Illustration by Jennifer Rodgers.
A patient has died. His nurse begins postmortem care.
“I tell myself the things I always do—it was his time, we did everything we could. I can hear someone crying outside the room.”
In this month’s Reflections essay, author Kassandra August-Marcucio shares her feelings as she performs the steps of this protocol after a failed resuscitation attempt. We are reminded of each task, of the feelings of guilt that can arise (“I was his nurse and he died!”), of the last contacts with the patient’s family.
“The exaggerated zip of the bag is final.”
Almost every nurse has cared for a patient after the patient dies. Sometimes the nurse and patient have barely met; sometimes the patient is well-known to the staff. Many nurses (most, I hope), whatever their religious or spiritual beliefs, approach postmortem care with some sense of the gravity of the moment of someone’s passing. The “routine” tasks involved take on a slightly different aura than the other tasks of our days. Still, it’s hard not to rush through postmortem care to attend to the pressing needs of other patients.
Nine years ago, trauma nurse Jonathan Bartels created the Medical Pause, a “practice [that] offers closure to both the medical team and the patient.” The Pause is a moment of silence of a minute or less, ideally performed immediately after death has been pronounced or resuscitation attempts have ended. It is not “religious” or proselytizing; the silence allows people of diverse practices and beliefs to share in respectful recognition of a person’s death in a way that allows for it to be meaningful to all.
Anyone can ask for The Pause. Bartels notes that it can feel awkward at first, but that over time it becomes easier to do because the importance of the practice is quickly felt. He has suggested words to this effect to start The Pause:
“Could we take a moment just to Pause and honor this person in the bed. This was someone who was alive and now has passed away. They were someone who loved and was loved. They were someone’s friend and family member. In our own way and in silence let us stand and take a moment to honor both this person in the bed and all the valiant efforts that were made on their behalf.”
Bartels sees this practice as a way to not only respect and honor the person who just died, but also as a meaningful act of self-care. The death of a patient may not be a personal loss, but repeated exposures to death can’t help but affect our emotions and sense of self. The Pause recognizes the impact of a patient’s death and offers a way for us to absorb and process it. (Last month, Bartels received a Pioneering Spirit Award from the American Association of Critical-Care Nurses for The Pause.)
I am impressed with your article highlighting an important step after a patient dies. As a new nurse in the profession I have had the experience of having to do postmortem care after a patient died and to say the least it is a sobering moment that caused me to reflect but also wanting to give the dead the respect he or she deserves. The medical pause you highlighted that was created by Jonathan Bartels, should be practiced by everyone who in that moment was part of the transition between life and death for that patient. So much can be communicated in that moment of silence, which demonstrates respect for the dead as well as for the efforts of the team.
How wonderful to have the Pause. It’s been many years since I participated in a code, and sometimes in the unfortunate failure of that code. I still carry the memory of the feeling of defeat as I walked away from the patient and spoke to the family with other team members. A pause not only honors the patient but reinforces the effort and intent we had made to save our patient’s life even if we ultimately did not succeed. Thank you for telling us of this protocol.
Thank you for this beautiful article. I have always intuitively done the Pause at the time of death, as a nurse. It is a beautiful and important step to take. Thank you for putting into words for all caregivers. Amy Ruff RN BSN