‘Inside UVA’: A Palliative Care Nurse on the Moments After a Patient Dies
Audio: ‘Inside UVA’: A Palliative Care Nurse on the Moments After a Patient Dies(25:56)
Palliative care nurse Jonathan Bartels describes how he created “The Pause” in this week’s episode of “Inside UVA.”
“Inside UVA”: Jonathan Bartels
Jonathan Bartels, palliative care nurse liaison at UVA Health: After four years, I got burned out. And so I was about to ... What do you do when you’re burned out? You go to your manager and you ask for a raise, right? Because you got nothing left to lose. I did, and the manager at the time looked at me and goes, “Yeah, no, you’re not getting a raise.”
Jim Ryan, president of the University of Virginia: Hi, everyone. I’m Jim Ryan, the president of the University of Virginia and I’d like to welcome all of you to another episode of “Inside UVA.”
This podcast is a chance for me to speak with some of the amazing people at the University and to learn more about what they do and who they are. My hope is that listeners will ultimately have a better understanding of how UVA works and a deeper appreciation of the remarkably talented and dedicated people who make UVA the institution it is.
I’m joined today by Jonathan Bartels, a palliative care nurse liaison at UVA Health who started his career in health care in 1986, and has served as an educator, ambassador and retreat facilitator for the School of Nursing and the University of Virginia since 2008. You may recognize his name if you watched last year’s Double Take storytelling event, where Jonathan told one of the best stories I’ve ever heard in the series. He’s also an original team member of the Compassionate Care Initiative at the School of Nursing and is well known for having initiated a practice in 2010 called “The Pause.” He’s received accolades from the American Academy of Critical Care Nurses, and the Schwartz Center for Compassionate Healthcare. In 2018, Jonathan received the American Association of Critical Care Nurses “Pioneering Spirit Award.”
He grew up as one of seven children to parents in Buffalo. And now as a father of four, he’s an artist, a mentor, a writer and a partner in an innovative hot sauce company called Mad Hatter Foods. Jonathan, we’re glad to have you back. And thanks for being with us today.
Bartels: Well, thank you, President Ryan, good to see you.
Ryan: Please call me Jim.
Bartels: All right, Jim. I will call you Jim.
Ryan: So let’s start with “The Pause.” What is it? Why did you come up with it? And what’s become of it?
Bartels: Starting with what it is, “The Pause” was a practice I started predominantly for my own health, because I was trying to find a way to heal, while healing, while working in the health care system as an emergency room trauma nurse at the time, and The Pause was a response to “How do you cope with death while working in an ER at the pace that we worked at?” And as a trauma nurse, you just didn’t know if something else was going to come in. But certainly wanted to denote that in such a way that it would at least cause some healing after we lose a patient. We can do everything possible. And sometimes it’s just a patient’s time. And traditionally, the response, especially within health care systems, was to kind of turn your back and walk away.
And so I started this practice – and it was actually watching a chaplain stop a room and pray. And I thought, “Wow, that’s beautiful, but the prayer doesn’t meet everyone’s needs. So how can I make this in a way that it meets everyone’s needs within that room?” And so that’s the inception of The Pause, which is, you know, to kind of [give a] synopsis, you could imagine a patient has just died, you’ve been trying to resuscitate them in the room, we call time of death. And then someone asks, from the group that’s caring for the patient, “Could we take a moment to just stop and pause? Can we take a moment to honor this patient’s life, to honor the fact that they were alive, they were loved by others, and they loved others? Could we also just take a moment and, in silence, in their own ways, hold that space and honor not only the patient, but their family left behind, and us, the caregivers, and the work that we did to try to help this patient?” And then we take a 30-second pause or a minute pause to hold that space.
Ryan: It’s a really simple, but completely powerful idea. And my understanding is that it has caught on throughout UVA Health and beyond.
Bartels: Yes, it caught out in here at UVA, and it’s also across the country and on at least seven continents around the world. That’s amazing. It’s shocking as someone who started something for himself, and then watched it grow into something that blossomed for so many others.
