By Tim Cunningham

He collapsed at school by his locker, just 11 years old. After 9-1-1 was called, the EMTs arrived and began CPR immediately. He was brought to our emergency department and we did everything we could — IVs, ventilation, sympathomimetic drips — but nothing worked. We couldn’t save him. The attending physician declared him dead — calling the code and noting time of death — as we, without a moment’s hesitation, stepped back into the noisy mix of an overcrowded emergency department.

Shaken — as I’ve been after every pediatric death I’ve ever witnessed as a nurse — I emerged into the hall to encounter another child’s livid mother, who’d stood outside the resuscitation room for 20 minutes waiting for a nurse to bring the medication her otherwise healthy child needed to be discharged from the hospital.

Under the hailstorm of her words — I was slow, I didn’t care, this hospital was crap — I felt not even an ounce of empathy. Wordless, angry, I retrieved the meds, administered them, and all but threw the discharge papers at the mother.

No excuses here: It was ugly, unkind, and unfair of me to treat this mother with such an edge. I still regret it.

That is often our world in emergency care. As nurses and physicians, we rush from room to room, family to family, crisis to crisis, expected to immediately let go of what just happened in one room and be present with the patient before us in the next.

And isn’t that what patients have a right to expect? Shouldn’t patients expect that their nurse or doctor is in a frame of mind that enables them to be authentically attentive? But how in the world can we provide the safest care if we ourselves are in tatters? There’s a sad truth here: We are not paid to be present. We are paid to get work done, no matter how impossibly sad, messy, or tragic that work is. And never does there seem to be enough time.


In the years since I moved from working in a trauma center in New York City to doing research at the University of Virginia, memories of that ER stay with me. Now, I’m studying an intervention that, while not a fix-all, may help prevent injury to patients and providers — it may even save lives. In hospitals on four continents, what we call “The Pause” has become a standard of care.

Here’s how it works: When a patient dies, any member of the care team tending him calls out for a pause. They might say something like, “Can we stop for a second to consider this person who’s died? They loved and were loved. They were someone’s friend and family member. Just for a minute, in our own way and in silence, let’s take a moment to honor this person and the efforts we each made on their behalf.”

The group is then silent for about 45 seconds. It’s personal, optional, and simple.

Preliminary results from our investigations have found “The Pause” is a boon to both healthcare teams and patients. Caregivers who practice it report a stronger sense of collaboration with the health-care team in moments of intense stress.

What’s more, providers consistently report that when they pause — no matter what they choose to do during those 45 seconds — they feel more grounded and ready to interact with their next patient or family. They feel more present.

Cited by the Schwartz Center for Compassionate Healthcare and the American Association of Critical-Care Nurses as a tool to elevate quality health care, this “Pause” keeps spreading. In short order (roughly the time it took you to get through the third paragraph of this commentary), health-care providers are finding they’re better grounded, and ready to face what’s next.


Pausing to breathe and reflect is nothing new, but encouraging caregivers to pause to honor a patient and a health-care team may be. “The Pause” may provide a compassionate edge toward better care for all of those involved. I wish to this day that we had paused at the end of the 11-year-old’s life, to honor him, ground our team, and prepare ourselves to face what would come next.

It would have helped me be much kinder to the next mother, her child, and the rest of the patients I treated that day.

Tim Cunningham, RN, DrPh, is director of the Compassionate Care Initiative at the University of Virginia School of Nursing. To read more about The Pause visit: