After the End

Clare Mackintosh

After the End follows two parents having to make a decision no parent should have to; whether to stop pursuing further treatment options and agree to only providing their 3-year-old son with palliative care going forward.

Pip and Max are parents to their son, Dylan, who is on life support because of a brain tumour and, despite various surgeries and rounds of chemotherapy, it is unlikely he will ever recover. They are told they must decide whether they should just pursue palliative care and not resuscitate him should his heart fail again or continue to look for other treatments. However, Pip and Max don’t agree.

The first half of the book alternates between Pip, Max and Dylan’s doctor, Dr Leila Khalili’s perspective, through the process of making the decision and ultimately going to court in the process. However, then the book follows two different directions, presenting us with what would happen in either timeline; one where Dylan is provided with only palliative care and one where he is taken to Houston, Texas for an alternative form of treatment.

I found this to be an interesting method of structuring the novel, and an unexpected one, because you never find out which timeline actually takes place, in a sense there is no true reality, there is just the two possible realities. I think this was a clever approach to the book because it manages to circumvent a more predictable narrative arc where the novel concludes with the judges’ decision.

Although I am unsure if I preferred reading about both realities, because whilst there is a lot of overlap between the events that take place, which reinforces the idea that what will be, will be, I found it in some ways uncomfortable to have a clear comparison of the two potential futures. I believe the intention is to demonstrate that there was no right or wrong decision and that either way life will present its trials and tribulations, but I personally found that it highlighted ways in which each choice was the wrong thing to do. Perhaps this was the actual intention, as it makes you confront how you would make that decision and what you would ultimately want in life, but instead I simply found it slightly frustrating to read.

That being said, I would still recommend the book as it is a truly moving account of what it is to be a parent in such a heart-breaking position, caring for a terminally ill child and subsequently coping with the loss of a child.