‘The In-Between’: A Memoir of Caring and Reverence

"The In-Between: Unforgettable Encounters During Life's Final Moments," by Hadley Vlahos.

About halfway through “The In-Between,” the memoir by hospice nurse Hadley Vlahos, we get a glimpse of what only a few get to experience. In loving prose, she honors those she cared for in their final days until they crossed over, or what she refers to as “the shift.”

Vlahos writes, “Although it’s hard to explain, this shift is one that every hospice nurse and person who has witnessed death has experienced—the tangible shift in the air.”  She compares it to walking into a room expecting to find someone there, only to discover it’s empty.

The read is both captivating and heart-tugging. We meet and get to spend time with terminally ill patients at their ends and see the imprint they leave on the relatively new nurse.

Hospice care requires a special kind of caregiver, as seen in Hadley Vlahos's memoir, "The In-Between." Inside Creative House/Shutterstock

In Chapter 1, we meet Glenda who was one of Vlahos’s first hospice home clients.  Glenda’s daughter and main caregiver calls for help because of what she sees as her mother’s increasing decline and a new symptom, hallucinations.

Conversations With Those on the Other Side

Entering the bedroom, Vlahos notices Glenda is having a lively conversation but Glenda is alone. Thinking that meds are in order, she’s informed by a supervisor that her patient is, in fact, in the crossing over phase—still here in this world, but with a step in the next. Who is Glenda speaking to?, Vlahos wonders. She is then introduced to Glenda’s long-deceased sister, who will remain here “until it’s time to leave.”

As Vlahos continues to visit her patient, she becomes accustomed to the two sisters conversing about their shared memories from ages ago, assured this is not a hallucination. It’s a jarring experience, both for Vlahos and the reader, learning about the “in-between” phase—that place where life ends, and another begins. There are similarities among her patients during this time, she says, and has become a believer that there is “something” after this life.

As Vlahos meets each patient, we’re aware of the inevitable ending to come, but with each passing chapter, both reader and author become more and more accustomed to what lies ahead. As medication is no longer the answer, the hospice nurse remains to make the patient comfortable, to keep an eye out for any change in status, and to help the caregiver or family member with whatever they need during this time.

Choosing to do this work was not in Vlahos’s plan. She wanted to be a writer and had no interest in nursing. But with grandparents who were licensed embalmers and funeral directors, she was introduced to death at an early age. The subject was a nightly family conversation. In college, she found herself pregnant and in need of a quick way to learn a skill and earn a living. A local college offered a nursing program, and Vlahos earned her nursing degree while juggling the demands of a newborn.

The day-to-day work of a hospice nurse is sometimes hard to share with friends and family. When dinner conversation turns to the ups and downs of their workdays, Vlahos brushes off hers with a short response along the lines of “same old, same old.” Though content with her career choice, Vlahos has learned to keep the details of her world to herself.

Limited Time

Vlahos clearly cherishes her experiences, surrounding herself with those aware of their limited time, eager to share the wisdom they’ve learned, and giving the author a new perspective on life and death. As Glenda was close to taking her last breath, her daughter Maria was at her bedside. Glenda expressed her love and gratitude, telling her daughter that it was time to go with her sister; it is a tender moment.

With some patients, there is little need for medical care, which leaves precious time for the nurse and patient to share stories and life lessons. As time goes on, and they begin to tire, we understand the difficulty for hospice workers. Despite their own admonition not to get emotionally involved, they find it a hard rule to follow.

Knowing that death is imminent, Vlahos can only stand aside and comfort family members when the passing has finished. That some patients can put off last breaths until a family member arrives gives Vlahos the belief that we have that power at the end. “I’ve had some patients intent on dying alone,” says Vlahos, “stealing away in the matter of seconds they’re left to themselves while a loved one goes to the bathroom.”

Author of "The In-Between," Hadley Vlahos. Zack Smith Photography

Vlahos is a credible witness to the crossing over-experience. In these chapters, we meet some remarkable people who, despite months to live, move into their final days with acceptance of what’s to come, a sense of relief, and almost joy.

‘The In-Between: Unforgettable Encounters During Life’s Final Moments’ By Hadley Vlahos Ballantine Books, June 13, 2023 Hardcover: 288 pages

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