Emergency Medical Workers "Pause" After Traumatic Death

Aug 18, 2015

In America, death is not something we often talk about unless we are forced to by circumstance or tragedy. But at hospitals, death is an everyday occurrence and medical workers must quickly learn to deal with it. But how do they cope? WMRA’s Kara Lofton reports on one initiative, called "The Pause," that started at the University of Virginia Medical Center two years ago and is now slowly being adopted by hospitals all over the country.

Charlottesville, VA - [Sounds from the hospital]

These sounds from an actual training clip from medicvideo on YouTube are reenacted every day in emergency rooms all around the country, including at the University of Virginia Medical Center.  A stretcher, fresh off an ambulance, comes sweeping through the emergency department doors. EMT’s, nurses, doctors, and techs run – toward the patient, equipment, a room - shouting, scrambling, hoping to save the life. It is the irony of this moment, when the patient’s life is slipping away, that they, the medical workers, feel so alive. Adrenaline makes them hyper alert and their own hearts pump faster, as if willing the heart in the body on the stretcher to keep pumping too. But they are too late. The patient dies. And there is someone else who needs saving. So they put down their tools, clean up, and move on.

For the past eight or nine years, variations on this scenario have been trauma nurse Jonathan Bartels’ reality.

JONATHAN BARTELS: Each time we would resuscitate someone and attempt to resuscitate them, you know at times we couldn’t save them. And it started to wear at me on times and I started to notice staff responses to that. And staff responses were often frustration, disappointment, a feeling of failure, you could see pain in the physician’s eyes, you could see pain in the nursing staff.

In order to cope, he said, most medical professionals stop thinking of the person in the bed as person, but rather just a body that they are trying to resuscitate. Disconnection, he acknowledges, is necessary on some level. But it can also be harmful and lead to burnout – a state he said he has experienced on more than one occasion. 

One day, about two years ago, after Bartels’ team tried and failed to resuscitate a patient, a chaplain came into the room.

BARTELS: We had worked on this patient for hours and the chaplain came in and kind of stopped everyone from leaving the room. And I went ‘wow that’s really bold.’ And she said, I’m just going to pray over this patient and then you all can leave. And I watched it and I felt - it was the act of stopping people - it inspired me.

The prayer portion was hard for him because he said he, like many others at the hospital, comes from a different religious tradition than the chaplain. But he kept thinking about her action. 

BARTELS: So the next time we worked on another person who didn’t make it, this time I decided to be bold and stop people from leaving and it just came to me. I said can we just stop for a moment, can we take a moment to stop and recognize this person in the bed. You know this person before they came in here were alive, they were interacting with family, they were loved by others, they had a life and if we could just take a moment as a group of people and just stop and just recognize this person in our own way and in silence, just take a pause, take a break and just do this together, but in silence.

The team agreed. 

BARTELS: And when it was done, and I only did it for about a minute, I said thank you all for the efforts that we did to try and save them. People walked out of the room and they thanked me, they thought it was really awesome. And then other nurses started to replicate this and do it and I realized I had something that should probably continue just by the fact that because other people wanted to do it themselves, and felt empowered to do it themselves, it started to carry on and started to take on a life of its own.  

Practitioners at UVA ranging from EMTs to nurses to anesthesiologists are now adopting the Pause. In 2013, Dorrie Fontaine, dean of UVA’s school of nursing, talked about The Pause during a keynote address at a trauma nursing conference. A nurse there, Michael Day, who is trauma care coordinator at a hospital in Washington State, took the concept back to Providence Sacred Heart Medical Center in Spokane where it is now being used. The concept is spreading, Bartels said, because it works.

The Pause has made a big difference for many at UVa, such as EMT and hospital tech Jack Berner, who says it gives him closure.

JACK BERNER: Death is a word that you have to use in this setting, you can’t use other terms to kind of soften it…but again it makes it so we can actually view the person as a person rather than as a patient that we see on an everyday basis, you can relate more to the case saying you know its somebody’s father or their mother, their sister or their uncle, rather than somebody you just see for five minutes. It makes it more real.

Prior to The Pause, Bartels said hospital workers processed death and dying two main ways: they either became emotionally numb or they were unable to disconnect the patient’s death from their own life experience. Both ways are unhealthy and lead to burnout. What is better, from Bartels' perspective, is to develop what he calls a “permeable membrane,” which The Pause helps develop.

BARTELS: And this membrane allows some in, but it also allows some out. So you are able to feel and you are also able to sense and give back. So the best way to cope with that in a healthy way, is you acknowledge your feelings when someone dies, you acknowledge the pain of that, but we don’t own that. That’s not my death, that’s not my family, but I can acknowledge that this is a natural process, and this is what happens and I can also acknowledge the pain that I bore witness to in caring for that family and caring for that patient.

A shorter version of this story also aired on NPR's Weekend Edition Sunday on Sept. 27, 2015.