This is such a departure for Clare Mackintosh, I wasn't sure she'd be able to do it but what a moving, joy of a book.

Who are the humans behind the medical ethics case studies? Max and Pip are in love and dealing, in their own ways, with their beloved son Dylan’s major illness. When their trusted consultant tells them that Dylan, only two, won’t pull through, a schism appears. And the only way forward is with barristers, a court case, and a social media campaign.

This is a moving study of the dynamics of grief. The judgement from the courtroom is a turning point in the novel, which leads us to the ‘what ifs’. Is it even possible to move on, whatever that means, when the worst thing a parent can imagine, happens. Can you keep it together - and stay together - when lashing out and resenting is what you’re feeling?

This is a novel not for the faint hearted, but one which which leaves you a little wiser and a lot more forgiving of human frailty and understanding of how we behave when tragedy strikes. .

Wow. I had just mentioned to a fellow book addict that I wasn't finding 2019 an outstanding year for new releases, thus far, and while I had read some great books I wasn't already questioning how I'd whittle down a top ten...then I read After the End.

This isn't the first Clare Mackintosh book I've read, and I've raved about her writing since I discovered her with an advance copy of I Let You Go, but After the End takes her storytelling and emotional resonance to another level.

Pip and Max are the strongest, most perfect couple you know, but now they have reached the most important decision of their life, and they disagree. What do you do when your beloved child is terminally ill?

This is a heart-rending and heart-breaking book, and as is possibly now to be expected with Mackintosh it doesn't necessarily take you where you think the story will. Imaginative, thoughtful, deeply felt and gripping, this is a definite contender for book of 2019.

This book totally gripped me right from the start.
I loved it. It was so moving, had me crying in parts, loved the characters,
It was really powerful and in a way has helped me accept a little more and move on a little from my own loss of my dad.

This was a truly heartbreaking read, and although Max, Pip and Dylan are fictional characters the impossible situation they are going through is very true for some parents. As a mum to a toddler myself, I found this a very difficult read, but I thought that Clare Mackintosh handled this incredibly delicate storyline beautifully, it was a well written and powerful read.

5 well earned stars

Such a well-constructed, emotional and gripping read by Clare Mackinosh. I would imagine it must have been such a emotional book for her to write, given her own personal circumstances. The book is so well written and will of course remind readers of cases which have hit the news such as Charlie Gard and Alfie Evans, and Clare has done justice to such cases in showing parents love and that it is never an easy decision in such tragic cases.
Max and Pip are wonderful parents, who both want the best for the very best for their son, Dylan. But when the consultant, Leila Khalil tells them the hospital believe nothing more can be done to prolong his life, what can Dylan’s parents do? What if Dylan’s parents do not agree about the best way forward for Dyan? Who will decide what happens next?
The second section of the book is split into two sections, what would happen if one course of action were taken and what would happen if another were taken. It flows between the two. It works extremely well.
Although the book is obviously sad at times due to the subject matter, it is a truly wonderful book.
Thanks to NetGalley for a Kindle copy of this book in exchange for an honest review.

This book was a stunner, and one of my favourite books in recent years. It touched me in ways that I really did not expect.

The first half of the book is dedicated to ‘Before’, which centres on Max, Pip and their young son Dylan. When they are told that the cancer Dylan has is inoperable, and has left him brain damaged, and with no prospect of walking, talking or communicating his needs to them, they are faced with a choice that no parent should have to make, whether to remove his life support and allow him to die. Unfortunately, Max and Pip find themselves at an impasse, with neither able to agree with the other.

In a situation where parents are unable to agree, the courts must step in, and the second part of the book, ‘After’ takes an almost ‘Sliding Doors-esque’ look at the two options of what would have happened if the judge ruled in favour of removing life support, and what would have happened if the judge ruled in favour of maintaining life support while other medical options are attempted.

