Toby's Take: The Pause

My dad, in his retirement years, made his “coffee money” ushering at funerals. Why would anyone willingly do that? First, he was lousy at golf. Second, as a longtime elementary school principal, he looked good in a suit while maintaining a calm and comforting demeanor in a chaotic situation.

This is what so attracts me to professional healthcare. When things get tense, scary, even dire, a caregiver is often the calmest person in the room.

During the worst part of the pandemic 3 years ago, our caregivers at The University of Kansas Health System had to take that up several notches. So many patients, so many deaths. There was barely time to move someone who had passed on out of a room to make way for the next patient.

“And so, you really sometimes don't even have a second to comprehend what just happened,” remembered Shelby Yearout, a nurse in our Cardiothoracic Surgical Intensive Care Unit.

Deaths happen in hospitals, and Yearout knew that when she signed up for this life. Somehow, though, when the deaths were happening multiple times a day, she and her colleagues had to find a way to cope.

“You have your thing. Some people really work out. Some people obsess on their dogs. But when it was to the level that it was …”

Time to hit the pause button.

Nurses throughout the health system regularly meet for practice councils. These are the hands-on caregivers at a patient’s bedside, and they review procedures based on what they’ve seen with their own eyes. A lot of good changes have come out of these councils.

One day, someone remembered reading an article about “The Pause.” When a patient dies, no matter what the cause or how hectic the moment is, The Pause allows nurses and their colleagues to stop and reflect on the life that had been lived and ended in their presence. It could be only seconds or a minute, sometimes longer. The Pause helped them gather themselves, with great respect for the loss, and move on in an appropriately quick fashion.

“It was just about giving yourself that moment where you could reflect,” said Leana Fox, a unit educator in the Cardiac Intensive Care Unit. “Some people did it on their own. Some people did it as a group. And then the really cool thing is that sometimes family were there as we moved later into the pandemic.”

Yearout remembers times when she had to turn a room quickly. And there she was, all by herself with a body, thinking about what had just taken place and the new patient coming in. Fox says The Pause seemed to allow for a better transition to “the next thing.”

“I give them the dignity back at the end of their life and celebrate the fact that they lived this life, they got to do these things. We were able to take care of them and honor the efforts that our care team gave.”

Here’s how The Pause works. When a patient dies, a caregiver, at the right moment, can ask others nearby to join in a reflection. There’s a script for those who don’t feel comfortable ad-libbing. In fact, this script is right on a nurse’s “badge buddy,” which is the featured photo in this blog post. A well-worn badge buddy laminate always hangs around Yearout’s neck, close to her security badge:

The Pause

Can I have everyone's attention, please? Let us take a moment of silence to pause and offer recognition for this patient's life. All are welcome, but not obligated to join.”

(After The Pause)

“In closing and in our own way, may we all acknowledge the care provided by our team. Thank you, everyone.”

Other units began hearing about The Pause and adopted the practice. Thankfully, it’s used less these days with the declared COVID-19 public health emergency officially ending last week. Like so many things, practices born during the pandemic live on today.

“We nurses are human too, and we have feelings,” Yearout said. “We have emotions, and we are really good at compartmentalizing.”

Reading a script isn’t required. In fact, Yearout remembers The Pause that hurt the worst and helped the most. No one said a word.

“We were coding the mom, and it was the worst code I've ever been a part of. The amount of people that were in the room, it was unbearable.”

They worked on the patient for 2 hours.

“None of us could speak, like literally the minute we called it. We went blank and we all kind of looked at each other. But the code team had experience with The Pause.”

“We all just nodded and stopped what we were doing and stood there for 30 seconds as we all just cried and looked at the room. And then we all nodded again and started cleaning up the room so the husband could come in and say goodbye to his wife. And you know? It was, it was beautiful.”