Loving couple Pip and Max have a decision to make. Their toddler Dylan has terminal cancer and after months in hospital, his body battered by operations and chemo, doctors want to withdraw treatment. It’s the hardest choice a parent could face – and Pip and Max don’t agree on what to do. One wants to keep fighting, seeking out new treatments abroad, the other wants to put an end to Dylan's suffering, Clare Mackintosh employs a Sliding Doors-type narrative to explore both outcomes in searing emotional depth. This an important story – and her tender, intimate description of hospital life make Pip and Max’s dilemma achingly real.

A version of this review originally appeared in the Sunday Express S magazine

I received a free ebook version of this book through Netgalley. Thankyou to both Netgalley and the publisher for allowing me to read this! My review is still honest.

After The End is a heartbreaking tale following Pip and Max, two parents who have to make a horrible decision concerning their young son who has cancer. It is an intriguing and upsetting discussion about what makes life worth living and how there is no right or wrong in horrific circumstances like these.
This book is a very intelligent one that explores a deep and meaningful relationship in all it's different forms in a sensitive and skilful way. The topics are handled with care and tact, and after reading the author's note about how she experiences something similar as a parent, it becomes all the more horrible and real. In the beginning, I was so absorbed in the emotions and setting of the PICU and this story became so vivid I actually dreamed about it. The characters are deep and flawed and I cared deeply about them despite their clear faults.
I really liked how the story diverges after the decision and shows the routes their lives would have taken either way. I thought it would become confusing by showing these two alternate realities simultaneously, but for the most part I was able to keep the two storylines separate. In both there are hardships and it really shows that in choices like the one Pip and Max are forced to make, there is really no right decision.
I don't think I can say it's a 5 star, but that's more a gut feeling than something I can articulate. If you like books that hit hard and that tackle difficult topics and pull on the heart strings, this one will not disappoint.

This book is very different to this authors previous books which I have read and loved. This is a very emotional and sensitive read. It is written beautifully and I dare anyone not to shed a few tears when reading it. I know I certainly did. A fabulous and heartbreaking story.

This is a story of a dying child and parents who disagree about his treatment. Baby Dylan has a brain tumour and despite the best efforts of his doctors, his prognosis is poor. Pip and Max are left with an impossible decision. Do they choose to let him go peacefully, withdrawing treatment and providing only palliative care, or do they try to take him to America for proton beam therapy, which could prolong his life for a few years but cannot cure him and may lead to a life of extended suffering. Pip and Max cannot agree, so they have to go to court. The second half of the book deals with the fallout of this process and its effect on their marriage.
Knowing the author's history, this must have been an incredibly difficult book to write, but it is extremely well done. At times, the book is difficult to read, and your heart breaks for Pip and Max, but the subject is sensitively treated and there is no shying away from the difficulties that the situation brings. The format of the second half of the book is very clever, and works really well.

A very difficult subject handled with compassion and care, showing all the different opinions on a terrible situation. I loved it, and found it heart-breaking, thought-provoking and uplifting.

I read this several months ago and never wrote a review. I am fascinated by the 'sliding doors' concept - the 'what ifs' of life, which path to choose ... and how great it would be if you knew all of the outcomes before making any decisions. But sadly life can't be like that. After the End does make that choice though - following the lives of Max and Pip after they have to make a tough decision regarding their young son's health. This book explores the heartbreaking decisions that so many people have to make about themselves or family members - guided by their instinct, love and grief along with often-conflicting medical science. The narrative is split between Max, Pip and the doctor involved in their son's care, filling the pages with their thoughts and emotions. When the parents can't make a decision, it's left to the courts to decide. The book made me cry, but it also gave me hope. It is very different from Clare Mackintosh's other books so far, proving her versatility as an author.

I just loved After The End. Very much a captivating story that tugged at my heart strings and had me reaching for the tissues. Definitely not one to read on public transport. I loved this book, very powerful read.

After the end by Clare Mackintosh should come with a waterproof mascara and a huge box of tissues, There aren’t many books that made me bawl my eyes out like this one did, in fact it’s rare for a book to have such an extraordinary impact on me! This book is heartbreaking, moving, tragic, a powerful story of love, grief and life-changing decisions. After The End is one of those rare books that you will haunt you long after you reached the last page. It’s one that will find you questioning what you would do if you found yourself in a similar situation.

This is a powerful and emotional story - Dylan is Max and Pips 3 year old who is brain damaged after having an operation for brain tumor. They are put in a difficult position of having to decide with what are Dylan's next steps - they can't both agree and so the courts decide for them - here is where the story really begins. That was the story of before and then is the After , this part of the book is told by Pip, Max and Leila ( the Doctor) each chapter is after the courts ruled and is a what would have happened in 2 different scenarios.
It is heartbreaking and I did shed a few tears but Clare has managed to bring to life all of the characters - I loved the second part of the book and all of the what if's ? beautifully written .

I have loved all of Clare Mackintosh's earlier books. In addition to the spellbinding mystery, her stories are extremely emotional. However none of them compare to After the End.

When Max and Pip's son, Dylan, fall's ill and the doctors put the question of survival to his parents, it is a decision that they can't seem to take together. But what if they can have both - One parent's choice of letting him try experimental treatments and extending his life span, and the other parent's wish to alleviate him from the intense pain and letting him go.

