The Pause

Jonathan Bartels: It looks a lot cooler on a bigger screen. It is really, really amazing.

As the creator of The Pause, that video resonates with me. The artists used images, music, and very few words to express the meaning behind it. I love that rendition because it really speaks to the essence of the practice.

Often, when we see images like these on a screen, we say, “Wow.” We’ve all stood somewhere like that, right? In a field, on a beach, on a mountain, outside by a lake. We’ve seen an image like this, and it produces a feeling of awe.

In academia, they call this ineffability. It’s the inability to find words to describe what you’re seeing, what you’re facing, what you’re experiencing.

Rumi, the Persian poet, couldn’t express his experiences except through poetry. It’s in that loss of words.

And I think that’s part of the power of The Pause. It’s where we capture the moment.

In 2009, I was a trauma nurse, and I needed to find a way to heal myself. I saw that something was missing, some kind of ritual.

After a trauma, I stopped the room and asked, “Can we take a moment? Could we just take a moment to honor this person’s life? Could we honor this patient? Could we honor the work we’ve done and do this in silence?”

Because I think silence captures a moment of death. There are no words that can fix or heal that moment.

So I started the practice, and it spread. It spread virally through people sharing my story, through their efforts and their own stories. It spread across the country and around the world.

But it couldn’t have spread without ambassadors, people who stood up and said, “I see what you’re doing. I see what you’ve done. I want to do it at my own facility.”

Dr. Silvia Perez-Protto, my friend who is coming up next, did this at Cleveland Clinic. She did it in an amazing way, and I invite her to the stage.

Silvia Perez-Protto: Thank you.

I grew up in Uruguay, South America. My father was an anesthesiologist and also a family doctor.

In the 1970s, at the end of his day, he used to pick us up and take us to see some of his patients at home.

I still remember one day when he told us that the patient would not be there because he had died. We were going to check on his wife because she was very sad.

Death was one of the many topics we discussed at the dinner table, so it was normal for me from the time I was a little girl.

When I came to the United States, it was a little surprising to me how difficult it was for people to navigate death and dying.

In a recent interview, Dr. Toby Cosgrove, the former CEO of Cleveland Clinic, shared that he is still haunted by some of the deaths of patients he cared for when he was a cardiac surgeon.

He said that doctors see death as a failure rather than a natural act.

So he established the End-of-Life Center and the Office of Patient Experience, which I now have the honor of leading.

Our goals are to respect patients’ preferences, improve the family experience, and foster caregiver resilience.

One day, a patient died in the ICU, and a fellow who had been a resident at Jonathan’s hospital conducted a pause.

The nurses loved it, and they approached me about spreading the practice across the organization.

We are very organized, so we created pilots and a script and asked for feedback. We placed the script in every nursing unit, on all the code carts, in every operating room, and on our phones as an app.

Then there came a day when it was my turn to conduct a pause in my ICU.

And I’ll be honest with you, I felt vulnerable. It was like walking into a space I had never been in before.

With time, it became natural for me. Now I wonder how I practiced for so many years without talking about the person and honoring the team.

The Pause has been transformational at Cleveland Clinic. We practice it today from the bedside to the executive team.

One in five Americans will die during or after an ICU admission.

Joan Cassell, a surgical ICU researcher, studied conflict among teams caring for patients at the end of life. She interviewed nurses, intensivists, and surgeons.

She found that nurses were the ones protecting the patient’s story and values. Intensivists were protecting the patient from suffering. And surgeons were protecting the patient from dying.

Death is the main enemy of a surgeon.

So when I heard Michael Hebb talking about Death Over Dinner, I thought: What if we gathered outside the hospital, without our lab coats, and had a human experience?

Could we share our own feelings about death and dying? Could that change the way we treat our patients?

Death Over Dinner has been transformational at Cleveland Clinic, and I’m excited for you to hear more about it from Michael.

Michael Hebb: Well, today I have one simple job and one slide.

And I’m going to save you the suspense.

Oh, there it is. I don’t even have to push the button.

We are now live.

The healthcare edition of Death Over Dinner is officially live, and there is no place I would rather announce that than right here at End Well.

For those of you who are unfamiliar with Death Over Dinner, let me explain.

First, death dinners are actual dinners. People get together, share a meal, and mostly talk about life, not death.

Mostly life.

They talk about their values and priorities. They also talk about how they want to be cared for during their final chapter, how they want to be honored, and how they want to be remembered.

When we started Death Over Dinner seven years ago, my hope was that the project would be deeply embraced by the American medical establishment.

You’re on the front lines. You see death every day.

Things went pretty well in the beginning. We launched from the main stage at TEDMED, and in a single night, there were more than 500 dinners in 20 countries, thanks to our partnership with the Elisabeth Kübler-Ross Foundation.

Then we joined the wellness collective RoundGlass so we could make the project global, and it became an international movement.

Since we started, more than a million people have sat down, shared a meal, and used our free resources.

In fact, the director of Death Over Dinner Brazil is somewhere in the audience, and we met at End Well. So thank you, End Well.

However, this wasn’t a movement of doctors and nurses. It became a movement of patients and citizens.

That all changed when I met Silvia Perez-Protto and Cleveland Clinic asked whether they could build the healthcare edition of Death Over Dinner with us, a completely new resource created specifically for clinicians and care teams.

So that’s what we’ve been doing.

We spent the last 18 months holding a lot of dinners and having a lot of conversations, making sure this would be useful for all of you.

I’ve been to a lot of dinners and a lot of death dinners, and I haven’t experienced anything more powerful than these healthcare edition dinners.

To see surgeons and care teams share the most vulnerable and difficult moments of their careers with one another, it’s not hard to imagine the medical system changing dinner by dinner when you witness the power of what happens.

So first, I want to invite you to try a dinner and tell us about it. Help us improve it together.

It’s there as a gift and a resource.

We’ve already been working with other extraordinary healthcare systems, including Memorial Sloan Kettering and Henry Ford Health System. Dozens of people are already offering feedback, but we would love yours.

So, it’s live.

And this has also happened.

You heard Jonathan’s beautiful talk and saw the film. The Pause is now an app.

We worked with Jonathan and Silvia to turn it into one, and it’s available in the app stores.

Please download it. Please share it. And please bring it to your institutions.

Thank you so much for having us today.