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

by Hadley Vlahos RN

Overview

NEW YORK TIMES BESTSELLER • Passionate advocate for end-of-life care and TikTok star Hadley Vlahos shares moving stories of joy, wisdom, and redemption from her patients’ final moments in this “brilliant” (Zibby Owens, Good Morning America) memoir.
 
“This extraordinary book helps dispel fear around death and dying—revealing it to be a natural part of our soul’s evolution.”—Laura Lynne Jackson, New York Times bestselling author of Signs and The Light Between Us

Talking about death and dying is considered taboo in polite company, and even in the medical field. Our ideas about dying are confusing at best: Will our memories flash before our eyes? Regrets consume our thoughts? Does a bright light appear at the end of a tunnel? For most people, it will be a slower process, one eased with preparedness, good humor, and a bit of faith. At the forefront of changing attitudes around palliative care is hospice nurse Hadley Vlahos, who shows that end-of-life care can teach us just as much about how to live as it does about how we die.
 
Vlahos was raised in a strict religious household, but began questioning her beliefs in high school after the sudden death of a friend. When she got pregnant at nineteen, she was shunned by her community and enrolled herself in nursing school to be able to support herself and her baby. But nursing soon became more than a job: when she focused on palliative care and hospice work, it became a calling. 
 
In The In-Between, Vlahos recounts the most impactful experiences she’s had with the people she’s worked with—from the woman who never once questioned her faith until she was close to death, to the older man seeing visions of his late daughter, to the young patient who laments that she spent too much of her short life worrying about what others thought of her—while also sharing her own fascinating journey.
 
Written with profound insight, humility, and respect, The In-Between is a heartrending memoir that shows how caring for others can transform a life while also offering wisdom and comfort for those dealing with loss and providing inspiration for how to live now.

Product Details

ISBN-13:	9780593499948
Publisher:	Random House Publishing Group
Publication date:	06/13/2023
Sold by:	Random House
Format:	eBook
Pages:	272
Sales rank:	8,047
File size:	1 MB

About the Author

Hadley Vlahos, RN, is a hospice registered nurse, mother, and wife. Her husband also works in the medical field as a doctor of physical therapy. Vlahos started her career as a registered nurse at twenty-two. As a hospice nurse, she now visits people at their home while also educating and sharing stories about hospice care on social media, where she has more than a million followers.

Read an Excerpt

Chapter One


Glenda

My hair was still wet from the shower as I stood in front of the television absentmindedly watching the news with my best nurse ever mug in hand. I was sipping my coffee when I felt a tug on my scrubs. Looking down, I saw Brody’s big blue eyes peering up at me.

“Juice, please?” he said, shaking his empty sippy cup in his still-chubby three-year-old hands. I smiled and picked him up, placing him on my hip as I walked over to the kitchen. After giving him his juice, I tapped my phone to check the time. I needed to leave by 7:20 a.m. to make it to the office by 8:00. It was 6:40 now, which meant I had just enough time to finish getting both of us ready and fed.

My phone rang as I opened the refrigerator to grab some eggs. I looked down to see my manager Kristin’s name flash across the screen. She never called this early. I wondered what was wrong.

“Hello,” I answered nervously.

“Hey, you!” she greeted me, sounding like she’d had way more coffee than me. “I need you to come with me to a patient’s home. Check your email for the address. I’m about ten minutes away.”

I quickly looked up the address, panicking when I realized that it was in a very nice part of town, just minutes from the beautiful white sandy beaches that Destin, Florida, is known for. Although I’d spent the latter part of my childhood in Destin, I now lived in the next town over, aptly named Niceville, in a little blue house that I had bought for Brody and me earlier that year. As a young single mom, I couldn’t afford anything bigger or closer to the beach, but I was so proud of this home that I’d managed to buy for us a few months into my first nursing job.

“I’m at least thirty minutes away and need to drop off my son at daycare. Is that okay?” I asked cautiously, worried the delay would annoy her.

“No problem!” Kristin replied cheerfully before hanging up the phone.

Anxiety set in as I realized I needed to move quickly. I put the eggs back in the fridge, deciding to forgo breakfast altogether, twisted my wet hair into a low bun, and threw on my scrub top. After making sure Brody was dressed in the appropriate number of layers (because, yes, northern Florida does have a winter!), I stepped out into the crisp, cold air and headed to his daycare.

Brody’s teacher barely looked up from her phone as I dropped him off at his classroom. “So sorry to bother you,” I said, approaching her timidly, “but I didn’t have a chance to feed Brody this morning. Can you make sure he gets breakfast?”

Without saying a word in response, the teacher rolled her eyes and let the kitchen know there would be one more kid than usual eating breakfast. I felt the familiar no-win pull between work life and mom life tug at my heart. One of the practical elements that appealed to me about hospice nursing is that it was generally an eight-to-five job, which meant predictability for my schedule with Brody, but not every day was like that, and apparently today was one of those days. It wasn’t even 7:00 a.m. yet, and I already felt like a failure in the mom category, but I couldn’t afford to lose my job. I was a few weeks into my new position as a hospice nurse, and in the process of training, which meant that I spent my days shadowing more senior nurses like Kristin as they visited patients. Keeping my manager happy had to come first.

I drove to the patient’s home, passing many beautiful beach houses just like the one I had grown up in. I turned left onto Coral Cove, and saw Kristin’s Hyundai sedan in the driveway of a beach bungalow with green shutters, surrounded by a few palm trees artfully placed around the front yard. The home wasn’t imposing in the way I had feared. On the porch, two rocking chairs swayed back and forth in the breeze, and the lights that glowed from inside the house were warm and inviting. I took a deep breath.

