Review: The In-Between: Unforgettable Encounters during Life's Final Moments by Hadley Vlahos, RN

 Dear Lit Loves,

Greetings!  And I am finally returning to review a recently released memoir written by a hospice nurse entitled The In-Between:  Unforgettable Encounters during Life's Final Moments by Hadley Vlahos.  So why did I select this book to read:  I recently lost my mother to stage four esophageal cancer adenocarcinoma.  Mom moved in with me and my brother as the local hospice facilities had no beds available.

I do not know if I could ever take on the career of a hospice nurse.  To me, hospice nurses have to change their schedules at a moment's notice should one of their home-bound patients have an emergency.  Also, I hate meeting people under circumstances in which one of their beloved is knocking at death's door.  I have to commend Hadley Vlahos for her career efforts as she handles the job requirements and raises a son as a single mom.  

No one really likes to talk about death until BOOM!  It is staring you in the face and you do not have a choice.  Thanks to the hospice nurses that took care of my mom, I now know that even if a loved one chooses to die at home, there is always a transitioning phase for those dying.  For my mom, it was when she started to lose control of bodily functions and there came a point where even if I was speaking directly to her, there was a mystical haze in her eyes.  

Interestingly, those who are in the active phase of dying often are "seeing" loved ones or people who have already died before them.  Seriously,  my brother and I witnessed this with our dad at the hospital.  Right out of the blue one evening, dad started speaking to his younger brother, John, who according to dad was right beside his hospital bed.  Dad carried on a full conversation with his brother.  I just listened.

There also came a point when I witnessed my dad bargaining with God.  Dad really wanted to remain here with us, enjoy retirement, and ensure his youngest physically and mentally disabled sister was well-cared for through her lifespan.  Additionally, I have also witnessed what Hadley Vlahos speaks about when she says people who are actively dying can often predict something that will happen in the near future.  For example, one day I arrived at my dad's hospital room and he quite clearly directed me to go locate and secure a lot more chairs for the hospital room.  He said, "There are a lot of people coming and we need to be ready."  I kept asking him who was coming and he said, "Family, friends, acquaintances, coworkers, etc."  It was a week later that dad died and our church was filled to the rafters and sure enough, ushers had to go find additional chairs.  

Does everyone residing with or at a hospice die at peace?  Mostly, but not all do.  My dad simply drifted away while we were in his hospice room.  In other examples, Nurse Vlahos witnesses someone under her care who basically "bleeds out" when dying.  My own mom was always trying to find a way to sit or lie in order to feel comfortable.  And trust me, it is very difficult as a family member to administer pain meds to your own mother.  No one has to spell it out for you:  those meds are to assist with the pain during the active dying process.  Is their a death rattle at the end of life:  Yes, but not all patients exhibit it.  My dad's death involved labored breathing and an eerie death rattle.  My mom just appeared at peace in her final moments almost as if she had just decided to lie down and take a nap.

I think one of the most important aspects in the book is that no one die alone.  Hearing is the last sense to go.  You can talk to the dying person and they quite possibly can hear you, but may not be able to respond to you.  Nurse Vlahos knows eventually she will lose each of her patients.  Until then, she visits with them, learns from them, advises them, and assists the rest of the family with processing the death.  

One of the most poignant moments in the book is when Nurse Vlahos is assigned to care for a patient who is homeless.  He lives in a tent under a highway or bridge along with other homeless folks.  It was touching to know that Nurse Vlahos went out of her way to help this man obtain food, medicine, and even someone who could contact her should this hospice patient need her.  Trust me, it is a privilege to be present with someone as they are leaving this world for whatever is next.  And when you lose your final parent, I can tell you with absolute certainty, you life will be forever changed.  And with that kind of change, a son or daughter will grieve at their own pace and in their own way.  

I highly recommend this book especially for readers who do not know of hospice or those who have told me they are frightened of hospice.  These are the folks who are the specialists.  They deal with death each day and continue to help folks who are transitioning from this life to whatever you believe comes next.  

Till my next review,

Grace (Amy)