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Author and Nurse Hadley Vlahos Shares the One Key Thing You Can Say to a Loved One in Hospice

New book ‘The In-Between’ sheds light on the process of dying and how to best offer your support

spinner image Book cover of The In-Between by Hadley Vlahos, RN and photo of the author

For anyone who has ever wondered about hospice care for themselves or for a loved one, Hadley Vlahos, an RN and six-year registered hospice nurse, has written The In-Between: Unforgettable Encounters During Life’s Final Moments. The book features her heartfelt reflections on her most impactful experiences with her hospice patients. Vlahos, 30, whose social media outreach about hospice care has amassed her more than a million followers, shares her insights on an often-taboo topic that warrants more open discussion.

Why did you write this book?I started sharing my stories about being a hospice nurse on social media three years ago. I was shocked how it resonated with people. Many don’t want to talk about hospice or death or dying. One day I got a direct message from someone who was at the bedside of her dying husband. She said that she had been watching my social media videos and that I brought her peace. She felt like I was there at his death. That’s when I decided that a book could go way deeper than a 60-second video.

Who is the book for?

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It’s for anyone who has lost a loved one or is going through grief or is considering hospice. It’s also for anyone who is fearful of death.

Why did you decide to become a hospice nurse?I did not start in hospice. I did an externship in a hospital where I did everything from delivery to immediate care. Then I became a nursing home manager. That’s where I saw hospice care for the first time. I was managing 40 patients. I would watch hospice nurses come in and sit one-on-one with their patients for a while. I said to myself, that’s what medicine is supposed to be like. I became a hospice nurse.

What’s the best part about being a hospice nurse?The best thing by far is the relationships. You are in people’s homes and surrounded by their memories, like all the pictures on the wall and their pets. You get to know people at a different level and you get to know them for many months.

What’s the worst?The worst thing is that there is a nursing shortage in every field. Hospice is 24/7, so it can be difficult to work all day, cover (for someone else) all night, then work the next day. It can be draining.

How do your patients approach the end-of-life process?People go through stages. Sometimes they are very resistant to going to hospice. We try to start slow and let them get to know us. They often go through a life review and become a bit more accepting. They talk about what they did well; what they wished they’d done. They accept the decline. Our bodies know how to die. Usually, people are at peace at the end.

It must be difficult getting close with patients you know will eventually pass on.

It’s not always easy. From what I’ve seen as a hospice nurse, I firmly believe that when people die, it’s not the end. I know it may be a while, but I believe I’ll see them again. This won’t be the last time I see them.

What are the benefits for the patient of being part of hospice?

You don’t have to go to the hospital anymore. This is huge for people with terminal illnesses who are always going in and out of the hospital. Now, it won’t consume your life. Instead, nurses will come to you 24/7 — even in the middle of the night. A chaplain will come to your home if you want. Social workers will come, too, to help tie up loose ends. In hospice, you can focus on what matters to you most at the end.

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And what matters for most people?

It’s different for everyone. I ask people: “What is your goal and what do you want to do to get there?” For some, it’s just being out of pain. Others might want to go to the beach or see family members.

How do you know if you’re a candidate for hospice services?

Your doctor is usually the one who initiates the conversation, but they don’t have to. You can call any hospice company and they will evaluate you and probably reach out to your doctor.  Before hospice, what we usually see are things like frequent falls or frequent ER visits. Sometimes it’s when you want to stop the chemotherapies and surgeries. Or maybe you’re eating less or feeling more confused. If you have a home health aide, they might know when is the right time to consider hospice care.

How has the nation's view of hospice been impacted by President Carter's recent decision to enter hospice?

What he did is great. The best thing it did was clear up misconceptions that hospice is for the last week — or last day — of your life. He’s been in for months. That’s a typical hospice stay — multiple months.

As a hospice nurse, how do you offer support?

In my book, I talk about one patient who I felt hardwired to heal. I talked to her doctor who reminded me that she wants comfort. I remember asking the doctor: “So I do nothing?” He reminded me there is a lot I can do. I can make her comfortable. I can call her family and give them updates. I can get her favorite foods. That is something. Just providing comfort is important.

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Is there something or someone that touched you the most as a hospice nurse?

Yes. There’s a person I call Carl in my book. He was very resistant to hospice care at first. I was searching for any way to connect with him and discovered his love of sports. I told him about my husband’s love of sports, and that’s how I got him to open up. I also told him about my interest in the news but that I didn’t have time to watch or listen to the news. So that became his job. He’d tell me the day’s news every day. One of our last conversations was about him thanking me for giving him something to look forward to each day. I still think of him every day. Things that seem so small can mean a lot.

It is tough always knowing the right words. What’s the worst thing you can say to a hospice patient?

The worst thing you can say is that by entering hospice they’re “giving up the fight.” If you allude to that, it implies failure instead of courage.

What’s the most supportive thing you can say?

“How can I be there for you?” One of the biggest things I hear is that hospice patients feel like people are walking on eggshells around them. Many of them want to talk about death. Let them talk.

Is there a commonality you see in many hospice patients?

Most go through a “life review” phase. They like to tell me about their life in general and talk about it. I’ll always listen and in the process, I get pearls of wisdom.

What’s the most important thing you’ve learned from your hospice patients?

The most critical thing I’ve learned is that how you treat people around you is what matters more than anything else. 

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