Sacred Pause is a ritual that acknowledges the significance of a patient’s death. More than an idea, its practice brings together health care providers, often with family members. It lessens the distance between Them and Us.
This video illustrates the essential elements of the ritual (used with permission): https://www.youtube.com/watch?v=_HVXM2YhZ2A.
There is “evidence” that practice of Sacred Pause produces positive effects on ICU nurses and physicians: “Sacred pause brings closure, prevents cumulative grief and distress, builds resilience, promotes team effort, and improves professional satisfaction of ICU team.” (Am J Hosp Pall Med 2018; 35:1337-1441). The practice is practical, non-religious, and tends to spread by word of mouth.
A Sacred Pause has three key ingredients: recognition of the deceased as a person with a life and relationships; recognition of the team’s efforts to treat him or her; a 30-60 second period of silence.
Here are scripts to help when first trying this process:
| “Let us take a moment to pause and honor Mr. Smith. He was someone who loved and was loved; was someone’s family member and friend. In our own way and in silence, let us take a moment to honor him. Let us also honor and recognize the care provided by our team.” “Let’s pause for a moment and recognize Mrs. Jones in this bed. Before she came into the hospital, she was alive. She had family and friends. She was loved by others. We are honored to have provided care to her. We honor her life, and we have witnessed her death. Let’s take a moment to pause.” |
As health care providers who have seen recently-dead bodies, we belong to a specialized community. We have to deal with the experiences individually, but a shared community of experience can soften the starkness of witnessing a death close at hand.
We live moment to moment usually, and often we are barely aware of them. But when patients die, witnessing that, we have an opportunity to acknowledge a unique moment – a place and time never before, and never again.
Rituals are acts that can help bring order to chaos, and comfort to pain. A ritual such as Sacred Pause can remind us of our connectedness: connections between this moment and other moments of loss, between this patient and ourselves, between the emotions of this experience and others we have had. With a shared community of experience, we can refresh our sense of belonging, purpose and meaning: we are not as alone in our experiences.
At times or often, we and the culture at large do not to wish to face the fact that our time together is always limited. Health is a gift. Our experiences, working in hospitals, remind us that the values of culture and the wishes of patients and providers must eventually confront the realities of biology. It has always been that way and always will be: providers of health care will be empty-handed at times, left only with their hearts and their spirits to support their patients. We have more gadgets and medicines than ever before, but we should not forget the traditions we belong to, which is to accompany patients in their illnesses.
My hope is that we can remain realistic (some call it being hard-nosed) about Things, but always seek not to become hard-hearted about People. That will take awareness of ourselves, and it will take the support of our institutions.
References:
- The Pause. Jonathan B. Bartels.
Crit Care Nurse 2014; 34:74-75.
Mr. Bartels started the Medical Pause at UVA, where it is part of the nursing curriculum now. “For us, pausing has made all the difference.”
2. Trauma workers find solace in a pause that honors life after a death
All Things Considered. September 27, 2015
Early news article about the history of the pause.
3. “The pause” allows for moment of silence after a patient death: the RN who developed it sees it as “a means of honoring a patient after they pass away”
ACP Hospitalist, Jan 2016
Interview with Jonathan Bartels RN in medical literature
4. “Sacred Pause” in the ICU: Evaluation of a Ritual and Intervention to Lower Distress and Burnout. Kapoor S, Morgan CK, Siddique MA, Guntupalli KK.
Am J Hosp Palliat Care 2018; 35:1337-1341.
Online survey at a tertiary care medical ICU (Baylor) found that responses were positive.
5. https://thepause.me/2015/09/26/the-medical-pause/
Jonathan Bartels’ website about the Pause
6. https://www.youtube.com/watch?v=_HVXM2YhZ2A
Teaching video at Providence Health Care. Spokane WA