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A review of ‘After The End’, the June 2019 novel by bestselling author Clare Mackintosh.

‘How can my child be a breath away from death, when evidence of his life is all around me?’

Unlike thrillers usually associated with Clare Mackintosh or her lively, humourous take on family life in a rural setting, prepare yourself. For this is the story of almost 3-year-old Dylan Adams suffering with medulloblastoma, an aggressive brain tumour, and the impact it has on his family.

Before his illness developed, Dylan enjoyed life like any child his age; feeding ducks, scoring goals, turning the pages of a book. Now incapacitated, parents Max and Pip keep vigil at his hospital bedside, willing him to recover and return home.

But after six bouts of chemotherapy and a handful of extubations to treat pneumonia, Dr Leila Khalili
delivers news to devastate their world: The hospital trust believes it in Dylan’s best interest not to medically intervene the next time a bout of illness necessitates treatment.

‘Hope is one side of a seesaw balanced by despair.’

Clare Mackintosh has thoroughly researched that expensive treatment exists in the form of proton beam therapy. For Dylan, it is at the cost of a long haul flight he may not survive and public crowdfunding which places his family in an unforgiving spotlight. All this with only the glimmer of hope that Dylan may live a few more short but precious years or months. But what price would any of us pay to feel our child’s skin on our skin, to lovingly comb their hair and sit beside them in a beautiful garden, knowing that the inevitable will happen sooner than it should but holding on, oh so tightly?

Consider, too, the case where if a child cannot live a pain free, drug free, independent existence, is that really living at all? Is it not better to let them go to sleep naturally, peacefully? To never endure another injection, never again be prodded by a visiting medic who monitors them like a laboratory experiment? To slip peacefully away, knowing that the love of their family is all around them, surely this is the kindest course of action?

The strength of Max and Pip, the couple who fit seamlessly together, is ferociously tested as they each wrangle with what they believe to be right for their son. Will their relationship navigate this crossroad? Will they ever agree upon what path is best to walk with Dylan? And will their marriage survive when the inevitable curtain finally falls?

For us, After The End takes a deeper twist as we read the Author’s Note and discover Clare is taking the reader on a truly heart-wrenching real life experience.

‘Science not emotion, facts not supposition.’

The narrative is cleverly split between Max and Pip, both in first person to place us firmly in their heads. Third person Leila stands to one side of the fence, observing the scene from beneath her qualified doctor’s gown. Yet we read rare glimpses into Leila the woman, and we empathise, too, with the doctor who does not let one day pass without Dylan in her thoughts.

But underlying the three character arcs is an appreciation for what makes the very heart of the National Health Service beat, and perhaps something most of us have encountered; the spirit of its staff. Purchasing (and hiding) kettles from their own purse because the canteen is too far away and breaks too few and far between. Buying stationery and books for patients and visitors to use because the budget is stretched so thinly. Offering tissues and tea from their personal resource to distressed relatives. Staying past the shift end to ensure the patients’ needs are met.

Author Clare has highlighted what makes one of the largest organisations in the world tick – human kindness. Despite characters being at odds with some of the medical opinions, the praise is undisguised for staff that go over and above their pay grade to ensure human needs are met even when medical ones cannot be.

This novel is harrowing yet beautiful. It will squeeze the breath from you yet it will fill you with love. It will re-teach you just how fragile is Life. Each page is emotionally charged and Clare Mackintosh herself applauds the reader for finishing it, if indeed they get that far. It’s a book bringing what truly matters into sharp focus, and prompting the belief that no matter your difficulties, you may still find joy in unexpected places.

To tackle a subject with such respect and eloquence, particularly one you have lived through, takes great courage. And so it is we will leave you with the message that we take from this novel and will think about for a long time to come:-

Reflect on a time that may no longer be ticking. And be sure to feel the joy and love within and around you that will always be.