The In-Between: unforgettable encounters during life’s final moments

Book review

  • End of Life Care

The In – Between – unforgettable encounters during life’s final moments

By Hadley Vlados. Ballantine Books New York 2023 259 pp

Reviewed by Dr Elaine Sugden

Hadley Vlahos was only 24 when she became a hospice nurse in the USA. Her maternal grandparents were funeral directors so, as she herself says: “death was literally part of life”.

Her wish had been to become a writer but the sudden death of a high school friend on the football field and the need to have a stable income to support her son turned her towards nursing. After graduation it was less than two years before she found her niche in end-of-life nursing.

Hadley’s role was as a hospice nurse. She attended, in their own homes, those whose life was ending and treatment would have no further benefit. “Looking back”, she says, “I can see that I landed exactly where I was supposed to, doing exactly what I was supposed to do.”

In the book ‘The In - Between’ Hadley tells the stories of her involvement with 12 end of life patients with different diagnoses. Their ages ranged from early 20's to over 80, many in middle age, men and women, single and partnered. Running through these stories were insights into Hadley’s training decisions, her own social situation and the provision, or otherwise, of care of the ill through insurance and state funding in the USA.

But that isn’t all. In this book Hadley has a special purpose - to record for the reader the ‘normal’ event experienced by many at the very end of life when they see or communicate with relatives or special friends who have died earlier. She says: “When I started working in hospice I didn’t know whether I believed in a higher power. While I still don’t have all the answers, the one thing I can tell you for certain is that there are things that defy medical explanation, and that in between here and whatever comes next, there is something powerful and peaceful. I’ve seen it with my own eyes time and time again.”

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