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

Nonfiction | Autobiography / Memoir | Adult | Published in 2023

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Summary

Background

Chapter Summaries & Analyses

Introduction-Chapter 2

Chapters 3-6

Chapters 7-10

Chapter 11-Conclusion

Key Figures

Themes

Index of Terms

Important Quotes

Essay Topics

Tools

Beta

Discussion Questions

Chapter 11-ConclusionChapter Summaries & Analyses

Chapter 11 Summary: “Frank”

Frank and his wife, Cheryl, are openly and firmly uninterested in religion. As she fills out the patient intake form, Vlahos asks him (as is required) what his beliefs are, and he asks her in return. She reflects for a moment, thinking about her complicated relationship with religion and all of the missing explanations from her youth. She used to search for answers that were black and white, but she now finds comfort in the idea that she cannot have answers to all of her questions. She eventually says she used to be scared of death but isn’t anymore because of all that she has seen—specifically, “seeing [patients’] fear wash away before they pass” (232). Frank suggests she write a book about her experiences one day and makes her pinky promise to include him in it as representation for people who don’t believe in an afterlife.

When Frank experiences his deceased loved ones coming to see him, his wife is concerned; he seems lucid, but Cheryl is uncomfortable with the idea that the experience might be spiritual. Vlahos assures her that many people experience these visions, religious and nonreligious alike. She suggests finding comfort in Frank’s happiness, even if she doesn’t know how to explain it.

Will, a hospice volunteer, comes to sit with Frank so he does not die alone overnight. He calls Vlahos with a medical question, and when she arrives and thanks him, he explains that he does this work because of a mistake he made in the past. He stopped speaking to his mother when she didn’t accept his orientation, and she died alone. This is his way of making sure no one else dies alone. Frank ultimately bleeds out via his tumor as Will and Vlahos stand watch. When his heart stops, Vlahos wakes Cheryl, who asks her whether Frank’s death was peaceful. Vlahos tells her honestly that it was.

Chapter 12 Summary: “Adam”

Vlahos is assigned a patient with brain cancer even though she requested not to be placed with such patients after Babette’s death. She still blames herself for the way Babette died and does not want to witness someone else experience what she’d hoped for Babette. Yet she arrives at the hospital to find a man Chris’s age lying in a hospital bed and a family just like hers surrounding him.

Adam’s wife, Jillian, does not want her husband to die at home, fearing their son would then forever associate their home with his father’s death. Vlahos tries to admit him to the hospice center, but the hospital is the only place with a room for him. Vlahos admits him to hospice within the hospital, and Jillian signs a DNR, as she knows Adam wants. However, the hospital staff want to keep Adam hooked up to a number of machines. Vlahos has to advocate for her patient not to have to undergo all the routine hospital procedures.

Finally, with their son sent home, Adam’s wife lies in bed with him as he passes. She sings “Hallelujah,” and as she reaches the final chorus Adam dies. Thinking about the fact that “Hallelujah” is one of Babette’s favorite songs, Vlahos is overwhelmed with gratitude for her life and family. When she goes home to express her love, Chris tells her how grateful he is that Babette died the way she did. While Vlahos viewed it as a personal failure that she died in a hospital far from home, Chris could never have made it to his mother’s side if she had died anywhere other than the hospital that happened to be close to where he was working. Vlahos lets this idea sink in and echoes Chris’s remark that “everything happens for a reason” (247).

Conclusion Summary

Vlahos notes that she is often asked about her beliefs, which she describes as a “journey.” She ultimately views one’s personal spiritual beliefs as less important than the way one chooses to live, which is what people tend to value on their deathbeds. However, she also notes that everyone dies in the same way. The consistent visitations from deceased loved ones that she has witnessed have informed her belief in the existence of something after this life, but she is comfortable with the ambiguity of the “In-Between.” She is able to see the suffering in the world while also noticing beauty and peace in some of the most painful moments. No longer a novice to hospice work, she reflects on the importance of taking seriously what her patients say to her and of letting them change her.

Chapter 11-Conclusion Analysis

In the final section, Vlahos ties up loose ends regarding her beliefs, internal struggles, and goals. Frank serves as a catalyst for Vlahos in several ways. His question about her beliefs requires Vlahos to concisely explain them to another person for the first time, and her knowledge of Frank’s atheism makes responding even more challenging. Nevertheless, Vlahos demonstrates Transparency in the Face of Death, telling Frank honestly that given what she has seen, she thinks there is an afterlife. Vlahos respects Frank’s beliefs in turn, promising to include him in the book he proposes she write.

Vlahos’s honoring of that promise—and her publication of the book itself—also illustrates the profound effect that Frank has on her. This theme of The Impact of Human Connection also plays out in subtler ways. When Frank admits that he fears death, Vlahos repeats a phrase that Sue said to her in Chapter 3: “I think more people feel that way than care to admit” (231). The direct recycling of this phrase exemplifies the ways in which Vlahos lets her patients change her. It also demonstrates her growth as a nurse; experience has made her more confident and capable. While the patient was the one quelling Vlahos’s fears in Chapter 3, she now draws on what she has seen to quell Frank and Cheryl’s anxiety.

Despite her increased comfort with her work, Adam’s family, which so eerily mirrors her own, poses a particular challenge. More than ever before, Vlahos must allow her personal life to inform her work, if only because the parallels are too striking to ignore. She has been trying to find the line between the personal and professional for the duration of the book, but now it becomes clear that the lines are—and should be—blurry. Her work makes her personal life more meaningful and vice versa. The structure of these final chapters also reflects this idea. Rather than relying on flashbacks as she did in the beginning of her book, the narrative remains in the present, becoming smoother as her two lives merge.

As Adam dies, his wife sings “Hallelujah,” which Vlahos mentions was also one of Babette’s favorite songs. The title of the song praises some unnamed higher power, and the lyrics emphasize the importance in celebrating life—even its tragedy. These ideas of gratitude and fate have been intertwined throughout the work and continue to inform the closing scene. After Chris expresses his gratitude for the course of Babette’s death, he says, “I truly believe everything happened for a reason” (246). Vlahos repeats the sentiment back to him, much as she repeated the lesson to eat the cake back to her patient Elizabeth. Through repetition, she underscores the extent to which she learns from others; coming from her own mouth, the idea begins to take shape as a belief that she can now apply even to tragedies.

One of Vlahos’s concluding statements is that “how you live your life is more important than what you believe in” (249). After a fruitless search for a concrete belief system, she decides to let her own moral compass guide her through life. She allows herself to make her own rules and draw her own conclusions rather than following what she is told in church, school, or work; in focusing so much on dying, she sees the importance in living intentionally.