The In-Between Time

By Marjorie Scaffa, Ph.D.

Liminal space – this is where many of us find ourselves now several months into this COVID-19 pandemic. The root of the word liminal comes from the Latin limen, meaning threshold, or a place of beginning or entering. It is the in-between time of grieving the old and uncertainty about the future. Although we may not like it, this is the process of change and transition and where transformation takes place if we learn to wait and sit with the discomfort of not knowing.

Change is often energizing and engaging. We saw this during the initial weeks of this crisis in the incredible outpourings of service offerings on social media. We saw this in the calls to “seize the moment” and use this time for personal growth. We saw this in the very real and dramatic shifts that businesses, governments, and educational systems across the globe made – without any playbook – to continue to serve the needs of the community.

In this liminal time, we are in a waiting space between two worlds. We will not be going back to the old as we knew it, and we do not know what the new will be. We are grieving the old and are uncertain about the future. Anyone who has experienced the loss of a loved one knows this experience of in-between time. It is crazy uncomfortable.

Some of the feelings many of you may be experiencing at this time include:

• Misplaced anger: Getting irritated or angrier than normal at people and things that would not normally make you upset. This may be driven by underlying thoughts like, “I can’t stand this!” and “When will this end!” as well as grief over the things that we are missing during this time.
• Difficulty focusing: As your brain tries to make sense of this transition, integrate all the information, and continue to move forward on a daily basis with the tasks at hand, you may find it more challenging to stay focused.
• Worry thoughts: “What will happen next?” “What should I do to prepare?” “How can I stay sane right now?”
• Antsy-ness: You maybe be noticing a sense of urgency in your body and mind to DO SOMETHING! You may have even taken action on those urges.
• Lethargy: A lack of energy to do much. This may be related to grief as well as the energy it takes to change and integrate new information. This needs to be honored.

These emotions and experiences are normal reactions to an abnormal situation. It is in our nature to avoid these uncomfortable feelings. However, it is when we step out of our comfort zone and practice being with the uncomfortable that the magic happens. Your patients will be doing this every time they are vulnerable and reveal themselves to you.

Here are some ideas for how to be with the uncomfortable feelings that may be arising at this stage of transition:

Remember that it is normal to feel restless, agitated and/or impatient. Our brains are wired for novelty. This drive is what helped us survive by keeping us curious and creative. You might say to yourself, “I’m feeling agitated. This is normal. Let me feel this.” You may be surprised how simply naming the feeling, in time, can help to soften it.

Get curious about you, including your capacity for tolerating difficult emotions. What are my habits? What do I typically do when I feel that little anxiety bubble creeping in? Do I pick up my phone? Do I eat? Could I sit with this feeling a little longer? A practice for this is what we call surfing the wave. Stress is like waves rolling into the shore. Some days the waves are small, barely a ripple, and other days, the waves are huge and overwhelming. There will always be waves. You cannot stop the waves, but you can learn to surf.

Here is the surf the wave technique:

1. When you notice a body sensation, thought, or feeling of discomfort, pause for a moment. 
2. Take three deep breaths, prolonging both the inhalation and exhalation.
3. Close your eyes and visualize being at the beach with a large wave taking form. This wave symbolizes your sensation, thought, or feeling of discomfort.
4. Watch as the wave reaches its peak and then starts to diminish and flow into the shore.
5. You should feel a sense of relief as the sensation, thought or feeling wanes.
6. Repeat the visualization as often as needed to reach a state of calmness.

You might discover that you have more capacity for being with uncomfortable feelings than you thought. This builds trust that we can handle difficult things and reminds us that we actually are resilient. This insight is huge! Uncomfortable experiences are going to keep happening (sorry!), and it’s good to know we can handle them.

Envision your future: Take a few minutes each day to reflect – and journal, if you can – about what you want for your future:

• What am I doing now that I have not been able to do before?
• Who do I want to be on the other side of this pandemic?
• How do I want my days to look?
• What do I want to bring to my life? to the world?
• What am I learning about myself now that I want to bring forward? What internal resources are showing up?

By spending some time listening to the quieter stirrings of our soul rather than reacting out of habit, we might discover some amazing things about ourselves, our relationships, and our deeper yearnings for the lives we want to create. The possibility for transformation is right here, if we are willing to shift out of the busy-ness of doing and practice being with – marinating in – the uncomfortable experience of liminal time.

Marjorie Scaffa, Ph.D., is a health and wellness counselor at the University of South Alabama College of Medicine.

Ovarian cancer researcher to present at SGO webinar

Research by a physician-scientist at the University of South Alabama College of Medicine will be presented virtually this week as part of a webinar series held in lieu of the Society of Gynecologic Oncology 2020 Annual Meeting on Women’s Cancer.

Rodney Rocconi, M.D., gynecologic oncologist at USA Health Mitchell Cancer Institute and professor of gynecologic oncology at the USA College of Medicine, will present his research on ovarian cancer in a webinar entitled “Front Line Ovarian Cancer: Turning up the Heat on Immunotherapy” on Thursday, May 14.

