In With the End in Mind, Dr Kathryn Mannix talks about death through cases she's encountered in her career in medicine, working mainly in palliative care in hospices. The main purpose of the book is to destigmatise death, to explain the processes in dying (how there is usually the same pattern that happens, regardless of the cause of death) and to encourage people to be more comfortable with death and speaking about it. It also informs us of the different ways hospice care can help people these days, that it's not all about managing someone who is about to die soon. There's pain relief, solutions to help improve quality of life and prolong living. I was surprised about CBT being used to help with the emotional and mental impacts of having a terminal illness

The cases are very sad at times, I was often crying while reading this book. But sometimes the tears were of happiness, in how some of these patients reacted to their illnesses and confronted their impending deaths. Dr Mannix treats everyone with respect and you can tell how grateful she is to have met these people and learned from them, which has helped with countless other patients down the line

There is a lot to learn in here, especially if you are scared of death or don't know much about it. I did at times find it a bit long, I think the repetitive nature of the stories didn't help this. Or it could have been the fact that I often was emotional listening to this that made it feel longer than it is. That said, I am glad I read it

This take on one of societies’ taboo subjects is intelligent, gentle and inspirational. It challenges conventional thinking about end of life care and expression of individuals’ wishes and hopes for a “good” death. So interesting!

Oh gosh, yes. This is exactly what I wanted, needed, in the wake of my mother's death and the discovery that I share the gene that caused it. A much needed discussion of end-of-life, death, grief, and life in general. Thank you. Thank you.

I loved this book. For the longest time I have been terrified of death, so much so that at one point I doubt I could have even read this book. But Kathryn manages to talk about the topic so touchingly that I was scared at all during this book. I loved reading Kathryn's first hand experience and the book was so easy to read because it was split to nicely into readable chunks.

‘With the End in Mind: Dying, Death and Wisdom in an Age of Denial’ by Dr Kathryn Mannix is a collection of anonymised patient case studies (or “stories” as Mannix calls them) drawn from her thirty years of experience as a palliative care clinician and consultant. It has been shortlisted for this year’s Wellcome Book Prize which I am shadowing with fellow book bloggers Rebecca, Laura, Annabel and Paul and is notably similar to one of the previous winners It’s All In Your Head by Suzanne O’Sullivan in that it seeks to demystify one of the most misunderstood aspects of medicine. In this case, it is death – the event that we will all one day meet (unless the transhumanists Mark O’Connell wrote about in To Be a Machine have their way…).

It is evident that a lot of thought has gone into the structure of this book to achieve the right balance between the life-affirming stories and some of the more upsetting ones. Some of the most memorable include Sally, a young woman who remains completely in denial that her cancer is terminal right up to the end, Billy, a prisoner who visits his dying mother in handcuffs, and Joe and Nelly, a couple who have been married for 50 years who both think the other doesn’t know that Nelly is dying. There are some “pause for thought” interludes inviting readers to reflect on the themes each section raises and there is also a chapter detailing how Mannix introduced the concept of death to her own children when they were young.

While more people are having open conversations about mental health and bereavement, the actual event of dying is still very much a taboo subject and few people really know what to expect. Through a variety of around 30 different cases involving people from all walks of life and age groups, Mannix explores what a “good” death is, and although the outcome of all of these stories is inevitable, most are positive in the sense that many patients are able to have their final wishes fulfilled. Mannix refers to palliative care teams as the “deathwives” or midwives of death, who guide people through the process and she discusses how treating mental health is as crucial for patients as managing their physical symptoms.

The focus on “stories” means that some of the most contentious debates surrounding religion and the funding of the NHS were mostly absent from this book. Euthanasia is addressed, although I think it probably should have been left out as it requires much more than a single chapter to unpick all of the issues surrounding that particular debate. On the other hand, I was surprised that patients with dementia were not featured in the stories here given that it affects so many people in an ageing population. I expect it would be challenging to write about patients who have little awareness of their surroundings, or perhaps it isn’t Mannix’s area of expertise, but it would have been interesting to know more about how clinicians approach these circumstances.

I read ‘With the End in Mind’ relatively quickly over about four days but some might prefer to dip in and out more slowly depending on personal circumstances. For me, this enlightening book is a strong potential winner for the Wellcome Book Prize and I hope it brings comfort and guidance for those who need it.