I found the characters of Max and Pip, and their love, really believable. They clearly love one another throughout the book, but is their love really strong enough to survive when they cannot agree on the care of their son? It is the kind of pressure that would put a strain on the strongest of marriages, and theirs is no exception. I found that my favourite character was Leila, the Iranian doctor who was responsible for the care of Dylan. I loved her own side story, as she wrestled with her own decisions regarding Dylan, and how the pressure of that decision affected her. I also loved Alistair and Tom, parents of another child in the NICU, side characters whose personalities shone from the pages of the book.

On a personal level, this book really touched me. Nearly 24 years ago I gave birth to a baby boy who was 9lbs 9oz and full term, but his lungs had stopped developing at 29 weeks. Over the following four weeks we had many moments in the Neonatal Intensive Care Unit (NICU) that were touch and go. The chances of survival for my bouncing baby boy were much the same as for a premature baby born at 29 weeks. He was in an incubator built for tiny babies, not 24 inch long whoppers, on a ventilator (which on one terrible night broke, and the doctor stood for four hours pumping air into our baby by hand while a ventilator was brought from another hospital). Another night we had our son baptised in the hospital, with a Catholic nurse as a witness, followed immediately by last rites, because he was not expected to survive the night. We were told he had had a brain bleed and they did not know how much damage it had caused. We faced a similar dilemma, and with my husband we found ourselves discussing whether we could let our son go, or whether we would fight for him even if his quality of life was compromised. Unlike Max and Pip, we both agreed with one another, but in the end he was a fighter who stuck in there until his lungs developed sufficiently, and is now a strapping 6 foot university graduate, who had asthma through his childhood, but achieved far more than anyone ever thought he would. Our hospital consultant, ten months after his birth, referred to him as his miracle baby, the one he truly thought he would lose. I will forever be thankful that I did not ultimately have to make the decision Max and Pip were faced with.

The reality of the hospital scenes in the book gave me flashbacks to my own experiences, so it was no surprise to read that the author had written from personal experience.

The ‘After’ section of the book, was slightly weaker than the ‘Before’ section because it constantly jumped not only between the two potential outcomes, but also backwards and forwards in time, so I found myself having to concentrate on which storyline I was reading, but all in all I did not think it detracted from what really is a thought-provoking and emotional book. I also think it would make an incredible movie or series.

I was given a copy to read and review via Netgalley, but I will be buying a copy of my own. This book is about hope, rather than loss, and although I shed tears throughout, they were tears of happiness in the end.

This read was a little close to home for me, so the tears were quietly rolling down my cheeks almost from the start. There’s a great suspenseful beginning in a court room that left me intrigued, but without a clue as to what was actually going on. I jumped to a completely wrong conclusion and the truth turned out to be far worse than I could ever have imagined. (I try never to read the blurb of a book just before I read it, so I’m usually totally surprised by the subject matter.)
Clare Mackintosh writes such real characters and approaches the heartbreaking subject matter of this book with empathy, compassion and wisdom. I wondered if she’d lived through something similar herself and it became clear in the author’s note why she was able to write this with such utter authenticity.
To start with, most of the action takes place in the paediatric intensive care unit of St Elizabeth’s Children’s Hospital in Birmingham. The story is desperately sad, but as it progresses, we do get some respite. The glimpses into the personal life of Dylan’s doctor, Leila, for example, are wonderful. Her mum is visiting from Iran, preparing the most delicious sounding meals for Leila and spending her days totally addicted to the shopping channel, which means Leila never knows what she’ll trip over next…
The story is packed with wisdom and we’re reminded how important it is to live in the moment, to enjoy every second with our children right now.
At a certain point in the book I became confused, as my logical brain dictates that we cannot have things both ways. I initially disliked the parallel universe ending, feeling a bit cheated, but then began to quite enjoy the possibilities. The second part didn’t totally work for me as the two stories became blurred a bit in my mind. This didn’t really matter though and in a way I think that may have been the point…
As I’ve mentioned, the start of the story is desperately sad and parents Max and Pip are faced with a decision no parents should ever have to face. But as the author writes: “this is not a story about loss, but about hope. Hope for the future, for a life beyond an unavoidable tragedy. We cannot predict the future when we make difficult choices in life , but we can shape the years that follow. We can choose to live again.”
Despite some misgivings, I do recommend this book as it’s beautifully written and packed with wonderful characters who come alive on the pages, gentle humour and real emotion. It’s also different and brave.

