Book Review: AFTER THE END by Clare Mackintosh

Title: AFTER THE END

Author: Clare Mackintosh
Publisher: G.P. Putnam's Sons
Read: June 2019

Expected publication: 25 June 2019

My Rating: 🌟🌟🌟

Book Description:

Max and Pip are the strongest couple you know. They're best friends, lovers—unshakable. But then their son gets sick and the doctors put the question of his survival into their hands. For the first time, Max and Pip can't agree. They each want a different future for their son.

What if they could have both?

A gripping and propulsive exploration of love, marriage, parenthood, and the road not taken, After the End brings one unforgettable family from unimaginable loss to a surprising, satisfying, and redemptive ending and the life they are fated to find.

My musings:

AFTER THE END is a difficult book to review, not only because of the subject matter but knowing that it reflects some of the author’s own experiences when her child was critically ill. As a parent, I cannot imagine anything more heartbreaking than having to decide whether it would be kinder to let your child die rather than continue treatment for the sake of prolonging his life. Most marriages would struggle under the strain, but what if, on top of all the heartbreak, the parents do not agree on the best course of action?

Mackintosh is a fantastic writer, so it comes as little surprise that she presents us with true-to-life believable characters who are trapped in this sort of nightmare. Pip and Max’s three year old son Dylan has terminal brain cancer and is currently in PICU. The doctors feel that further treatment is futile because it would not be able to cure Dylan, and the effects of the would be so devastating that he would be severely brain damaged. Pip agrees. Max doesn’t. He wants to try proton treatment to prolong Dylan’s life, even knowing that Dylan will never be able to lead a normal life for the time he has left. So where do you go from there? If the parents cannot agree, a judge will have to step in to make a decision as to what is best for Dylan.

As you can see, as much as the book will break your heart, there are also some valid ethical questions at play here. Max reasons that any life is worth living, even one where Dylan will be severely brain damaged. He feels that Dylan would still be able to feel some joy, and the love of his parents, and any extra time they could have with him would be worth the rigours of the treatment. Pip disagrees. She thinks her son has suffered enough already and she doesn’t think he should exist in a state where he is not able to live a fulfilling existence. She does not want to put him through any more pain. So who is right and who is wrong? I think you could debate this for hours, days, years and still not come up with an answer. So how can a judge decide?

As the title suggests, the second half of the book focuses on the time “after the end”, meaning after Dylan’s death. Two separate options are explored, determined by the judge’s ruling. It was a clever “alternative universe” type concept that also shows that life will go on, even though Dylan’s death may seem like the end of life as they know it for both parents.

To lend a impartial perspective to the narrative, the POV of a doctor caring for Dylan is also included, a voice I really enjoyed. It also showed the human side of the medical team caring for terminally ill children, and that they are not unaffected by their charges’ fates.

As the story goes, this could never be anything other than heartbreaking, and it will be a strong trigger for anyone who has ever been in a similar situation or is vulnerable in some way through the death of a loved one. For a bookclub, it would make for some fantastic discussions around the ethical issues and the outfall of the judge’s decision. Purely judged as a novel, I found that the second half dragged in places for me and lost my interest at times. I found it interesting how Pip and Max’s lives went on after losing their son, but felt that too much time was spent on the part of the story where the reader is emotionally drained from exploring their own emotions regarding Dylan’s death and his parents’ terrible dilemma.

Am I glad that I read it? Yes, definitely. It was thought-provoking and confronting and challenged some of my own beliefs. Would I recommend it to anyone? That depends – it is a sad and often depressing read, so if you are vulnerable at the moment be aware that there will be triggers. I loved the way the author was able to present both parents’ different views in a non-biased manner that allows readers to reflect on both options without being steered in the direction of the author’s own opinions.  Most other authors who tackle this type of subject manner do so with an agenda, which refreshingly was absent here, allowing the reader to come to understand both parents and why they felt the way they did. I hope that writing this novel was a cathartic for the author and thank her for sharing such a personal, painful issue with us!

Thank you to Edelweiss and G.P. Putnam's Sons for the free electronic copy of this novel and for giving me the opportunity to provide an honest review.