Ryan: Right. And my guess is that for the family of the patients who have died, it’s probably comforting as well.
Bartels: It was shocking because it wasn’t necessarily my intent. But The Pause, it’s a demonstrative act of compassion that families can see; they see that the patient counts more than just a disease or more than a traumatic issue, that we truly all take that time and – a friend of mine told me about a time her husband died on a bicycle. And he came into the hospital. And she said, “I’d only heard about The Pause, and they did the practice. The whole ER stopped in that trauma bay, and I could feel the difference.” And it really, really meant a lot to me.
Ryan: So going backwards, when you were at Double Take, you told the story of your childhood. That was fascinating, compelling and heart-rendering. I wonder if you could share a little bit about your early days and your family life and your eventual route to nursing.
Bartels: Sure. I’m one of seven kids, and a bunch of my brothers and my father were physicians. And if you know anything about physicians, most times they know by the time they’re 8 or 9 years old, they want to be a physician. And so my brothers kind of all knew where they’re headed.
And I just didn’t know what I wanted to do. And part of that was just the course I’d taken as a special ed kid, and just the educational pursuits I kind of went after. And at one point, I deviated; I graduated with a psychiatric degree or a psych degree, a bachelor’s in psych. And I did volunteer work for a psychiatric hotline, for a suicide hotline. And it was, I liked the work, but I hated not seeing the person in front of me, because I couldn’t read it. And so I realized I had to do something.
And so I decided to then start to pursue and follow my bliss towards studying comparative religion. So I got into Western Michigan University and studied Western mysticism and Eastern philosophy and Eastern mysticism. And I really loved it. It was cool. It definitely fed me. It didn’t necessarily feed my three kids.
Ryan: Not a lot of high-paying jobs as a mystic?
Bartels: No. So I, I kind of, at one point, while I was pursuing that degree, I had a dear brother of mine die [at] 35.
Ryan: Sorry to hear that.
Bartels: Thank you. And his name was Brian. And I was asked to come back to Buffalo, New York, where my parents lived. And I sat with Brian and did vigil with him overnight, and kind of helped him kind of transition in the process of dying. And it was such a tragic, but moving experience, that I walked away from it and said, “You know, I’ve been studying this mysticism, you know, and just pontificating and a graduate-level kind, of course, but what I did with my brother was real and palpable.” And so I said, “What should I do?” and I decided to join nursing. And so I dropped out of my graduate program, with just one semester left. And I regret that, but don’t regret that, but jumped in and pursued nursing and wanted to go into nursing so that I could provide the same care that I did for my brother, for anyone’s brother, sister and mother, you know, and that was really my pathway. And I ended up wanting to pursue palliative care.
And it was a new field at the time, or hospice, but no one was hiring. And no one was really hiring in the Northeast. I was looking in Vermont, looking in New York. And so a friend of mine walked up to me one day, he’s like, “Hey, I was just at this, you know, recruitment area, and University of Virginia is hiring.” And I’m like, “That’s awesome.” Because I was down to like my last $1,000 with three kids. And I’m like, “I gotta do something.”
My brother, my oldest brother, was a surgical chief resident down here at the time. And my little brother was a pediatric resident. So I came down and interviewed at UVA. And believe it or not, Jim, they had a hiring freeze at that time.
Ryan: Oh, my gosh, you’re kidding! It’s the opposite now!
Bartels: Exactly. So they shut the door, right behind me, when they hired me. And so I came in in 1998 and thought I’d be here a couple of years, but fell in love with the University of Virginia and with Charlottesville and with the community. And 25 years later, I’m still here.
Ryan: Wow. And when you started nursing, did you know right away that this was the path for you?
Bartels: When I started nursing, yes; when I started health care, no, because when I started health care, I was 18. And that was 1986. That was at the height of HIV. Also the staffing ratios were horrible. And I actually had a nurse look at me one day and said, “I want to tell you something and look me in the eye.” And I was like, “OK.” She said, “Don’t ever be a nurse.” And I was like, “Whoa.”