With thanks to Netgalley and Sphere for this ARC in exchange for an open and honest review.

Clare Mackintosh is one of my favourite authors and I am always excited When she releases another book. Although I am a fan of psychological thrillers I also enjoyed A Cotswold Family which was a selection of Clare`s column pieces.

I feel a bit conflicted with this review. In Clare`s author's notes she explained that the story was based around her son who was critically ill. Clare and her husband had to make the same decision as Max and Pip in the story.

After The End was beautifully written and my heart ached for Max and Pip. I enjoyed reading about Leila Khalil who was Dylan`s consultant, and her mother Habibeh who had arrived to the UK from Tehren. It was also nice to read about the other patients in PICU and their different stages of recovery. My favourites were Tom, Alistair and their daughter Darcy.

I had a lump in my throat when Leila explained the hospital would only offer Dylan pain relief and palliative care. What a terrible situation and I could understand why Pip wanted to let Dylan slip away painlessly. I could also understand why Max wanted to take Dylan to America for treatment.

The book was split into before the courtcase and after. In the after section the story split into two different endings, if Pip won the case and Dylan passed away shortly after. Of if Max won and he took Dylan to America for protom beam therapy. I personally didn't enjoy this which I have awarded three stars. I thought it made the story more complicated with the new characters in each scenario. I think more could of been written about the court case and the relationship between Max and Pip beforehand.

Overall I enjoyed this book and it certainly made me think. Congratulations to Clare for her effortless transfer to a different genre.

This was a hard read, as I suppose was to be expected of a book with a child's terminal illness at it's centre. The book follows parents Pip and Max, and is split into two(ish) bits: before and after their son Dylan's death.
I enjoyed the second half considerably more than the first half, though I missed (if that's the right word!) Dr. Khalili once I passed the halfway point. The first half felt, at times, drawn-out and overwhelmingly sad, probably because I knew where things were headed for Dylan. The second half felt far more hopeful, and did a better job of showing off the way that Mackintosh mixes observational humour with heartbreak. Setting the two stories alongside each other worked really well - I think most people obsess over 'what-ifs' after the smallest decisions. And the ending... well, I thought the ending was perfect.

This is an emotional read that pulls on the heartstrings.
It’s any parents worst nightmare to have a child become so ill that they may not survive.
Clare Mackintosh tells the story in such a sensitive way it’s clear she’s got experience of such a tragedy. The couple in the book are facing a dilemma about the life of their child and when they disagree on what’s best for their him, we see their lives crumble around them.
An emotional read that had me engrossed from start to finish.
Thanks to Little Brown Book Group and NetGalley for the opportunity to read this book.

This is a very well written emotional story. It was a hard and heartbreaking read in places. There is so much pain and love and heartache in this story. It is beautifully and sympathetically written.

Thank you to Netgalley for my copy.

This story is a heartbreaking, thought-provoking tale that is very well written. I wasn't sure whether I would be able to finish, just because the subject is so gut-wrenching. But it is very sensitively done.

"After the End" was a powerful and emotional page-turner of a novel, beautifully executed by Claire Mackintosh.

There are some authors whose books you just want to read because you already know from experience that you will be reading a winner. For me, Clare Mackintosh is one of those authors. I found 'I See You' to be a really gripping thriller that I found hard to put down. This book was very different, Rather than being a psychological thriller like the author's other novels, "After the End" was more of an emotional family drama.

