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

“I’m sharing these stories because there are so many misconceptions about both death and the process of dying. I get it.”

Stating outright one of her purposes for writing, Vlahos works to gain readers’ trust by demonstrating where she is coming from. Before she was a hospice nurse, she admits, she too was unaware. Now, however, she wants to communicate the beautiful truths about this line of work.

“While I still don’t have all the answers, the one thing I can tell you for certain is that there are things that defy medical explanation, and that in between here and whatever comes next, there is something peaceful and powerful. I’ve seen it with my own eyes, time and time again.”

Vlahos’s honesty is meant to disarm the reader as she admits she cannot explain everything she will explore in the book. She uses alliteration—“peaceful” and “powerful”—to suggest the beauty of what she agrees is impossible to explain. She asks the reader to trust her because she has witnessed firsthand what she is going to relay, and she underscores her experience in this field with repetition: “time and time again.”

“Just then, there was a loud pop in the corner of the room. The chandelier had burned out, leaving us in complete darkness.”

Vlahos uses onomatopoeia to vividly describe the experience of the chandelier burning out as she announces Glenda’s time of death; the word “pop” resembles the sound it describes. The chandelier is a symbol for the invisible but (in Vlahos’s eyes) undeniable truth that Glenda’s deceased sister visited Glenda before she died.

“Meet them where they are.”

This quote comes into Vlahos’s head as she tries to understand why her patient Carl is running around his house looking for his child, who died years ago. The meaning is metaphorical, urging Vlahos to consider what Carl is experiencing from his own perspective.

“I was being silly. This was all just a coincidence. Or a hallucination. Or something like that.”

After seeing a bluebird perched outside of Carl’s house and thinking it might be Anna, Vlahos tries to disregard her own thoughts and intuitions. She tries to explain it away by giving two unlikely explanations. By using phrases rather than complete sentences, Vlahos shows that her thought process is grasping and incomplete. She cuts herself off rather than follow each idea to its end, trying to explain something that may not have a rational explanation.

“We are comforting each other. Never apologize. We both love you so much. God put you in our lives. We both know this.”

Delivered by Carl’s wife, Mary, after he dies and Vlahos apologizes for crying, this line is the first blurring of Vlahos’s professional and personal lives. The short sentences present each truth simply and undeniably. The final line, “We both know this,” is ambiguous. Mary could be speaking of herself and Carl, her deceased husband, or she could be acknowledging a truth that both she and Vlahos know.

“I tried to walk the line between following the rules and connecting with patients.”

Vlahos uses the idiom “walk the line” here, using a visual metaphor to suggest that she is trying to do two things that feel mutually exclusive. As the story goes on, Vlahos is sometimes forced to stay to one side of the line, but she increasingly feels that The Impact of Human Connection is worth the costs.

“I know it’s not what you’ve been taught, but you’re doing what you’re supposed to be doing.”

Delivered by Dr. Kumar, this line clarifies an idea that haunts Vlahos, which is the fact that sometimes her actions as a hospice nurse contradict her training. Dr. Kumar reassures Vlahos to that the goal of hospice is comfort, not treatment, and stresses the importance of her work by repeating “doing.”

“You’re going to have to give up your ideal life in order to live the life planned for you.”

Father Tom, the priest at Vlahos’s mother’s church, says this during his sermon and ultimately convinces Vlahos not to get an abortion. Using the passive voice, this line hints that an unspecified someone or something has “planned” Vlahos’s life. She eventually comes to believe that everything led her to her life as a hospice nurse—that it is a life she was “meant” to have.

“When the time comes, we all want the same things: care, comfort, and connection.”

Vlahos uses alliteration to express one of the book’s fundamental ideas, which is that everyone dies in the same way regardless of who they are or what they believe. Humans are more similar than different, and by using “we” she connects herself to all people.

“So many of us can’t choose when we go to sleep at night, and yet we seem to have some control over when we die.”

Here, Vlahos contrasts two universal life experiences: sleep and death. She uses italics for emphasis as she marvels that, amid all of the inconsequential things people can’t control, people somehow ensure the consequential things have maximum meaning.

“Whenever I felt resentful about working on Christmas Eve, I reminded myself of the nurses who had been away from their family to take care of Brody and me on the night I gave birth.”

This line exemplifies Vlahos’s thought patterns throughout the book. She experiences a negative feeling and proceeds to use her life experience to focus on gratitude instead—an example of balancing joy and pain.

“I felt like I had to tell you this because I see myself in you. I never anticipated dying at forty. I always thought I would have more time. I wish I would have spent more time with my loved ones. I wish I’d just eaten the damn cake.”