Kathryn Mannix's With the End in Mind: Dying, Death and Wisdom in an Age of Denial is written from her own experiences as a specialist in palliative care, and this proved, for me, both its strength and its downfall. The book is structured around a series of fictionalised case studies drawn from Mannix's own experiences, many of which are deeply affecting. I was particularly touched by the stories of Sally, a young woman dying from melanoma who refused to accept that her condition was terminal, and Holly, a mum of two teenagers dying from cancer of the cervix, who suffered from a last bout of restless energy before passing away. Mannix writes particularly well on the characteristic patterns of somebody who is entering a gradual decline. As the hospice leader she's working with on Holly's case describes it to Holly's daughters: 'Have you noticed that she stops breathing from time to time? That tells me that she is unconscious, very deeply relaxed... That is what the very end of life is like. Just very quiet and peaceful. I don't expect she will wake up again now.'

I find books of this kind difficult to review because the risk of sounding like you're passing a (totally unqualified) judgment on the writer's professional career. But ultimately I have to judge With the End in Mind as a book that Mannix has written, separating it from Mannix's personal achievements, and in this context, it fell very short. It's crucial to feel that you trust and respect the voice that is telling you such sensitive stories, but With the End in Mind left me feeling frustrated, angry and suspicious. This was for a number of interconnected reasons:

Unlike similar medical writers - Henry Marsh's Do No Harm and Atul Gawande's Being Mortal, Better and Complications come to mind - I felt that Mannix was keeping her professional distance, positioning the reader as her patient. Each section ends with a 'Pause for Thought' that I found simplistic and patronising, and unlike Marsh and Gawande, she writes virtually nothing at all about her own professional mistakes, although she says a little about other people's. In every story, she positions either herself or her palliative care colleagues as the all-knowing voice of reason, and after a while, this started to feel a bit sinister.

This was compounded by her discussion of euthanasia, a subject that is obviously very relevant in this context. While I am broadly pro-euthanasia, I wouldn't have minded if Mannix had directly challenged my views by offering up new evidence to support her obvious concerns about euthanasia options such as those offered in the Netherlands. Instead, I found her approach incredibly disingenuous. I almost stopped reading With the End in Mind after 'Please Release Me: B Side' where Mannix tells a story about one man's unpleasant experience in the Netherlands that is entirely based on hearsay, and I realised that a number of stories she had been telling in that section had been deliberately engineered to emphasise the benefits of palliative care as opposed to euthanasia. Again, I would have found this less troubling if Mannix had been upfront about it: instead, she claims that 'many of us in palliative care roles are exasperated by the trenchant, black-and-white opinions of the campaigners for either view [on euthanasia]' but makes her own views pretty clear when she says at the end of the chapter on the Netherlands that 'Once the euthanasia genie is out of the bottle, you must be careful what you wish for', echoing familiar 'slippery slope' arguments. All of this made me very uneasy and uncomfortable.

Finally, Mannix uses the metaphor of 'natural birth' throughout the book to promote her vision of a 'natural death'. She writes that 'both processes can proceed safely without intervention, as any wise midwife knows.' This infuriated me because of the damage, pain and suffering the language of 'natural birth' and the doctrine of little medical intervention has caused to women and their babies. Indeed, the Royal College of Midwives recently dropped campaigns for what they called 'normal birth' in recognition of this fact, although women are still denied the right to choose interventions like caesarians (in contravention of NICE guidelines on childbirth) as a consequence of this ideology. As the language of 'natural birth' is unfortunately quite common, I wouldn't see this as a significant problem for Mannix if she didn't repeatedly return to this metaphor across the course of her book. This, along with the problems I've noted above, left me doubting everything she said about birth and about death.

This is an excellent all-round guide to preparation for death. It’s based around relatable stories of the patients Mannix met in her decades working in the fields of cancer treatment and hospice care. She has a particular interest in combining CBT with palliative care to help the dying approach their remaining time with realism rather than pessimism. In many cases this involves talking patients and their loved ones through the steps of dying and explaining the patterns – decreased energy, increased time spent asleep, a change in breathing just before the end – as well as being clear about how suffering can be eased.

I read the first 20% on my Kindle and then skimmed the rest in a library copy. This was not because I wasn’t enjoying it, but because it was a two-week loan and I was conscious of needing to move on to other longlist books. It may also be because I have read quite a number of books with similar themes and scope – including Caitlin Doughty’s two books on death, Caring for the Dying by Henry Fersko-Weiss, Being Mortal by Atul Gawande, and Waiting for the Last Bus by Richard Holloway. Really this is the kind of book I would like to own a copy of and read steadily, just a chapter a week. Mannix’s introductions to each section and chapter, and the Pause for Thought pages at the end of each chapter, mean the book lends itself to being read as a handbook, perhaps in tandem with an ill relative.

