After The End by Clare Mackintosh

review

Max and Pip are shattered when their two-year-old son, Dylan, is diagnosed with a life-threatening brain tumour and their worst nightmare comes true after months of treatment proves to be ineffective. As their son’s condition deteriorates, the doctors tell them there is nothing more they can do for him and it is time to prepare for the end. Distraught, Max and Pip are torn between fighting for their son or letting him go peacefully.

Unwilling to give up, Max researches alternative treatments in the United States and discovers a new technique which just may save Dylan’s life, however it won’t stop him from being severely brain damaged. Max decides it is a chance they have to take but is stunned when Pip says their son has suffered enough and it is time to let him have some peace. At odds with each other, Max moves out of the family home and the hospital begins legal proceedings to decide what is best for Dylan since his parents cannot come to an agreement. Convinced he is right, Max starts a Go Fund Me page to raise the money he needs to take his son to the States and he soon gathers a following on social media who start to campaign on his behalf.

If you are familiar with the recent story of little Charlie Gard whose parents lost their court action to continue his medical treatment, you will know this is a highly emotive issue which tore people apart. Mackintosh doesn’t pull any punches here as Pip is vilified by the public for being a bad mother and the doctors at the hospital are abused by protesters as they go to work every day. While there are people in Max’s corner who genuinely care about what happens to Dylan, it is also clear many of them are jumping on the bandwagon and making ill-informed judgements on things they know nothing about.

The narrative of the story is told from three points of view which helps us understand how Max and Pip come to their own conclusions and you really sympathise with both parents regardless of which side you end up taking. The third point of view is from Dylan’s doctor, Leila Khalili, who is torn between her professional instincts and her compassion for the parents. Yet, Leila has a job to do and it is her medical opinion that Dylan be allowed to die and she presents her findings to the court while being condemned as Doctor Death by the media.

Adding Leila’s narrative into the story helps us see the medical personnel involved in stories like this are human beings who do really care about the hard decisions they have to make and are not the heartless monsters portrayed by the campaigners. As the media circus continues, the case is finally brought up in court and after four days of evidence, the judge is ready to announce his decision but we never learn the verdict.

The second half of the book begins with the opening lines of The Road Not Taken by Robert Frost which is an immediate clue as to what is about to happen. At this point, the story diverges into two different paths, one where Pip won the case and Dylan was allowed to die, and the other where Max won and Dylan got his treatment. The chapters alternate between Pip and Max to show the different outcomes, however Max’s story jumps three years ahead to a scenario where Dylan didn’t die until he was six and a half.

I’m not going to go into detail about what happened because it is best discovered for yourself, suffice to say both paths lead to heartache and neither scenario is presented as the correct one. While it would be easy to get confused by the two strands, the author skilfully weaves them together and you get accustomed to it very quickly.

As I said previously, notable cases like Charlie Gard will immediately come into your mind when you read this book, however it is like a punch to the gut when you read the Author’s Note and realise Mackintosh has gone through this whole thing herself, albeit without the intrusion of the public and media. Mackintosh is very honest when she says the doubts about whether you have made the right decision or not never leave you and she masterfully recreates that in After The End. In the aftermath, both Pip and Max question their choices endlessly and it never gets easier.

As we follow Max and Pip through their different scenarios, we are eventually led back to the judge’s verdict, however the chapter is told from Leila’s point of view and she chooses to leave the court room before the choice is made. While some readers may find this frustrating, the truth is the decision doesn’t really matter as Max and Pip’s life will never be the same again.