybe a laugh, with that patient. I still go back to that journal now and then and look through the 300+ entries and pause and remember how their life touched mine without them ever knowing it. I guess that was my own little “Pause” and a way that I found to honor those people that I had the privilege of caring for.
I was made aware of you and your mission by Chloe Pestana. She grew up with my daughters……All parents looked out for all kids in our town…and we are Aunties and Uncles to all of them….Chloe was no exception. Chloe’s loss of Legend devastated all of us, but it is her bravery and honesty about her own experience that is changing the narrative surrounding death.
I did a You Tube search and found a clip about The Pause and was truly moved to tears. Thank you so much for your work and your mission. Aloha, Kehau
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Thank you Kehau,
Aloha .
Chloe brought me to tears in a room full of hundreds of people. She told me her story and as she spoke, all the other noise in that big room disappeared. She is very special and I am honored my small act has touched so many. I believe her experience will do that much more for others who have faced the loss of a child.
Be well sister.
Thank you for the lives you have helped.
Jonathan.
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