Using anaphora by starting each sentence with “I,” Elizabeth strives to communicate her conclusions about life to Vlahos. The cake serves as a symbol for all of life’s pleasures, which she wishes she spent more time enjoying. It represents both literal cake—a reference to her struggles with an eating disorder—and also the human connection she missed out on by worrying so much.

“Years later, I still think about Elizabeth. I remember how I never once saw her sad or angry, despite the fact that she died so young and so alone. She never asked, Why me? She was the very essence of making the most of what we’re given.”

The thought of dying “so young and so alone” frightens many people, yet Elizabeth faced her situation with no resentment. Vlahos repeats the word “so” to emphasize the extremity of Elizabeth’s situation, further underscoring it with the use of a rhetorical question that Elizabeth herself never even asked.

“‘Just put us somewhere and forget about us,’ John said, sounding defeated. ‘I died long ago when she lost all memories of us.’”

John uses hyperbole to communicate the depth of his grief. He is so disheartened by his wife’s Alzheimer’s that he says he died with his wife’s memories of their relationship. This emphasizes the importance of human connection, suggesting that without mutual love and recognition, a person has nothing to live for. This grief contrasts with the moments of joy and unconditional love he later experiences with his dying wife.

“It’s easy to focus on the fact that, in so many ways, they don’t seem to be here anymore. But what we don’t think about as often is: Where are they?”

Vlahos writes this about her work with Edith, who has Alzheimer’s. The question of where those with Alzheimer’s “are” is posed both literally and figuratively. Their minds do not seem to be “here,” but that implies they are somewhere else experiencing something, which strengthens Vlahos’s belief that everyone has something to teach even when their experiences do not seem to make sense.

“I’m not used to making choices. I don’t think I’ve ever made a decision in my life. Reggie and I have been together since we were teens, and we always made all the decisions. Then he got sick and we were shuffled around like cattle; test here, doctor’s visit there, go see another specialist over in that town.”

Lisa compares her and her husband Reggie’s experience navigating the healthcare system to cattle being herded. This simile emphasizes the dehumanizing nature of the healthcare system. She expresses frustration with feeling like an animal—not getting the opportunity to ask questions or make one’s own decisions like all people deserve.

“I scanned the cemetery; so many last names of patients I had cared for stared back at me. ‘That’s a lot of people I love,’ I said, tearing up.”

Vlahos uses imagery to paint a picture of a cemetery full of names she recognizes: all the people she has cared for. For both her and the reader, this image serves as a reminder of the breadth of her impact and experience.

“The therapist leaned back in her chair, raised her eyebrows, and replied, ‘You think you have that power?’”

Vlahos’s therapist asks this rhetorical question in the context of Lisa’s suicide after her husband’s death. In asking a question to which the answer is clear, the therapist forces Vlahos to realize the ridiculousness of feeling guilty over something she never could have controlled.

“Allison knelt in front of Lily as if she was praying. With fresh tears streaming down her face, she removed Lily’s bright green sneakers one at a time, then grabbed the bowl of sand and placed Lily’s bare feet into it. Allison lovingly grabbed Lily’s fingers, repeating over and over, ‘You made it, Lil. You made it to the beach. I love you. You made it.’ I watched as one tear fell down Lily’s cheek and onto her T-shirt. Allison cried harder. Then, as if the universe knew, the wind stopped along with Lily’s breath.”

Vlahos uses simile and imagery to communicate the impact of witnessing this scene of two young women: one dying and one watching her friend die. Vlahos begins with a simile that suggests the religious or spiritual nature of the situation; Allison’s actions resemble “praying.” Vlahos then vividly describes the sand and Lily’s sneakers, bare feet, and hands to paint a picture of the loving nature of this interaction.

“Death is like birth: you know it’s coming, but the timing is unpredictable (even more so in the case of death), and it’s an anxiety-ridden process of waiting.”

Vlahos uses simile to compare two seemingly opposite events—birth and death—and to suggest that they actually have a lot in common. This comparison develops the idea that the most beautiful things often go hand in hand with the most difficult, although here she focuses on the negative experience of waiting for each to happen.

“Not only was my mother-in-law gone, but I had failed her.”

Vlahos uses this simple sentence structure to express how horribly things went wrong. She believes she failed to give her mother-in-law a peaceful death, which is the most permanent way she could have failed. However, Vlahos later experiences what she takes to be interactions with her mother-in-law after the latter’s death, suggesting her “mistake” (if it was one) isn’t so irrevocable as she here suggests.

“What makes you think that being around doctors and nurses makes me feel safe?”

Albert says this to Vlahos when she suggests that he go to a nursing home. With one rhetorical question, Albert makes her reevaluate her biases and assumptions. Previously she thought that a hospital or nursing home was unilaterally better than living under a bridge; this question forces her to reconsider. Albert values being with his loved ones more than being “safe” from a medical perspective.