The Pause

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“Forever is composed of nows.”
Emily Dickinson


A young woman is wheeled into the trauma bay. She’d been crossing a busy intersection at night, clad entirely in black, and was hit by a sport utility vehicle moving at full tilt through the crosswalk. Smears of blood streak her face like war paint, and her arms are bent at unnatural angles. Her body lies exposed, her clothing in snipped tatters about her small frame as we do an initial physical assessment.

These are the final moments of her life, but no one knows that yet. She remains unresponsive, and given the number of blunt injuries she has most likely sustained, we decide to intubate.
Intravenous access is established. Our FAST exam [focused assessment with sonography in trauma] is positive for massive abdominal bleeding. We speak in low staccato to one another, poised for what will happen next, willing her body to come back, her eyes to flutter open, our monitors and instruments to detect any surviving circuitry within her.
Then there is no blood pressure, then no pulse, and the monitor chirps asystole. The tension escalates as compressions begin, 100 deep beats per minute. Drugs and fluids are rapidly infused. We expertly move in a choreographed dance dedicated to saving lives. From the outside, it must look like chaos, but our dance in the emergency department is known. We have done this before, and each of us knows his or her step in this trauma bay by heart.
We try to bring her life back for 45 minutes before we realize it’s too late, and the code is called. On this day, the day of the young woman, I remember defeat and exhaustion, but also more than that: a kind of vacancy, a space where the pull of emotion gets tamped down by time, fatigue, and grief, leaving an empty numbness in its place.
It is as if our team lost the most important game of the year only to be told we’re due to assemble at the 25-yard line once again. I watch my colleagues throw off their gloves and stride out of the room, leaving the naked, lifeless body on the table. Not a glance back, just a step back out into the world of the emergency department where patients stream in like locusts. It isn’t heartless: it’s force-fed anguish.
There is no time for a breath, or thought or tears. A death that gives us pause as humans leaves us as clinicians with no time to pause. Maybe, I think, that’s the problem. It was on the day of this girl’s death that I changed my response to and ceremony around death. Her death wasn’t our first, and it would not be the last, but I remember it because it did mark the end of the old way and the beginning of the new—our pause —and my determination to speak up, to ease up on the tamping down of emotion, to be brave.
Emulating our unsinkable chaplain and shedding whatever compunction I felt about changing our routine, I used the next difficult case—just days later—as a platform for a shift, this pause.
However haltingly it began, somehow, it became ceremony. After a death in the emergency department, I would stand, ask that no one leave, and invite my peers to bear witness with me, to be together and present in a singular moment of grief and loss. I would ask each to, in their own way, offer silent recognition of the lost human life—someone’s mother, father, sibling, or child—to remember that the person who had died loved and was loved, to understand that the person’s passing deserved recognition, and to acknowledge that our own efforts, too, were worthy of honor. Forty-five seconds, maybe a minute, a minute and a half.
For us, pausing has made all the difference. This pause honors those lives that do not get saved and gives us a moment to contemplate the passage and bring the sacred into what is often a profane environment.
In so doing, we recognize this sad rite of passage. Our pause, in its own way, breathes life back into what can feel like an airless, emotionless room where we work. With it, we stop and allow ourselves to be present in the natural, real events that have unfolded. We are together, yet apart.
We recognize that stillness is very human, as is the desire to tamp down things that hurt, disappoint, and exhaust. But we become still. In my own practice, I am learning to try not to tamp my feelings down as much. Around the University of Virginia, we talk about ways to keep ourselves resilient, to keep ourselves from squashing the very human elements that make the practice of medicine the noble and soulful profession it is.
Jonathan B Bartels RN BSN

27 thoughts on “The Pause

  1. What a deeply moving but also deeply disturbing article this is. I was thinking while reading: “What? They just walk off this dead body to go to the next emergency? Their own souls can’t possibly handle that! And the girl’s family/parents? How the heck….!?”
    And then, while I continued reading, tears started streaming down my face and I can only laud the writer for his ‘insight’ – May all personnel read this, take note of the importance of PAUSING too and of one’s own body/heart/soul gather up new courage, strength and power to continue. It’s SUCH important work but only a sound, healthy body & soul can be of assistance and help to another body & soul.

    1. Yes that’s the reaction I had too Kiki. It is a beautiful, yet difficult reminder for all of us to stay connected and to honor each precious moment we are given together. Thank you 🙏🏻💕

  2. What a well written story about an awakening to the sacred in each and every one of us, in whatever situation we find ourselves. The story shows how two opposites co-exist in one more part of our human experience. The violence of what is done to attempt to bring a body back to life alongside the sacred work of saving the soul of another whose body has been so damaged and broken- such is our human experience in the realm of the relative. Powerful story, Karen. 🙏🏻💕

  3. Beautiful. After 36 years as a funeral director and a firefighter/EMT, I couldn’t agree more. I’ve forwarded this to two of my daughters. One is a NICU nurse and the other is in medical college to be a pediatric trauma surgeon. They already know this, but it will reinforce their beliefs. Thank you 🙏

    1. Thank you Ray. I’m so glad this is known and is beginning to be practiced around the world. Thank you to you and your daughters and their important work in the world. 🙏🏻💕

  4. Hauntingly sad, but yet the beauty of this one human soul who decided to try and make a difference in honoring the cycle of life. Praises to him, and wouldn’t it be wonderful if every ER department had such a practice, or even if they taught this in medical school? It was so difficult when I lost my husband in the ER to see how some treated him and the experience, which in turn lead to more confusion for us. Grace, I see this individual as grace.

    1. Yes beautifully said Heather. I am grateful to Nurses like him too and remember having similar feelings with the staff at our hospital when our son was there. Each of us can make a difference when we step up in courage. 🙏🏻💕

  5. A beautiful observance that honors the soul that has passed, but even more importantly, keeps the health workers in touch with their own. This ought to be taught in med school!

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