And years later, I realize her expression was an expression of suffering. She was going through so much as a nurse, you know, institutional violence, you know, just the overwork and workload that was overwhelming. So I took that to heart and I avoided going to nursing. But then, once after my brother’s care, I never questioned not being a nurse.
Ryan: You’re working in palliative care now, but you had worked in the emergency room; you’ve worked in intensive care units. So have you gone back and forth, or did it take you a while before you got into palliative care because people weren’t hiring as much in that area?
Bartels: So I was lucky enough. There’s a guy named Carlos Gomez back in the day, and a lot of people may know him from the listening. But Carlos started a palliative care program here at UVA. And I was an acute care nurse at the time, working in transplant. And Carlos was recruiting for his new unit. He had a bunch of hospice nurses. But he needed some acute care nurses.
So he brought me in and a woman named Holly Edwards, who you may know – she used to be the mayor of, of Charlottesville. She and I worked together, and a bunch of other awesome people worked together. And the hospice nurses trained me to do hospice, and I in turn tried to help them out in terms of teaching them how to do acute or critical care when patients are krumping; you don’t just let go, you’ve got to try to get them to the ICU and, and do whatever you have to for the patient.
Ryan: Right? And all these years later, do you find palliative care as satisfying as it was when you first began?
Bartels: So to be honest, yeah, um, when I first began, we were so new in the hospital that we were more of a place that people are sent to die. So in four years, I can’t even count the amount of people I assisted in that process and in the dying process. But after four years, I got burned out. You know, because I didn’t – I wasn’t trained to really care for myself. I wasn’t trained to process.
And so I was about, what do you do when you’re burned out? You go to your manager, and you ask for a raise, right? Because you got nothing left to lose? I did, and the manager at the time looked at me and goes, “Yeah, no.”
So a dear friend of mine at the School of Nursing, Regina M. DeGennaro, looked at me and said, “You would be awesome in ER,” and I’m like, “Oh, no, I know I’d never want to go there.” And I went down there and I took to it like a fish to water. It was just an amazing experience. I love the dynamics and the diversity and anything from psych to an earache to a mass trauma. It just the more chaos, the better, back in the day for me. It was it was really a fit made in heaven.
Ryan: But then you eventually came back to palliative care. And is that because palliative care has changed from what it was when you began?
Bartels: The opportunity arose for me to then move into a position that dear friend Karen Boyle was working in and she retired. And they needed a nurse liaison type of position. So I moved into that and actually was able to define that role further, as we hired new – more nurse practitioners into our group and as we kind of moved through learning as we went along. Yeah.
Ryan: And what are the, what’s the range of patients who are in palliative care? And to what extent are palliative care and hospice alike and different?
Bartels: So palliative care, we care for anyone with a life-limiting illness. That’s really one of the stopgaps for us, is you have to have an illness that’s life-limiting. That’s anywhere from cancer to ALS to liver failure to cardiac failure. And what we do is we come in at any point during the diagnosis. And our goals are twofold. One is to help control your symptoms and improve your quality of life. The other is, at some point and at some junction in your life, where you have to make decisions that are difficult. We help you both identify what your goals are, and advocate for you, and also help to kind of relay whatever information needs to be relayed at that junction to you.
I’ll never forget, I was taking care of an anthropologist from UVA. And she had a bunch of sons that were all academic. And we met as a group to try to decide what to do next for this, for this awesome academic. And her granddaughter came in the room. And as we’re going around introducing ourselves – her name was Rose – she looked at me, and she said, “What do you do, sir?” And I said, “I’m palliative care.” And she said, “Oh grand, you’re the truth teller.” And I’m like, “Yes.”
I love that. I love that phrase. I love that statement. And I’ve kept that since then. Because that’s what we do is help both speak your truth, and then speak the truth of your illness at the same time.