After the End takes you through their life during and after they have made their decisions. What would life for Max and Pip have been once they decided to make the most difficult decision of their lives. The story is told from Max as well as Pip's POV and also from that of Dylan's doctor, Dr. Khalili. While it took me a while to understand what the story was trying to say, once it started making sense, it became increasingly heartbreaking to experience their individual lives as well as their lives as a family. Dr. Khalili's POV adds a unique insight into the parents minds as also into her mind as a doctor who has equally difficult choices to make every day.

This was one of the most difficult reads for me and not one I can easily forget.

Books involving parents, and the (potential) loss of a child are some of the most heart-wrenching stories to be found. This is most likely to be because so many of the readers are parents themselves and therefore the connection and empathy we feel is tremendous (I feel a thesis in there somewhere!)
In Clare Mackintosh's powerful novel, 'After the End,' Max and Pip are face quite literally with a 'life-or-death' decision that they must make on behalf of their young son Dylan.
Max and Pip are one of the strongest couple's you might come across, but when Dylan is diagnosed with an inoperable and terminal brain tumour, their lives as they know them are quite literally torn apart. After Dylan experiences a catastrophic brain bleed, Max and Pip must make a terrible decision on behalf of their young son; either they allow treatment that will extend Dylan's life in his current condition for longer, or refuse the treatment which will enable the child to slip away peacefully, without intervention.
What happens when the two parents disagree as to what they must do? Inevitably their relationship will flounder and in part two of the book the reader experiences a 'sliding door' scenario, where the outcome of both decisions based on Max and Pip (with some limited input from the Doctor involved) is seen through to its logical conclusion. Interesting!
I love a good meaty topic in a book, and 'After the End' is certainly that!

Beautifully written, tackling such an emotive subject. Made hard reading as a parent at times, and can't even begin to put myself in their position. A tricky topic and a bit of an emotional minefield was handled with such care and really was a bit of a rollercoaster. A definite five star for me, and have already recommended it to a half dozen others.

‘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.

I read ‘After the End’ by Clare Mackintosh in one day on holiday, it is compulsive reading. It begins in a courtroom as everyone awaits the verdict of the judge. Leila, and at this point we do not know what role she plays in this story, watches two parents hold hands as they await the verdict on their son’s fate.
This is a book of two halves. The first is compelling, telling the story of how Max and Pip Adams find themselves in the courtroom described in the Prologue. Their two and a half year old son Dylan has a terminal brain tumour, surgery has removed only part of the tumour. Max and Pip are a strong couple, committed to each other and to Dylan. So far, they have coped. That is, until the hospital says it recommends no further treatment as Dylan has no quality of life. The reactions of Max and Pip to this advice are different and traumatic. Should Dylan be allowed to die peacefully without further painful, disruptive medical intervention? Or should he be taken to America for cutting edge medical treatment which his NHS consultants warn is not suitable for him? As the court case approaches, trust is broken, a pro-life group gets involved, secrets are told to the media, and Pip and Max are on all the front pages.
Part two centres on what happens after the court case and this, for me, is the weaker half. In a kind of ‘Sliding Doors’ approach, Mackintosh alternates chapters for two different outcomes of the court case. For me the technique was confusing, perhaps better signposting in chapter headings might have helped. I realise she is making a comment about the randomness of life but the ‘after’ story would be emotionally stronger if one option was told.
The community of Dylan’s PICU unit was so well drawn it felt real. Reading the Author’s Note afterwards, it becomes clear that Mackintosh experienced her own real life tragedy. The small details make it oh so believable. The specialist nurses, the parents of other patients, and doctor Leila Khalili are so well drawn. In a novel so emotional and at times polarised, I think it was important to include the viewpoint of Leila. Mackintosh is so good at showing the emotions of people on the edge, living in an abnormal world centred on the four walls of a hospital room, separate from the outside world operating as normal.
Understandably this book has been a word-of-mouth hit but it comes with an advance warning for anyone suffering grief at the illness or loss of a child. At times it is difficult to read, but its bare honesty is refreshing.
Read more of my book reviews at http://www.sandradanby.com/book-reviews-a-z/

A brilliantly emotional yet important book. Told from multiple points of view this is a very sad and emotional read... and I loved it through my tears whilst hugging my children.

A great read.

A hugely emotional read, and one I read in one evening. Loved the sliding doors type second half, with different situations playing out. Ive come to know the author as a thriller author and this is a big departure but it really works.

What a dilemma! I've a feeling I know what I would choose but would always wonder if it were the right one. This story really made me think and at times, had me in tears.
I have read previous books by this author and she never fails to deliver something different.

I have to add to my previous comments as I have just bought this book as a present for my daughter.

This book took me a long time to finish because every time I started reading, I would just cry. Max and Pip are everything and I felt for them so much.

It's a beautiful story and so heartbreaking. It's a real tour de force from Clare Mackintosh - a complete departure from her other books. I love her thrillers, but I hope to see more books in this genre from her in the future. I've recommended this book to everyone I know.

Having read all of Clare’s previous novels I’m always excited when she releases a new one. This book is however something a bit different to her normal thrillers.

Max & Pip are a strong, happy couple with a beautiful little boy, but then their son Dylan gets sick and they are faced with the hardest decision any parent has to make.

But they don’t agree on the decision….

The ensuing story covers 2 possible outcomes that happen “after the end”. It doesn’t hold back from showing the pain, heartbreak & struggles that each character encounters as they question whether they’ve made the right decision.

This is probably the one book that will stay with me for a long time, it’s poignant and heartbreaking and a true credit to Clare.

Heartbreaking. Highly recommend! Devastating losing a child and the trauma that it does to a relationship. Told from different perspectives and it does jump around a fair bit, but stick with it, it is worth it!