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

In these chapters, Vlahos introduces the ideas that the rest of the book builds upon. The Introduction lays a foundation for readers to understand Vlahos as a person as well as the concept of hospice and end-of-life care. By detailing her upbringing and education, Vlahos not only explains how she came to work in hospice but also establishes her credibility. Vlahos did not accept the religious precepts she learned as a child without question, and the fact that she approaches spiritual matters with a skeptical yet open mind lends weight to her assertion that, as she also states in the Introduction, there is something after this life.

This belief in an afterlife informs but is not essential to Vlahos’s contention that hospice work can be beautiful as well as painful. The idea of The Connection Between Peace and Suffering is one of the memoir’s core themes, surfacing in both explicit and implicit ways. In Chapter 2, for example, Carl’s final illness is the foundation upon which Vlahos builds meaningful relationships with both Mary and Carl himself. The scene in which Vlahos and Mary prepare Carl’s body for burial represents in miniature the contrast between the situation’s deep sadness and the joy it gives rise to, as the women burst into uncontainable laughter over their inability to knot a tie.

In addition, the first few chapters introduce and exemplify Vlahos’s belief in the importance of letting people change her. This theme of The Impact of Human Connection recurs throughout the entire book and informs Vlahos’s stylistic choices. When describing her experiences as a hospice nurse, Vlahos often uses language and grammar that capture her thought processes in the moment. In Chapter 2, for example, a series of staccato sentence fragments illustrate Vlahos’s struggle to find a rational explanation for what she has observed, like a hallucination or a coincidence. By immersing readers in her perspective at the time, Vlahos encourages close identification. The fact that readers’ first experience of hospice care is also Vlahos’s—Glenda was her first patient—produces a similar effect.

Several important symbols also arise in this section of the book, most notably the chandelier and the bluebird. The chandelier flickering and burning out is Vlahos’s introduction to the idea of the dead coming back to get their loved ones, and she presents it in dramatic terms. Vlahos says there was a “loud pop” as the chandelier burned out and that they were left in “complete darkness” (21). The sound’s onomatopoeia and the resulting darkness are both meaningful. The chandelier’s “pop” is an explosive signal seemingly made for someone as new and as skeptical as Vlahos; it demands her attention and ultimately convinces her that Glenda’s sister was there to receive her. Vlahos uses the “complete darkness” that followed the burnout to symbolize the ignorance in which most people live. By avoiding the idea of death and dying, most people never witness the peace and happiness with which most people pass. By starting the book with this story, Vlahos not only encourages readers to accept that something beyond explanation may be happening but also suggests the arc of her own spiritual journey: from darkness to (at least partial) enlightenment.

The bluebird represents Anna even before Vlahos knows Anna exists; its preternatural stillness the first time Vlahos sees it lends weight to Vlahos’s contention that it is Anna, as she notices its odd behavior when she has no reason to do so. When Vlahos later concludes that the bluebird is Anna coming to fetch her father, she does not explain what she thinks may be happening in a physical sense, nor does she seek a comprehensive explanation as she did in Chapter 1. This is the first time Vlahos is able to accept a strange phenomenon without asking questions, and her response is due in part to Carl’s obvious contentment. After Anna visits, Carl feels a sense of peace and even excitement, eager to reunite with the daughter he lost so many years before. While Carl apparently sees Anna in her human form, Vlahos eases readers into the idea of communication with the dead through the symbol of the bluebird. As the book goes on, these moments of communication manifest in subtler ways—through wind or relayed conversations—but here, Vlahos finds comfort in a physical symbol of her patient’s relationship with their deceased child.

From desperately searching for any medical explanation for Glenda’s visions to speaking to a bird who she believes is Carl’s deceased daughter, Vlahos is flexible in her beliefs, quickly adjusting to the inexplicable nature of the events she witnesses through her work. Her openness to these experiences reflects her commitment to understanding her patients’ perspectives and caring for them on a human level, even at this early stage in her career. Indeed, this was what prompted her to leave the nursing home where she met her boyfriend, although the fact that they did meet in this way speaks to the nature of their relationship; they both understand the industry, care for people, and prioritize connection. However, if Vlahos is unwavering in her efforts to be the best nurse possible, she often feels unsure in these first chapters. She consults her handbook, apologizes to her patients’ loved ones, and grapples with situations she later handles with ease. Vlahos utilizes flashbacks to introduce her personal life—e.g., her son, Brody—which creates a disjointed feel that emphasizes the current disconnect between her personal life and professional life. As Vlahos changes her personal belief system in response to her professional experiences, her two lives become more entwined.