When I first started reading I was a little unsure whether I would find the subject too uncomfortable and I certainly spent some time pondering what I would do in the same situation. This was a very cleverly written novel and an utterly heartbreaking story but also really compelling and ultimately hopeful. It was a powerful portrayal of a couple pushed to breaking point and a gripping and convincing story of loss and love.

"After The End" was a truly beautiful story and it is a book that will stay with me. An absolute must-read that I highly recommend.

I received a complimentary digital copy of this novel, at my own request, from Little, Brown Book Group UK via NetGalley. This review is my own unbiased opinion.

Max and Pip are the strongest couple you know. Only now they're facing the most important decision of their lives - and they don't agree.

As the consequences of an impossible choice threaten to devastate them both, nothing will ever be the same again.

But anything can happen after the end . . .

No spoilers, but what a heart breaking book this is … so sad. I can not imagine being in that situation, and don’t want to be. Also love and laughter. I did not want this book to end. Loved it! 5*

This was a beautiful, but very sad book. The two main characters, husband and wife Pip and Max, find themselves in an impossible situation that will either make or break them. Their terminally ill son, Dylan is nearing the end of his short life. One parent wants him to live, the other wants him to die. The story that unfolds is touching and very moving, made more so by knowing that the author based her book on her own experience. The only reason I have not given this book 5 stars is because I found it a little difficult to keep up with what was really happening in the second half of the book. But nevertheless, I'd highly recommend it.

What happens if you have a very sick child and you and your partner can’t agree on whether to let them die or try potentially life-prolonging treatment?
Borne of Mackintosh’s own experience, this visits this incredibly difficult subject, and what happens after the decision is made.
There is a ‘sliding doors’ effect, in that we see what would have happened, whichever way the decision went. I found it slightly tricky keeping a hold on which story I was following and - hand on heart - I’m not entirely convinced I’d get 100% in an exam on this - but it didn’t affect my enjoyment!
This makes for a heartbreaking and very touching novel that approaches a decision that can never be right or wrong, from the point of view of all involved including the doctor, Leila.
I don’t have children but still found it very poignant and personally affecting.
A novel like this could never be an easy read but it’s a compelling and well-executed one. Recommended.

Max and Pip have a toddler called Dylan. Sadly he has been diagnosed with a brain tumour of which surgeons couldn't remove all off. Then they are given the devastating news that the Timor is growing again. There is nothing more the surgeons can do but give him palitive care and make sure that he is pain free. Max, not wanting to give up on his son, researches the disease, hoping to find a cure for his son. He finds that it can be treated in America. But first he has to take the hospital to court so that they will keep Dykan alive until they get to America.

This book reminded me so much about Charlie Gard, a young boy from England whose parents fought to keep their young son alive so that he could be treated in America. My heart was on my sleeve reading the first half of this book. I couldn't get through it quick enough. The second half has a duel storyline. The first being Pip's senario, she just wanted the palitive care for her son, she did not want to see him suffer any longer than necessary. Max's story is where his where the court grants him his wish to take Dylan to America to receive more treatment. The senario sare told in alternative chapters and at times, this was quite confusing. Though they are both written about beautifully. If the author had stuck to one conclusion, this would have been a 5⭐️ read.

I would like to thank NetGalley, Little Brown Book Group UK and the author Clare Mackintosh for my ARC in exchange for an honest review.

Totally engrossing, brilliantly constructed and beautifully written, this book cannot fail to move and haunt the reader. It is any parent's worst nightmare to have a child become so gravely ill that they need intensive care and may not survive despite all that modern medical science can achieve. And, if death is thwarted, what of the quality of life remaining? Clare Mackintosh puts us into the shoes of one couple facing that nightmare, and through them we experience some of the possible consequences of the situations and decisions that need to be made. When you want the best for your child, just what is that best? And with a child who needs everything you've got, what is left for each other? It is a brave and carefully researched story, which is both entertaining and thought-provoking. I cannot recommend it enough.

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.