Every time a patient dies at Presbyterian/St. Luke’s Medical Center in Denver, the nurses, doctors, and other hospital staff who cared for them stop. Someone from the small group—which, in some cases, spent weeks or months getting to know the person, helping him or her fight cancer, COVID-19, or another difficult illness—takes a moment to recognize the significance of the death. They were someone who loved and was loved. They were someone’s friend and family member. They all then spend a few minutes together in silent reflection.
The ritual, known as “The Sacred Pause,” is currently being implemented at HCA Healthcare’s hundreds of hospitals across the country, including here in Colorado. Presbyterian/St. Luke’s was one of the Centennial State’s original locations to use it on a regular basis beginning earlier this year, after the practice had been originally proposed by a nurse in another state. As the COVID-19 pandemic drags on, and healthcare workers continue to struggle with stress and burnout, the hope is that it will give them a space to grieve and process the weight of their work, so they can continue to provide proper care.
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“Sometimes when we declare [the] time of death, it is tough to have that closure,” says Laura-Anne Cleveland, associate chief nursing officer at Presbyterian/ St. Luke’s Medical Center and Rocky Mountain Hospital for Children (RMHC). “We are running to the next patient or next thing. The pause gives the ability to actually identify and recognize that there was a person whose life was lost. And that it means something to everyone in that room.”
Cleveland says that prior to the pause being implemented in recent months, many nurses and doctors had developed their own ways to honor patients who had died. “When someone dies in the emergency department, the primary nurse kind of prepares and cleans up the body,” she says. “I would take that 20 to 30 minutes and talk to the person. Let them know they were loved. And that I hope you are somewhere where there’s peace.”
But many other healthcare workers were struggling to find an outlet for their emotions. “I had one specific nurse tell me the other day that the drive home was usually when she would cry, and cleanse, and process her day, because when she got home people didn’t really want to hear about the icky parts of her job,” Cleveland says. “She said it’s really neat to be in the hospital now to do that.”
The pause has formalized efforts to prioritize the human aspects of medical care, along with the clinical ones, according to Rev. Michael Guthrie, the director of spiritual care at Presbyterian/ St. Luke’s and RMHC. His team has helped make the ritual a regular occurrence at the hospital, adding scripts for what to say during the opening stages of the pause (i.e. the lines in the opening paragraph), and facilitating times for hospital workers to come together and engage in the ceremony. He has also been a part of sharing best practices for observance with other HCA hospitals in the area. (The ritual was proposed by a nurse in another state, but Presbyterian/St. Luke’s was one of the original Colorado locations to use it on a regular basis, beginning earlier this year.)
Such efforts have felt especially needed in recent months, as hospital employees continue to care for patients suffering devastating side effects from COVID-19. “We’ve been in fight-or-flight mode for 18 months,” says Cleveland. “Typically, we can do that for a short period of time knowing that an ending will come, but it hasn’t. You can see the negative effects on the nursing staff.”
Guthrie says the sustained nature of the pandemic, on top of the usual challenges of caring for patients, has led to compassion fatigue—a growing indifference to the trauma and suffering one is seeing and experiencing—for many health care workers. The Sacred Pause, however, provides them with another tool to develop resilience, especially as the Delta variant promises to cause another surge in COVID-19 patients.
“Part of it is about allowing staff to, in a way, honor and recognize the amazing work that they do under tough circumstances,” says Guthrie.