The Power of Pause

By Dorrie K. Fontaine, Dean of the School of Nursing
(adapted from Dean Fontaine’s Convocation address, JPJ Arena, Sept. 28, 2013)

Many of us certainly recall Thornton Wilder’s “Our Town” – a 1938 play about two families experiencing life’s many junctures — birth, marriage, work, death – in fictitious Grover’s Corners, an imaginary turn-of-the-century New England town. One often remarked-upon scene in particular towards the play’s end reminds many of us of this bittersweet passage of time, even among the humdrum days and infinite details that largely comprise a life.

“It really goes by so fast,” laments a young Emily Webb, who’d died in childbirth and is subsequently reviewing her own life from heaven. “We don’t have time to look at one another … Do human beings ever realize life while they live it? Every, every minute?”

Of course we don’t. We are often not paying attention. And our colleagues, spouses, our friends and especially our children are the unlucky recipients of this dwindling focus. But as a nurse, attention – the “rarest and purest form of generosity,” wrote philosopher Simone Weil – is the key ingredient so necessary to our care. So it’s up to nursing academics to teach students how to pay attention – and to understand that it’s attention that is in so many ways the basis for compassion.

We often talk about whether empathy and compassion can be taught – whether a nursing professor can, in fact, teach students to learn to pay attention, be empathic. And many people still believe that we “come as we are,” that we’re born with abundant compassion and the ability to empathize – or not – and that those drawn to nursing we hope have larger than usual reservoirs of compassion to offer their patients.

I wager that these are indeed teachable traits. And we instruct our students in them every day at the School of Nursing.

One way we teach students to pay attention is by learning to pause – something most of us don’t do often enough in our busy lives. There is great power in pausing. Nowhere is that more evident than in our own UVA Medical Center ER, where ER nurse Jonathan Bartels established “The Pause” a few years ago.

Jonathan’s Pause — a 45-second to two-minute ceremony — takes place after a patient codes after a difficult or traumatic resuscitation attempt. Here’s why he did it – in his own words:

“I noted that when people die after a traumatic instance, a code, often I would see surgeons and docs and nurses walk away with frustration, throw their gloves off in a defeatist attitude, not recognizing that the patient was a human being we worked on saving. So after these deaths I decided it would be a good thing to stop and pause and do a moment of silence. Just stopping. Honoring them in your own way, in silence.”

Jonathan’s Pause offers time to honor the human life that was lost, recognize the loss the family experienced, and acknowledge the medical team for their work and valiant effort. And there is no single way to pause – how it looks depends wholly on the individual who’s pausing.

Maybe it’s a prayer, for those who pray; maybe it’s a time to close one’s eyes, clear one’s head and be still, for those who meditate; maybe it’s a time to take a series of breaths for those who need to settle their spirits; maybe it’s a reflective quiet to reflect and prepare for what’s next.

Some sigh – or shed or fight back tears, owning their sorrow. Others cast their eyes upward and fold their hands. But however it looks, this is a pause that marks a passage. Patients’ families often participate too, and feel its value.

It’s a reflective pause. A pause of resilience.  And very literally a pause between patients, too. And it’s catching on here at UVA. Recently after a difficult death on one of the medical units, an anesthesiologist said to his colleagues, Can’t we just do the Pause like they do in the ER?

These are simple and powerful practices and ideas. And being fully present, paying attention – and teaching and learning how –will enable us to change our culture, to create resilient nurses, physicians and colleagues who can better care for themselves so they may care for others with compassion and strength. Those are the guiding principles of our Compassionate Care Initiative. These are ideas that work.

Everyone wants a compassionate nurse’s care; every one of our students wants to be that nurse. We’re teaching them how.