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

An Episcopalian is a member of the Episcopal Church: a Protestant sect of Christianity within the broader Anglican Communion. Vlahos was raised and went to school in the Episcopal Church but struggles with accepting its teachings unthinkingly rather than asking questions. Having seen suffering in the world, she particularly wonders how an all-powerful God could let that happen. Throughout the book, her morals are influenced and changed by the way she grew up, people she meets, and what she feels is right. Nevertheless, she remains influenced by her childhood faith. After a sermon at her mother’s church in which the priest seemingly speaks directly to her, she decides not to get an abortion (the Episcopal Church generally disapproves of elective abortion but stresses that it is ultimately the woman’s decision, opposing anti-abortion legislation).

Alzheimer’s is the most common form of dementia, typically affecting people over the age of 65. Though considered a terminal condition, the disease progresses slowly, so patients with Alzheimer’s cannot be admitted to hospice until they reach the point of “moderately severe dementia” or “severe dementia” (108). Because Alzheimer’s affects cognitive ability in a way many terminal illnesses do not, Vlahos uses it as a symbol of the powerlessness associated with being deemed sick. Vlahos suggests that it is easy to dismiss the humanity of patients with Alzheimer’s and consequently ignore all they still have to give the world. For example, when Vlahos’s patient somehow predicts a fire that occurs weeks after her death, Vlahos comes to believe that Alzheimer’s patients may have unique insight from another world.

Medicare is US federal health insurance for people who are over the age of 65. Medicare is discussed in this book as an option for some hospice patients who cannot afford to enter a nursing home. However, the age limit means that some of Vlahos’s terminally ill hospice patients are barred from using Medicare—part of Vlahos’s implicit critique of the US healthcare system.