The book is unique in giving a doctor’s perspective but telling the stories of patients and their families, so we see a whole range of emotions and attitudes: denial, anger, regret, fear and so on. Tears were never far from my eyes as I read about a head teacher with motor neurone disease; a pair of women with metastatic breast cancer who broke their hips and ended up as hospice roommates; a beautiful young woman who didn’t want to stop wearing her skinny jeans even though they were exacerbating her nerve pain, as then she’d feel like she’d given up; and a husband and wife who each thought the other didn’t know she was dying of cancer.

Mannix believes there’s something special about people who are approaching the end of their life. There’s wisdom, dignity, even holiness surrounding them. It’s clear she feels she’s been honored to work with the dying, and she’s helped to propagate a healthy approach to death. As her children told her when they visited her dying godmother, “you and Dad [a pathologist] have spent a lifetime preparing us for this. No one else at school ever talked about death. It was just a Thing in our house. And now look – it’s OK. We know what to expect. We don’t feel frightened. We can do it. This is what you wanted for us, not to be afraid.”

I would be happy to see this advance to the Wellcome Book Prize shortlist.

Favorite lines:

“‘So, how long has she got?’ I hate this question. It’s almost impossible to answer, yet people ask as though it’s a calculation of change from a pound. It’s not a number – it’s a direction of travel, a movement over time, a tiptoe journey towards a tipping point. I give my most honest, most direct answer: I don’t know exactly. But I can tell you how I estimate, and then we can guesstimate together.”

“we are privileged to accompany people through moments of enormous meaning and power; moments to be remembered and retold as family legends and, if we get the care right, to reassure and encourage future generations as they face these great events themselves.”

Magnificent, insightful, compassionate, enlightening book on accompanying the dying

At the risk of plagiarism in this review, I use many of the words from Kathryn’s book itself to describe her book. I believe it is a book that must be read before a diagnosis of a life-threatening illness and I highly recommend it to all.

Kathryn is a palliative care medical doctor who brings the richness of her experience and wisdom from dealing with the dying to the pages of her book. Kathryn enables patients and families to be ‘the architects of their own solution’ when faced with the knowledge of imminent death. She says this is the key to respecting their dignity. Kathryn illustrates this with many stories of the patients and families she has worked with throughout her career in medicine. Her stories include the many colleagues who make up a powerful team for the benefit of patients and families.

Kathryn describes her use of Cognitive Behaviour Therapy (CBT) to assist her patients and families develop emotionally, mentally and spiritually better ways to deal with impending death. She highlights the benefits of psychological intervention even at the end of life.

Kathryn says: “Working in the face of death will always feel profound, numinous and sometimes overwhelming”. Kathryn comes across as an intelligent, wise person with a massive amount of patience and compassion.

Thank you for this book, Kathryn. I did not want to read it at first but I found the reading easy and heart-warming.

BonnieK

Breakaway Reviewers received a copy of the book to review.

A moving and necessary account of how death and dying is experienced and perceived in the modern age. Describing situations with real-life patients with a range of conditions and outlooks, Mannix tactfully guides the reader through a comprehensive discussion about death and dying: both physical and existential. Not only does this book intrigue through her shared experiences, but it provides practical advice designed to facilitate discussion between families and assist readers in similar situations. Divided into small sections I found this book really accessible and comprehensive. It will stay with me for a long time.

REVIEW AVAILABLE AT abookorten.wordpress.com FROM 17TH FEBRUARY 2018

My rekindled interest at the end of last year in death and subjects surrounding it continues with this fascinating book, which I received as a free proof in exchange for an honest review. This is a professional memoir by palliative care specialist Dr Kathryn Mannix. Within six sections, the author approaches aspects of dying as it effects patients, their families and those caring for them; each chapter tells its own story, all of which add up to carefully encourage the reader to think more closely about dying. 

This is certainly not an easy book to read - it is heart-rending and intense for many reasons. The stories recounted are gently put, but the details are often tragic - the subject of most stories are at the end of their life. Palliative care offers an alternative look at medicine, which occasionally runs against what loved ones of the dying want it to look like - rather than racing to save life at any cost, the focus is on helping the patient to face their death at the best time and in the most comfort they can be. With an ageing population kept alive longer and longer by medical advances, it was comforting to know that this still exists in medical fields: those who are not singularly focused on life, but on good life. And when that ends, on a good death as well. 