Rocconi’s research found that vaccines made from patients’ own tumors could prolong the lives of women with ovarian cancer, particularly those without a BRCA gene mutation. The presentation is one of four pre-recorded sessions to be aired during the webinar. Rocconi and other researchers will answer participants’ questions live via Zoom teleconferencing.

The SGO meeting, which had been planned for March 28-31 in Toronto, was cancelled after large gatherings were banned because of the COVID-19 pandemic. Members were invited to register for webinars to learn about selected research findings.

Uterine cancer research co-authored by Nate Jones, M.D., gynecologic oncologist at the Mitchell Cancer Institute and assistant professor of gynecologic oncology at the USA College of Medicine, had been slated for oral presentation at the meeting. The study identified differences in certain molecular profiles of uterine cancer between African American and Caucasian patients. The research findings are expected to be posted online or presented at a later date, according to the SGO.

Pediatric grand rounds set for May 15

Ryan Himes, M.D., section head for pediatric gastroenterology and hepatology and nutrition medical director for the Pediatric Liver Transplantation Program at Ochsner Health in New Orleans, will present a virtual pediatric grand rounds on pediatric acute liver failure at 8 a.m. Friday, May 15.

In his presentation, Himes will discuss the common causes of acute liver failure in children of different ages, explain the concept of “balanced coagulopathy,” and review the utilization of N-acetyl cysteine for appropriate cases of acute liver failure.

To register: https://southalabama.zoom.us/meeting/register/tJEocu2vrTwjH9dPFfOIgOLBTS9ZtEQwl70U

Pediatric grand rounds is held the third Friday of each month from 8 a.m. until 9 a.m. For more information, contact Jessica Petro at (251) 415-8688 or jpetro@health.southalabbama.edu.

College of Medicine CARES Fund supports medical students in need

The University of South Alabama College of Medicine CARES Fund was created in response to unforeseen financial hardships brought about by the COVID-19 pandemic. Spurred by our students’ immediate need, USA College of Medicine leadership established this fund to assist students affected by the economic fallout of the pandemic. 

Your gifts will help provide emergency support to future physicians. Gifts to the College of Medicine CARES Fund will be matched dollar for dollar up to $100,000 to increase the impact on students facing difficulties caused by the pandemic. 

To make a donation, visit https://giving.southalabama.edu/comcares, or call Kelly McCarron, associate vice president of medical affairs for USA Health Development, at (251) 445-8423. 

USA College of Medicine students take virtual Hippocratic Oath

John Marymont, M.D., vice president for medical affairs and dean of the USA College of Medicine, speaks to the class of 2020 via Zoom.

Fourth-year medical students at the University of South Alabama College of Medicine became the first class to take the Hippocratic Oath separated by the social distancing of COVID-19.

“The noble profession you’re entering, the weight that it carries and the respect and gratitude that society has for you is so evident in today’s reality,” said John Marymont, M.D., vice president for medical affairs and dean of the USA College of Medicine, speaking by Zoom video conferencing to the 66 graduates as they prepared to take the oath Friday. “You’re entering the workforce in a society faced with significant challenges due to a pandemic unprecedented in modern time.”

Andrew Bright, D.O., assistant professor of surgery, leads
the Hippocratic Oath for graduates who matched in the
U.S. military.

Marymont said that society is looking to physicians as leaders, healers and comforters, and for hope. “Embrace this challenge, and, as Nike says, ‘Just do it.’ Do it with compassion, dignity, honesty, respect and resilience,” he said.

Marymont led the graduates in the Hippocratic Oath, an oath of ethics named for the ancient Greek physician Hippocrates historically taken by physicians stating the obligations and proper conduct of those practicing medicine. Graduates who matched at U.S. military facilities also took the military oath led by Andrew Bright, D.O., assistant professor of surgery at the USA College of Medicine.

Typically, both oaths are taken during Honors Convocation, the ceremony when graduates are recognized for their academic achievements and are awarded doctoral hoods by individuals of their choosing. Social distancing requirements prompted by COVID-19 led to the cancellation of the class’s in-person Match Day and Honors Convocation ceremonies.

Ben McCormick, class president, took the Hippocratic Oath by Zoom at a beach house in Fort Morgan, surrounded by close friends and family. He said that while the experience for the class of 2020 is unique, its meaning of the oath remains the same.

“The dedication to being ‘loyal to the profession of medicine’ and to the ‘good of the sick to the utmost of (our) power’ carries even greater weight as healthcare workers face firsthand the effects of a global epidemic,” said McCormick, who is staring an internal medicine residency at the Mayo Clinic in Jacksonville, Fla.

The class of 2020 is the 45th class to graduate from the USA College of Medicine, bringing the total number of physicians to graduate since the school’s opening to 2,836. About one-third of physicians practicing in the Mobile area have earned their medical degrees from USA or have completed residency training at USA Health hospitals.