“The Pause”

“That just happened? And you’re here? I’m so sorry.” When my patient said this to me, I’d been caring for a young woman who had had an accident resulting in brain death. She was intubated and on vasopressors when her family decided to focus on comfort, and they graciously allowed me to be with her when she died. A few minutes after pronouncing her, squeezing her hand, and hugging her mother, I received a page that the primary care patient I had offered to see in urgent care while I was on weekend call had arrived. 

I tried to collect myself on the short walk from the ICU to urgent care. I took deep breaths and said a quick prayer for my deceased patient and her mom before entering the exam room. The patient was warm and friendly, and updated me on his chronic pain. I tried to listen, but it was impossible to act like I wasn’t acutely grieving. Eventually I apologized, explaining that I was distracted because a patient I cared about had just died. His response kind and I was grateful he understood. We soon concluded the visit, and I returned to my inpatient work. 

That experience taught me it’s unnatural for us to immediately return to work after a tragedy. It’s also unhealthy and not normal–there’s no other field that would expect this. People need to grieve after tragedies in order to heal. But how do we acknowledge a patient’s death when the reality of our clinical lives is that we don’t usually have control over our workload? 

One way to acknowledge a patient’s death is through “The Pause,” or a group moment of silence after stopping resuscitation efforts. This helpful video explains in detail how to do this. Although developed for use following a code, I’ve also done it during rounds and other meetings. Writing condolence cards and attending patients’ funerals has also been healing, and at times I’ve made donations to charities in patients’ names with a note sent to their families. Sometimes, at the end of the day, I’ve sung the traditional Irish song played at funerals in my own family. 

There’s no right way to grieve, and it matters more that we do it rather than how we do it. Particularly while we’re all still grieving so much loss as the pandemic continues, we should seek ways to find solace and support others doing the same. 

This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.