The In-Between: Unforgettable Encounters During Life's Final Moments

The main themes of this book revolve around the moments before, during, and after death. The author experiences several instances of what she concludes is communication between the living and the dead. These experiences of hers and her coworkers are so frequent that she says, “I couldn’t ignore the evidence of something more beyond death. To me, that was no longer rational” (231).

Many religions teach that human existence continues in some form after death, whether that entails an afterlife or reincarnation in the material world. In the memoir’s US context, Christianity is the predominant religion and often influences the ideas of even those who do not explicitly adhere to Christian teachings. Christian beliefs regarding the afterlife differ by sect, but many churches teach that immediately following the death of the body, the soul goes to a place of either reward (Heaven), punishment (Hell), or purification (as in the Catholic doctrine of Purgatory). Raised strictly Episcopalian, Vlahos grew up believing in an all-powerful God, the resurrection of Jesus Christ, and the existence of Heaven and Hell. Vlahos experienced confusion and doubt regarding these beliefs as she matured, but a sermon convinced her not to go to an abortion clinic. Over the course of her memoir, her philosophy becomes progressively less defined by one organized religion and more defined by her own conclusions based on medically unexplainable phenomena. However, she continues to adhere to some notion of an afterlife. Based on all that she has seen, she draws a few conclusions about this state or experience—in particular, that deceased loved ones come to meet people who are dying and that the dead look out for the living. She further feels that a religious experience set her on the path to her calling, which is hospice work.

Vlahos’s ideas about the afterlife are of course not universally shared. While some people who do not adhere to an organized religion nevertheless believe in an afterlife, many agnostics and atheists view death as likely entailing the cessation of all experience. Vlahos’s patients’ philosophies regarding death fall everywhere along this spectrum: Some express confident belief in Heaven and Hell, others take comfort in not knowing, and still others are resigned to nothingness. Regardless of their personal beliefs, Vlahos suggests, these people tend to experience dying in similar ways: When brushing up against death, people inevitably reflect on their lives, and the regrets they express relate mostly to worrying too much rather than living and loving. Vlahos concludes that “how you live your life is more important than what you believe in” and that “no matter what you believe, everyone dies in the same way” (249). These quotes imply that while humans cannot control how they die, they can control how they live, which is ultimately what matters anyway.

Vlahos’s stories also explore death in the context of the medical field’s commitment to treatment rather than comfort, detailing the effects this has on patients and nurses. While it is not stated explicitly, there is an underlying suggestion that perhaps death is not something to avoid at all costs—something further demonstrated by the peace and happiness many patients find right before death. Vlahos writes in a context—21st-century Western society—where religious and nonreligious people alike tend to have less direct experience of death than they would have in previous eras, when most medical care took place at home. In some ways, this cultural estrangement from death informs the memoir as much as questions about death’s exact nature, as Vlahos seeks to promote Transparency in the Face of Death.