My favourite chapter comes within the section on 'Naming Death', and focuses on the growing up of Mannix's own two childen, and having conversations about death as they grew older; at what ages they began to understand different things, and how that affected them; what things she and her husband were able to do to make it easier for them. As a palliative care doctor and a pathologist, they are well prepared parents for this, but the supportive and honest approach they take would be good reading for any parent wondering how to broach the subject with their own kids. 

The other thing which makes this book a joy to read is the amount of love crammed into these pages - between spouses, between grandparents, parents and children, between friends who have known each other years and those who meet in hospital; love within communities and the deep mutual admiration that colleagues have for each other. Mannix is far from keeping the spotlight for herself: there are many amazing other health care professionals whose skill and compassion are shown. In many ways this book is a testament to the wonderful people working in the NHS. 

Practical considerations are also given here. Many of us haven't really thought about what we would want when we die - what sort of medical intervention we'd be okay with, what we wouldn't want, when we would rather be let go. Through the stories and 'Pauses for thought', Mannix offers a toolkit to start those thought processes and considering some difficult questions, with the reassurance of how much easier it makes things at the crucial moment. 

For anyone interested in the subject matter, this book is a very elegant tour through the ways we die today, and how, culturally, socially and personally, we can improve them, if we are willing to look death straight on and acknowledge its presence.

With the End in Mind:
Dying, Death and Wisdom in an Age of Denial
By Katherine Mannix
Published by William Collins, December 2017

Katherine Mannix is superbly qualified to write this book, having spent a huge part of her long and distinguished medical career in palliative care, working with people who are dying.

From her first encounters with death as a medical student, then as a junior doctor, she has experienced dealing with patients, their often troubling physical problems as their health deteriorates, their families and all that the dying process entails. Familiarity does not breed contempt, however; rather it breeds sensitivity, compassion, respect, kindness and a respect for those about to undertake the final journey towards death.

Just as no two births or lives are the same, neither are any two deaths identical. They all may share similarities, but dealing with the dying and their loved ones can still produce surprises. Some people are in absolute denial that they are actively dying right up to the point where they lapse into unconsciousness; others request to be kept fully apprised of any changes in their medical conditions in order to plan ahead and prepare themselves and their loved ones.

There is no "right" way of dying and Dr Mannix discusses in some detail how different diseases influence the dying process and stresses that symptoms can almost always be successfully controlled to allow the patient to live as positively as possible until death supervenes.

I cannot find enough words to praise this magnificent book, but simply wish to echo her advice to discuss all these things with your own loved ones, make them aware of your thoughts and wishes and document your wishes. It will make life so much easier for you and for your loved ones when the time comes.

"In sharing the stories of so many ordinary people as they reached
their final days, I hope that I have shown that, in the end, none
of us is ordinary, that each unique individual is extraordinary in
their own way. As we approach the ends of our lives, we experience
a shift in perspective that allows us to focus on the most important
things in our own domain. This shift is both poignant and
freeing, as these stories illustrate. Living is precious, and is perhaps
best appreciated when we live with the end in mind.
It’s time to talk about dying.
I have. Thank you for listening. Now it’s your turn to talk."

What a wonderful book. Full of life in the superb landscape surrounding death. This is well overdue in a society that lives it's vicarious life through social media and non human face-to-face contact. We are taken, like a four year old, with trepidation through the doors of the death room where all is calm. Almost everyone is scared of death in one way or another. This book lifts the lid on those mostly private and un-talked about moments in the normally extreme privacy of a persons death. It is so reassuring as to seem to verge on fiction. The CBT aspects were also deeply fascinating. Everyone we meet, all condemned, as are we all, to death, is magically painted in the most vivacious colours. We all know we will be one of those but so many people fear the process so much they never get to the bedrock of what actually happens. This book should be free with every first pension payout. Great stuff.

Thank you to Netgalley and the publishers for providing me with a copy of this book in return for an honest review.

I wasn't sure what I was expecting on requesting this book from Netgalley. I am one of those people who has a pretty morbid fascination with death and dying. While my life has until now been untouched by the deaths of close relatives, I- like many others- have pondered and feared how my death and death of my loved ones may come about.

Kathryn Mannix's fabulous book clears up so many misconceptions of death and dying. I was enthralled with her recollections of patients she had encountered through her career as a palliative doctor and her insights, as well as her own personal thoughts and beliefs. I'm not a reader who is easily moved by the written word but Kathryn Mannix managed to 'get' me more than a few times. This unique book was beautiful and poignant, sometimes funny, very bittersweet. It was an emotional rollercoaster which I didn't want to end.