Kristin met me in front of the house, her impeccably curled blond hair framing her face, which was beautifully made-up even at this hour. “Ready, Freddy?” she asked, flashing her perfect smile. I smiled slightly in return and nodded, feeling insecure in my wet bun and bare face.

The truth was, I didn’t feel ready. As a hospice nurse, of course I knew that attending a patient’s death was inevitable, but I hadn’t had to face it yet. I had a sense this patient was going to be different.

As we walked up the concrete steps, a frazzled red-haired woman in her forties opened the door before we could even knock. She looked like she had just rolled out of bed, yet hadn’t slept for a moment.

“Come in, come in,” she said, waving us inside. I could smell coffee brewing in the kitchen as a barking teacup poodle ran up to us, pausing to sniff my brand-new sneakers, a gift from my mom to celebrate my new job.

“So, she’s been talking to deceased loved ones?” Kristin asked the patient’s daughter, Maria, who was now trying to herd the dog into a laundry room off the kitchen. Hearing this, I raised my eyebrows, my suspicions confirmed. This was not another “normal” visit, after all. Despite what movies and television might lead you to believe, most of a hospice nurse’s day is spent driving from one patient’s home to the next, where we spend thirty minutes to an hour checking in on the patient and helping their caregiver or family member with whatever they might need to keep the patient comfortable. Maria did need help, it seemed, but not in the usual ways of checking to ensure her mom had the proper medications, that her symptoms were under control, or routine wound care.

“If you want to call it that,” Maria replied as she grabbed a coffee mug from the kitchen cabinet. “I call it being out of her damn mind. She’s mostly talking to her sister, who passed before I was even born. Please make this craziness stop. I can’t sleep.” Maria took a long gulp of coffee, as if to emphasize the point. As she drank, I took a deep whiff, allowing the strong smell to help ground me as my mind buzzed with confusion. “All she does is talk to herself nonstop. Y’all must have some medications to make her sleep. If not, I’m going to call 911.”

“Okay, Hadley and I will go take a look at her,” Kristin told Maria reassuringly.

As we walked down the hall, I began hearing the faint voice of a woman. We entered the bedroom and I took in the sliding glass doors that led out to a patio, a heavy wooden dresser and matching nightstands, and a smaller table next to the dresser, piled high with books. A large chandelier hung over it, beautiful and ornate. As my eyes scanned the room, they finally came to rest on Ms. Glenda, whose white curls were cut short to frame her face. She roared with laughter even though there was no other sound—or person—in the room.

I watched Ms. Glenda incredulously as she continued pointing and laughing at the air in front of her, seemingly unaware that Kristin and I were there.

“No, no, no!” she exclaimed. “I didn’t say that. You are too much!” Her laughter echoed throughout the room.

Kristin walked up to her bedside and lightly touched her arm. “Hey, Ms. Glenda! It’s Kristin and one of our newer nurses, Hadley.” I stepped up to her bedside and waved awkwardly.

“Well, hey!” Ms. Glenda greeted us. “You’ll have to excuse me, we haven’t spoken in years.”

“Who haven’t you spoken to?” Kristin asked.

“Oh! I couldn’t be any ruder, could I?” Ms. Glenda said with a heavy Southern drawl. “This is my sister. Do you need to take my blood pressure now, sweet pea?”

Kristin nodded and pulled out the blood pressure cuff from her nursing bag. I stood nearby, looking on in confusion, stunned that she was so unbothered by the fact that we had just been “introduced” to an invisible, deceased sister. Before coming on as a hospice nurse, I had worked in a hospital, where Ms. Glenda would have been medicated with antipsychotics before she could even finish her sentence.

After Kristin finished taking Ms. Glenda’s vital signs and declared her numbers to be perfect, she went to grab Maria. For a moment, it was just me and Ms. Glenda. I wasn’t sure what to do or say, so I met her eyes, half smiled, and awkwardly played with the zipper on my own nursing bag. Thankfully, Kristin was only gone for a moment, and once she returned to the room with Maria, she started laying out the “game plan.”

“I know you’re tired and concerned about your mom,” she said to Maria. Then, turning to Ms. Glenda, she said, “And, Ms. Glenda, I know you have people you need to catch up with, so what we’re going to do—as long as you two are okay with it—is initiate something called continuous care.”

It’s only at the point when the family caregiver can’t handle a situation anymore that we initiate continuous care, where a nurse remains at the home round-the-clock either until the patient’s symptoms are more manageable or the nurse is otherwise no longer needed. I hadn’t been in a continuous care situation yet, and I was eager to see it performed and to learn all about the antipsychotic medications hospice used.

Editorial Reviews

Tender and transformative . . . The great surprise of The In-Between is that it makes dying feel like a peaceful, dynamic, and nourishing event that can potentially transform the lives of those who are left behind. Readers will cheer on Hadley Vlahos and, like me, be forever grateful that she wrote this book.”—Christie Tate, New York Times bestselling author of Group

“Vlahos’s compassionate, beautifully written book contains profound wisdom. It is for anyone with an open heart who loves a good story and anyone who fears but would like to better understand hospice and the end of life.”—Katy Butler, New York Times bestselling author of The Art of Dying Well

“Gentle and moving, The In-Between takes readers where few think they would want to go: deep into the world of hospice nursing. The combined beauty, faith, and compassion found in each patient’s death is meaningful and sublime.”—Theresa Brown, RN, New York Times bestselling author of The Shift

“Gentle encouragement for all those who live under life’s running clock and for those who love them.”—Kirkus Reviews

From the Publisher