Nursing Book Club
The In-Between by Hadley Vlahos, RN
A hospice nurse's account of patients as they face the end of life
Most of us have no experience with what happens between a terminal diagnosis and the funeral home. Hospice nurse and TikTok star Hadley Vlahos, RN, has been through that process repeatedly and wants to take the mystery and fear out of it for the rest of us.
Vlahos is an unusual nurse. She came to nursing as a way to support herself and her infant son, not as a long-term career goal. However, after she joined a hospice team — an uncommon career selection for a young nurse — nursing became a calling.
Hospice is the final phase of a patient’s life and care. Usually, patients receive a hospice referral when their physician estimates life expectancy at six months or less. At this point, the patient decides to forego further medical treatment and opts instead for palliative care, which typically focuses only on pain control, along with support from nurses, aides, social workers, and chaplains to help the patient accept this last journey.
With years of end-of-life care experience, Vlahos seeks to explain what happens next in a non-frightening way that people unfamiliar with hospice care can understand and accept.
What she defines as “The In-Between” is the state patients enter during their final moments, where they have one foot in this world and one in the next — whatever that may mean for them. The patient may see things that we don’t see, or perceive time in a way that we don’t experience.
Twelve Patient Journeys
In The In-Between, Vlahos describes the journeys of 12 of her patients and discusses the similarities in their final experiences, despite their great social and economic differences.
Some of her patients owned expensive homes with ocean views, while others lived in trailers or in homeless encampments beneath highway bridges. Some were people of faith and some were nonbelievers. Some had the support of their family, while others had no next of kin, or loved ones who were clueless about how to help.
Even so, Vlahos says many of these patients shared the same experiences in their last moments. While everything doesn’t always go as expected even with the best planning, she argues that with the help of a caring hospice team, any patient can experience a “good death.”
A Family of Funeral Directors
The In-Between is also the story of the author’s own journey and how she became a committed hospice nurse. It could be said that she had a head start in her familiarity with death because her maternal grandparents were funeral directors, and her mother grew up around funeral homes and morgues. Vlahos herself was raised in a highly religious family and attended parochial schools.
However, she insists that none of that really matters. Vlahos believes the signs of “The In-Between” that she has observed in her patients are there for anyone to see who is open to the experience. The provocative subject matter alone makes this book singular; Hadley’s powerful memoir of nursing makes it special. We walk along with her as she learns her craft and becomes a mature nurse.
Depending on your religious or philosophical point of view, you might not agree with all of her interpretations of what she has witnessed, but even if you have to briefly suspend your disbelief, you may find this book enlightening.
The In-Between by Hadley Vlahos, RN (Ballantine Books, 2023)
CHRISTINE CONTILLO, RN, BSN, PHN, is a public health nurse with more than 40 years of experience, ranging from infants to geriatrics. She enjoys volunteering for medical missions.
In this Article: End-of-Life Issues
