A book review of After the End by Clare Mackintosh
After the End by Clare Mackintosh is a heart wrenching tale of a parent’s worst nightmare; having to make the decision whether your child lives a severely disabled and shortened life or dies peacefully. A decision that Clare, herself, has had to face. That fact makes this novel not only well researched and well written, but also very brave.
There were many times during the reading of this book that, after a couple of pages, I would need to lay it to one side and have a walk around the house. Yet, at the same time there are moments of sparkling wit and genuine kindness that would defrost the iciest of cynical souls.
Dylan has a brain tumour, diagnosed at three years old. His parents, Pip and Max, blame themselves that they didn’t notice the symptoms sooner. The story begins with a very ill, very frail Dylan in PICU (paediatric intensive care unit). He’s not responding to treatment and the tumour, operated on previously, is growing back. And being close to the brain stem any further aggressive treatment would lead to severe and untreatable disabilities. The hospital advise palliative care so that Dylan can pass away peacefully. However, Max discovers a new therapy, proton beam treatment, in the US. The treatment has a reasonable chance of success, but at what cost? What is success? How is it defined if Dylan could be left unable to move, speak or learn. What is life? Is it just breathing, or does there need to be more than that to make an existence worth living? This is what Pip and Max need to decide.
And they can’t agree.
Because of this the hospital must make a formal recommendation to the courts. Pip wants to let Dylan go. No, she feels that it’s best to let Dylan go. Best for Dylan. Max wants to prolong his son’s life as long as he can. He believes that life is life, no matter what. There is no right and wrong, which is what makes this story so tragic. And if there is, it is for no one else to decide but Pip and Max.
They go to court and it tears their marriage apart.
But then, what Clare has done to turn a page turning tale into a very clever page turning tale is to tell the remainder of the story alternately between both court rulings. First that Pip is allowed to let Dylan go, and the life she attempts to rebuild afterwards. And then from the point of view of Max, and what happens after they take their son to America.
There cannot, of course, be a happy ending in the traditional sense of the word. But read on.
This is not a book that was an enjoyable read, as such. However, it is a book that makes one think about ones own life, and how thoughtfully and preciously it should be used. Being alive, living in the ‘squeeze life ’til the pips squeak’ kind of way, is not to be taken for granted for a single moment. Because none of us know how many of those moments we will have.
For me this book reminded me of that. For that reason it’s a very meaningful read.
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