Ryan: That captures it so well. My father-in-law died of cancer not too long ago. [He] had a palliative care nurse who would come to his home, and I can tell you the difference in his outlook, and our entire family’s outlook changed, in part because I think he felt like he had someone who was listening, like really listening to him, and who was a partner. And I just think that gave him so much comfort and reassurance that he wasn’t walking this completely unfamiliar path alone.
Bartels: And that’s really the heart of compassion, right Jim? So if you look at, if you break down, like empathy versus compassion – empathy is “I feel with you.” And compassion is, “I come beside you, and I help you through that process together. So you’re not alone.” And that’s, that’s really what I would define as compassion and compassionate acts.
Ryan: So speaking of compassion, you’ve been involved with the Compassionate Care Initiative at the School of Nursing. I wonder if you could talk a little bit about that.
Bartels: Sure. A dear friend donated some money to UVA, and she was married to a guy named John Kluge. Her name was Maria Tussi Kluge. And Maria met Dorrie Fontaine when Dorrie first came –
Ryan: The former dean of the Nursing School.
Bartels: Yes, Dorrie Fontaine, the dean of nursing. I’m sorry, I should identified –
Ryan: Oh no, that’s my job.
Bartels: But Tussi Maria had a vision. She had lost a child in her first marriage to a medical error. And she saw the damage that had done and she wanted to find a way to have care providers that are in training, learn ways to do self-compassion, and do self-care. So that they can apply and integrate and bake that into what they do every day when they’re working with patients.
And so I’ve had the pure pleasure of working and running retreats with people like Susan Bauer Wu, who’s now the head of [the] Mind and Life [Institute] with Maria Tussi Kluge. And with so many others – [a] friend of mine, Esther Golda Lozano, who is over at Sentara, who has now implemented these retreats over there.
And what we do is we just give people an eight-hour day of just self-care, and also have them kind of experience that themselves by us caring for them. And I had a – I’ll never forget a young man who was at UVA School of Nursing, who, before Aug. 12, he had come to me to say, “I want to do this retreat, because I’ve been in the military.” And he said, “What it felt like for me after getting back from Afghanistan, was like an R&R, and I loved it. And I want to do that for the surgical ICU.” So we coordinated with the surgical ICU.
And this is the baffling thing, Jim. It was, we had the retreat on the day of Aug. 12, because we didn’t know what was going to happen, but we wanted to go ahead with it. So these nurses did a full day of the retreat, and then at the end of the retreat I do this practice called “lovingkindness.” It’s a meditation. As soon as I got done, all their phones started ringing, and we they were notified of the mass casualty incidents as they were coming in. So they immediately left my retreat and went into the ICU, went into the ER, and provided care that day.
Ryan: Wow, holy cow.
So I’ve always wondered whether the idea of compassionate care could be extended to other professions where the jobs are incredibly important and incredibly hard, and so you see a decent amount of burnout. So I’ve wondered whether there should be something similar for teachers, for example?
Bartels: Definitely, there should be. There’s a group that I know, Holistic Health, that’s been doing this both for teachers and for students, and they’re out of Baltimore. There are two brothers and a friend that have been doing this. So it is being done. And I know, Maria Tussi Kluge also did that here in Charlottesville for teachers.
Ryan: Oh, interesting.
Bartels: Yeah, yeah. That was her next focus, was really to try to have teachers start to experience some of that, right.
Ryan: And is it sometimes hard to persuade people to participate, because I would think that caregivers are the type who would be reluctant to think about themselves and feel like, “This is self-indulgent,” like “My job is to care for others, like, I don’t need this,” or it’s, “I don’t deserve this.”
Bartels: It definitely can be for certain people. What I tell them is we’re bringing you grandmother wisdom. At the end of the day, you might be like, “Oh my god, this guy is Captain Obvious. But at the same time, not obvious.” And so yes, it’s hard. But once people realize – you know, COVID unleashed a lot of stuff. Right? And, and the Lorna Breen Foundation before that was happening. We were doing this for the last eight, nine years, with our students and with other health care institutions. Because we recognize there were so many Lorna Breens out there; man, so many people that I help train in the ER that ended up dying, either at their own hand or because of just, you know, not treating themselves well. And that’s that goes across all disciplines. We have to heal while healing. We just have to.