This may be the most important book I have ever read. I never realised just how much I needed to read a book about the process of death but having experienced a significant amount of loss which caused emotional trauma I feel as though this book will be able to help me understand what I witnessed. I thought what I saw and heard was barbaric and horrific but I am comforted to find out the process was actually a pretty normal and typical death. This is because we, as a society still don't talk about death. I would like to thank the author for taking the time to write up true stories about a variety of experiences of death with candour and even some humour. I want everyone I know to read this book so they can understand just how well you can live life if you understand how the end will be.

An emotive subject for all, but dealt with in such a way that makes for an unexpectedly life-affirming experience as a reader. Beautifully written, with touches of genuine humour in amongst sadness and pragmatism. I've already recommended this to my friends and family.

"I realise that it is a rare privilege to be present and to serve those who are approaching their unmaking. I was discovering that I was not afraid of death; rather, I was in awe of it, and of its impact on our lives."

Perfect for fans of When Breath Becomes Air, With the End in Mind is a collection of case studies about dying from Dr. Kathryn Mannix, a specialist in palliative care. Far from being melancholy (though I'll admit I shed a tear or two), this collection is a hopeful and comforting insight into what it means to reach the end of one's life and how we should reclaim the lost art of dying.

For someone who has not had much experience with the death of close friends or family, it was interesting to consider my own feelings on this subject. Fear? Denial? Both are there. I tried to recall conversations with anyone about my own death or the death of loved ones and could only remember odd snippets asking my parents and fiancé if they wanted to be cremated or buried; something I felt I had a responsibility to know. Nothing about the actual act of dying.

It is precisely this lack of conversation that Mannix is trying to change with this book. Despite all of the benefits the advances in medicine have brought us, we have only postponed the inevitable, and in doing so, lost the natural expectation and understanding of death.

I found Mannix's prose to be lyrical and soothing. Just like any good doctor, she meets your concerns from the off, with an early section about what to expect and how to read this book. Is it sad? Yes. Irene's husband was the first to make me cry and we meet him in the first chapter. Was it so sad that I couldn't continue? Not in the slightest. I felt like I was taking a natural journey, being introduced to a daunting subject by a wise and open teacher. Mannix incorporates stories of her own experience of the deaths of friends and family members, as well as how she and her husband tackled the issue of how and when to explain death to their children. At the end of each section is a "Pause for Thought" with open questions and conversation starters, designed to get us talking. This is not about Mannix and her career in palliative medicine, this is a deliberate challenge to do better in how we approach the end of our lives. A friend joked with me that this was not the most festive read I could have chosen for the Christmas period. Finishing it a couple of days before the end of December, I had a new sense that death could be more like the end of the year, taking stock of everything we've done and looking on to the next journey. Whether we believe in an afterlife or not, perhaps if we approached dying like we do New Year (the celebratory vibe more than the actual boozing), we might be less afraid of it.

"Enabling people to be architects of their own solution is key to respecting their own dignity. They are only in a new phase of life; they have not abdicated personhood."

Another challenge that the author lays down is in how we treat the elderly and terminally ill. The quiet respect Mannix and her colleagues give to their patients without question is a subtle defiance against a culture that writes people off once they cease to become 'useful'. In ignoring death, we also ignore those who are entering that last phase of their lives. One cannot help but wonder if a more open conversation about death would result in more consideration for the dying, and better investment in social care facilities that treat the elderly and unwell with the dignity and respect they are owed.

The fact that all of us will encounter death at some point in our lifetime is the reason why everyone should read this book. Just as everyone will have their own, unique experience, I think everyone will find something in this book that will speak to them. For me, recently engaged and planning a wedding, the cases where Mannix was treating patients who were afraid to leave their husbands or wives were particularly emotional for me, tapping into fears of committing my life to one person and losing them too soon. For another reader it could be the cases where patients were afraid to die in pain; for another, the patients afraid to live in an intolerable state, thanks to a degenerative illness. There is truly something for everyone here.

"It's your life that you are working on finishing well. It's a mighty piece of work. Give it the attention and the time you deserve."
5/5 stars for a profound and hopeful book about the remembering the lost art of dying, and in doing so, remembering how to live.

