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Crossing The Liminal Space Of The Pandemic

Discussion in 'Hospital' started by The Good Doctor, Oct 23, 2021.

  1. The Good Doctor

    The Good Doctor Golden Member

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    We have been walking down a long hallway for many, many months. We left the room we resided in pre-COVID, but we have not yet found a room to rest. We are in the liminal space of COVID. This is unsettling and unnerving — liminal space often is.

    Liminal space in architecture is the area between discrete, functional spaces, a way of passage, but not the place where beds are placed, where meals are eaten, where cushy seats are arranged together. Artists often use liminal space to give a feeling of uncertainty, anticipation and often anxiety or dread. Liminal spaces in our personal lives are those gooey times between what seems more clearly defined ages. The teen as a liminal space between childhood and adulthood is a primary example. Jungian psychologists discuss the risk of getting “stuck” in a liminal space, the transition not happening as it should. We all know the perpetual adolescent, the friend whose midlife crisis oozes over decades. Liminality can feel like a treadmill — lots of effort, little distance traveled.

    There is a fascinating breadth of inquiry and study regarding the liminality of time, space, and psychology. We study that which interests us and that which scares us. We want to make the unknown knowable and mark our path forward clearly. None of us wants to be “stuck.”

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    Some artists fill liminal space as a way of asking and, perhaps, answering questions. We place doors and thresholds in buildings to close off the liminality to define our rooms of living. We create rituals and rites of passage for our life transitions to declare new beginnings and give closure to what we are leaving.

    Thinking about liminality for me started with a conversation with a psychiatrist pre-COVID. (Dr. David Kopacz, truly a holistic thinker. I cannot say enough about the work he does with veterans, residents and the medical community.) You see, I am personally in midlife liminal space.

    For 20 years, I’ve been a family physician, long enough for the babies I delivered to be having children of their own. I am no longer the young doc, solidly mid-career, trying to decide if my future in medicine is being decided for me or by me. My marriage is the same vintage as my medical practice. Twenty years is long, but as my husband noted, strangely not one of the big, named anniversaries, like the silver or gold.

    My children are all solidly in liminal teen times, one transitioning from home to college this next year. My husband and I see on our horizon so many changes, emptying nests, family contractions, so much anticipated loss. In the way our relationship transitioned in our early years with the expansion of family, moves, deployments, we know our relation to each other will change again.

    Liminality can be felt in my career, my family, and the world around me. I am in an Escher drawing of curved and intersecting hallways. And many of you are too.

    There is so much unfinished work around all of us, adding to the feeling of uncertain movement, unclear if it’s forward or back and always on wobbly legs. The months around and after the last election were a dangerous rope bridge of transition for many, and some still feel stuck on that swaying bridge. America is not where we were at its inception regarding racism, sexism, classism, but we certainly can’t put a bow on any of them as “fixed.” There is not an easy or sure path for equity, cohesion or closure.

    The pandemic highlighted the liminal space of our society. And too, we are in the liminal space of the pandemic. We are not in the fearful, desperate early days. We are not wiping down our groceries. Our health care teams are not trying to fashion PPE from air filters and layers of chintz. Most of us in health care are vaccinated, and many of our families are too. We have ventured out of our homes, and most of our children are back in school. We have finally hugged each other.

    Sadly, too many of us have died. And we have seen the messaging of health care heroes die off as well. The bells that rang to offer appreciation for those frontline health care workers and our dear friends who supported the frontline outside of health care have gone quiet. Now we have protesters on the sidewalks balking at the idea of a vaccine to protect us all. Some of those protesters were once on our teams. We have people proclaiming their worry about using something they think is unproven while asking for something that certainly has been disproven. We have people tell us to our faces that they don’t trust our judgment, then come to our clinics and hospitals wanting us to care for them when they are desperate. And we do.

    We certainly have not crossed into our new normal. We know it won’t be exactly like our previous normal. And nor should it be. We don’t know what it will be. We don’t know when it will be. And as we continue to watch thousands die, we don’t know who will be with us in that new normal.

    As I have talked to colleagues, patients, friends, and family, a theme of lost time is echoed between them. Lost events, yes, but more a strange sense of the fluidity of time, which has become slippery and forgettable. Groundhog day all over again. When did that happen? How long have we been doing this? When will that occur? All unclear.

    So here we are, somewhere down this long hallway feeling off-kilter, tired, and not sure of our direction. How do we navigate this space and move forward when we have learned we cannot count on future plans? How do we stop feeling stuck? I would propose there are two significant things we can do to help orient us and keep us moving forward.

    Mindfulness trains the mind to stay in the present, trying to avoid perseverating over the past or future and just be. In our typically stressful, normally abnormal world, I would agree. But these are abnormally abnormal times. There are many blurry memories of the last couple of years. If we don’t know where we are going, knowing where we are and where we have been can be a start.

    When the world shut down in March of 2020, I started “Coronapocolypse Journals” for our kids. We kept them together through that school year. We flipped back to recall the silly things (teeny tiny s’mores) and the hard things (worries about parents in health care).

    In retrospect, the 30-page journals seem naively optimistic. I did not start new ones. It seemed less urgent to write after surviving that first school year. But the three months of journaling time feels more real than the diaphanous memories of the last 15 months. It is time to tell the stories of this time. Go through your photos and recreate a timeline. How you tell your story may be different. It may be by painting in the edges of partial memories, speaking your story to friends or colleagues, or in prose. It is your story, and it is important.

    The other thing we need are placeholders for time as we go on. Knitters will place markers so that as they come around a row, they know just where they are without counting. We need stitch markers, so if we come across them, they can orient us. These life placeholders, these hatch marks on the wall, are created in different ways. I would suggest finding a type of action or ritual to help us define these units of time.

    We have become a less ritual-oriented society long before the pandemic postponed or canceled funerals and weddings. Some rituals and standards were stuffy, elitist, racist, sexist, and we can bid them adieu. But losing other rites of passage have left voids. My father did not want a funeral, and we complied. But that robbed people who care about my siblings and me a simple way to connect with our grief and show their support. Our friends and extended family needed to move through their shared grief with us, but there wasn’t a clear way. We all need ways to process grief. We want closure. Rituals have often given that.

    What about when what we are grieving is still happening? How do we create punctuation in this run-on sentence that COVID has become? What could those moments of mini-ritual be? This is where we must get creative. New Year’s Eve is a human-created celebration of the end of one year and the beginning of another. December 31 and January 1 often feel the same, but they cleave time. Birthdays too, can help define time. Celebrate milestones that are important to you or that amuse you. Make new milestones, new New Year. Happy Ides of October? I’m in.

    The 25th school lunch prepared for the year? Break out the cupcakes. A decade ago, I declared a new year starting in October. It helped me stop piling all of the year’s heartaches into one mass. 2011.75 was not that much easier, and they still were heartaches. But they had a new compartment to be held. It was artificial and silly, but it helped. It put a semicolon in that very long year for me.

    Finally, when we get there, to the end, to the next room, to our new normal, how do we feel closure and completion? How do we close the door on the other side of this liminal space? How do we settle into the soft chairs in front of the post-COVID fireplace? I think it is the same way we get to that room. We tell our stories. We grieve together, and we celebrate together. We decorate that new room with reminders of the sorrows and the strength of this time. I’m envisioning a New Orleans’ style funeral for COVID: Lively music, amazing food, bright colors and really great style and all my favorite people. I’ll start shopping for a fabulous hat.

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