Seeking Selah.

Abstract

To the Editor: There is a word that appears 71 times throughout the Book of Psalms in the Hebrew bible: selah (). Its etymology is enigmatic—to this day, its precise definition remains elusive to Judaic scholars. My preferred interpretation characterizes selah as a “holy pause.” 1 It is an invitation to suspend choral music, stop prayer recitation, and engage in a moment of silent reflection. Selah. A concept that feels in conflict with the foundations of my medical education. On tests and during rounds, I was trained to look ahead to the next physical exam maneuver, the next diagnostic test, the next step in management. For 4 years in medical school, I honed my ability to formulate schemas and differential diagnoses—and with it, my ability to dwell in the future rather than reflect in the present. But when I joined the COVID-19 wards in New York City as an early medical school graduate, I suspended this mindset. In the thick of the pandemic, there often was no “next.” There was only waiting: for patients to get better (or not); for the curve to flatten; for some form of reprieve. And, so, in my earliest days of doctoring, it was selah that I relied on most. There was the pause outside each patient’s door where, gowned and gloved, I carefully inventoried PPE. Selah. There was the quiet that came after twisting an oxygen knob, my eyes trained on the vitals monitor. Selah. And then there was the most wrenching selah of all: when I held the clunky hospital phone to my ear, waiting to deliver harrowing news to a patient’s loved one. With no “next” to rush me out of these moments, I lingered—I was more present. Though insulated by N95 masks and face shields, I connected better with patients, their families, and even my own emotional state. The mental space formerly occupied by to do lists and uncalled consults had been repurposed for deeper human connection. I long for a time when the hospital will feel as it did pre-pandemic—when the bustle of academic medicine will resume, rounds running late from chalk talks and journal clubs. But I also hope that even at our busiest, we will remember the lesson of this moment and set aside space for stillness. Selah.