This book was so insightful and given me a different way of looking at the process of dying. Have recommended it to all the peers on my Counselling course as think the material is invaluable. Given me a lot of food for thought

This was a remarkable book, and one that I needed to read. Although it is primarily about death, it is also very much about life – about living your life to the full, by not fearing death when it ultimately comes: “Immortality seems in many ways an uninviting option. It is the fact that every day counts us down that makes each one such a gift”.
The author, as a palliative care doctor, is very well acquainted with death and dying, in in the book she portrays many different ways in which the processes can take place. She deals with the actual physical changes that take place (decreased energy levels, increased time spent sleeping, altered breathing, unconsciousness, death), and the mental changes that can take place in both the dying person, and in their friends and relatives (denial, fear, confusion, acceptance, planning for the future, legacy, tying up loose ends). The overwhelming picture of the end is one of peace.
In former times, death and dying were part of everybody’s lives, and took place in the home, among the family and friends – old and young. Nowadays, death occurs mainly in hospitals, with doctors and nurses, and maybe a few selected relatives and friends. There is more mystery attached, and a death is often seen as a failure, something that could (should) have been prevented.
The author believes that with these changes, we have lost our understanding of the process of death, and have replaced our acceptance of its inevitability with fear: “Euphemisms like ‘passed’ or ‘lost’ have replaced ‘died’ and ‘dead’. Illness has become a ‘battle’, and sick people, treatments and outcomes are described in metaphors of warfare. … at the end of their life they will be described as having ‘lost their battle’, rather than simply having died”.
The work of the palliative team is to minimise the pain and anguish at the end, focussed: “not on saving life at any cost, but on enabling goodbye”.
I am not afraid of death, but – like many people – have been afraid of a long drawn-out and/or painful dying. This book has allayed a number of my worries. “It’s a truth rarely acknowledged that as we live longer thanks to modern medicine, it is our years of old age that are extended, not our years of youth and vigour”. As I become increasingly disabled, death as an end-point becomes more attractive. I would like to have the option of deciding when to die – but as the book points out – it is never that simple. At what point do you say enough is enough? Things that seemed unacceptable last year, I can now work my way around. What defines a life worth living varies from person to person – and from day to day. In this country, euthanasia is illegal. The book deals with one person from the Netherlands, where the repeated offer of euthanasia became more unbearable than the appalling state of his health: “Ujjal ran away from that certain, controlled dying to live with the hope of uncertainty”.
Death happens to us all. It requires some planning so that when it comes, it goes as smoothly as possible for all concerned. That is not to say, that we should perpetually dwell on our mortality, but that we give our end some thought, and ensure that those nearest and dearest to us are aware of our wishes. For the bereaved “It’s not about ‘getting better’ – bereavement is not an illness, and life for the bereaved will never be the same again. But given time and support, the process itself will enable the bereaved to reach a new balance”.
“Living is precious, and is perhaps best appreciated when we live with the end in mind”.
I highly recommend this book – to everyone.

With the End in Mind

Reading about death and dying isn't the type of book I normally read, but it's a situation we all face and I've read a couple of well written newspaper articles by Dr Kathryn Mannix.

What a journey this book proved to be. Sometimes sad, often amusing, every page is filled with honesty, compassion and the most incredible insight into end of life situations. Some endings are difficult, but I was surprised by the relative ease with which many face their final hours, days or weeks. The reason is the extent to which they and those close understand what's likely to happen. Dr Mannix is a rare and gifted individual whose empathy is exceptional. She's able to communicate with people in such a way that they can articulate their fears or concerns and she then enables them to deal with them in the most positive way possible. This is an extraordinary talent and the book should be required reading for most medical professionals. It's not bleak; every story covers a different situation and at the end of each section Dr Mannix guides the reader through various reflections or questions.

It would be a great first step in moving back to managing end of life care more positively, in the same way that birth is managed. There are known and clear stages which all can prepare for, armed with relevant knowledge. This book won't be for everyone; it's a difficult and occasionally challenging read. But I'm so pleased I tackled it and I've learned so much. It's ultimately both rewarding and uplifting and my thanks to the publisher for the privilege of an early review copy via Netgalley.

Although this book is written by a palliative care consultant it is very easy to read for a lay-person. The stories are thought-provoking and the sections between ask interesting questions for the reader to consider. There is a strong bias towards cancer cases since that is one of the specialisms of Dr Mannix and I would have appreciated a bit more variety. This book should be recommended for anyone who has a terminal illness, and for relatives and close friends. There is much here that is life affirming and a key message is "choices". In view of the recent case of a woman who's living will was ignored we should all make sure that we understand what those close to us wish for in their final years / months / days. I for one would not wish to be kept alive with no quality of life.
Some people might find this a difficult book to read but they should persevere as we need to be more open about the whole subject. Recommended.