Ryan: So I’m curious, has your experience as a father influenced the way you approach your work?
Bartels: At times, Jim, at times. Especially, I recall taking care of a young child, and he had died of an accident. And I’ll never forget, he was in pediatrics and the nurses asked me, “Could you come in here and could you help take care of this kid? We’re moms. And we’re having a hard time doing this.”
And I looked at my orientee, Tim, and I said, “Tim, let’s do this. Let’s go.” In my head, I’m looking at this child who has died in the bed. And all I see is my own child. That’s all I could feel. But we did. We supported the family, we worked through it. But it’s instances like those that it really for me, it increases the value I have with my family, my children, that are now all adults, to really embrace those moments that we have. Because, you know, it’s not cliché, right, like life passes like a lightning bolt.
Ryan: Yeah. Well, you see it.
Bartels: Yeah. Yeah.
Ryan: All right. So last question, completely different direction. Talk to me about hot sauce.
Bartels: All right. So Mad Hatter Foods is, is a super condiment. It’s a dip. It’s a salsa, it’s a marinade. It’s got a vinegar base. It’s olive oil, and it’s a habanero. And we have three different flavors.
Ryan: So where did this come from?
Bartels: A couple of friends of mine had started doing this. They called it their pagan breakfast, and they would make this sauce and they didn’t have a name for it. And they would give it away like moonshine, and everyone loved it. They just wanted more of it. And they decided to try to go legit with it. And it even – at one point, two of my partners at the time did the incubator program over at Darden. So they did that that whole program, and we’re still kicking, you know, seven, eight years later, and you know, loving it.
Right now, my partner is Nathan West. His mom, June West, teaches at Darden. You may know her. Yeah, she’s a professor over there. But yeah, that’s where it started. I just enjoyed cooking with these guys and putting on some heavy metal or whatever music we got going and just making sauce. It was wonderful.
Ryan: Well, Jonathan, I gotta say, thank you so much for taking the time to be on the podcast. But more importantly, thanks for all you’ve done – not just for UVA, but especially for the patients who’ve been lucky enough to cross paths with you.
Bartels: I’ve been blessed, Jim, and I I’m just grateful to the universe for the opportunity to be where I am now. Thanks.
Ryan: Yeah, thank you.
Mary Garner McGehee, co-producer of “Inside UVA”: “Inside UVA’ is a production of WTJU 91.1 FM and the Office of the President at the University of Virginia. “Inside UVA” is produced by Kalea Obermeyer, Aaryan Balu, Mary Garner McGehee and Matt Weber. We also want to thank Maria Jones and McGregor McCance.
Our music is “Turning to You” from Blue Dot Sessions. Listen and subscribe to “Inside UVA” on Apple Podcasts, Spotify or wherever you get your podcasts.
We’ll be back soon with another conversation about the life of the University.
It’s enough to give you pause.
If you’ve watched “Emergency NYC,” an episodic Netflix documentary about frontline health care workers that has a 100% critics’ satisfaction rating on Rotten Tomatoes, then you’ve had a front-row seat to the dramatic, draining work happening every day in the city’s hospitals.
It’s a dramatic rendering of the reality of life and sometimes, death.
Years earlier, that reality led an emergency room nurse at UVA Health to pioneer a calming and sensitive approach used in hospitals in the immediate aftermath of a patient’s death.
Jonathan Bartels, now a palliative care nurse liaison, is the 2010 pioneer of a practice called “The Pause,” and this week’s guest on “Inside UVA,” University of Virginia President Jim Ryan’s popular podcast.
“The Pause” is used in hospital settings immediately after a patient has died. Health care workers stop for a moment to honor the patient, the family and the health care team.