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

Content Warning: This section references death and dying, including by suicide.

Vlahos states in the Introduction that one of the book’s goals is to answer questions about death that most people are too afraid to ask. As a hospice nurse and a human being who has experienced loss, she has a perspective on both the medical and emotional aspects of death. However, Vlahos’s openness about these issues rarely entails definitive claims; through her stories, she reveals that while she looked for concrete answers about death in the past, she has since found comfort in its mystery.

Vlahos suggests that society is reluctant to discuss death frankly even in contexts where it is directly relevant. In the Introduction, for example, Vlahos seeks religious explanations of death and suffering, but her mother simply tells her to stop asking. Even as a hospice nurse, she faces silence and a lack of basic information. Consequently, she is unprepared when she first sees a patient apparently interacting with a deceased loved one. Vlahos asks another nurse about this, who casually answers, “Yeah, it happens all the time” (16). The response suggests that the phenomenon is so obvious and commonplace that it hardly needs mentioning, and Vlahos’s experiences bear that out. However, there is little public awareness of this reality, as evidenced by the fact that the hospice company constantly receives calls from families concerned that their dying loved one is seeing dead people. This can be alarming to witness if one isn’t prepared for it, yet Vlahos’s overall message is that there is no reason to fear it: Regardless of whether one believes it points to the existence of an afterlife, these interactions overwhelmingly comfort the patient and are therefore something to embrace rather than hush up. If more people spoke about death, Vlahos suggests, there would be much less fear surrounding it.

Vlahos’s transparency extends to her daily work, where she makes connections with patients by telling the truth. For example, she tells a patient who is wary of nurses that she had a baby when she was 20 and afterward feared that she was “damaged goods,” letting him see her own fear and humanity. Immediately, he opens up and starts to joke around. In addition, Vlahos explains the mechanics of various diseases, protocols, and documents to her patients, giving them (and the reader) basic information about hospice and medical procedures that they might not otherwise know. This has a very practical purpose even beyond dispelling anxiety about the unknown: Vlahos recounts several instances of doctors and nurses taking advantage of vulnerable or uneducated patients, implying that it is important for people to understand the basics of a process that every single person will one day experience.

Although she can educate readers and patients on the facts of dying, Vlahos does not pretend to have all the answers regarding its meaning or significance, and acknowledging those limitations is part of her transparent approach. Nevertheless, she suggests that it is important to talk about death openly, not least because death itself seems inherently connected to honesty. Dying prompts many of Vlahos’s patients to reflect on their lives and take stock of what really matters; Elizabeth, for example, opens up to Vlahos about her biggest regrets in life and urges Vlahos not to make the same mistakes. This vulnerability is part of what makes hospice work so meaningful to Vlahos, as it reconnects patients and those around them to submerged aspects of their humanity.