This is the story of some of Dr Kathryn Mannix's patients. She has written this because, as a palliative care specialist of 30 years, she has seen a lot of people dying. She is also aware of the lack of information about the process that is available to patients and their families. This attempts to redress the imbalance. As a by product of this we get to learn quite a bit about the author and her career too.

I have read a few books on the subject of dying over the past few years. They have all been of interest and informed me to some degree whether they illustrate personal stories or look at the bigger picture. The "personal stories" approach ones that I've read so far were those of one person's story. This book contains a lot of personal stories, all different in the same way that we are all different people. One commonality is the misunderstanding of the stages and process of death. The book has a very good introduction to the subject as a whole. There is also a "health warning" on medicines and this book that sets the tone very well.

Very early on in the book I realised why palliative care might suit Kathryn Mannix. Concern, empathy and interest are very evident. The writing seems to reflect what I imagine her personality to be - skilled, caring and empathetic. It is also highly readable. The names of her patients have been changed and there is nothing that will give away exactly who is being referred to.

If there are not signs of dampness around the eyes when reading this book I'd be frankly amazed. My eyes were frequently damp and some of the stories had tears rolling down my cheeks. I must emphasise that this was not in a bad way. This book may well not be for everyone however it tackles very difficult subjects with great gentleness. The people in these stories are remarkable people.

The book starts with Sabine's story and looks particularly at the process of dying and the need for honesty at such a time. I'll not go through the individual stories - Kathryn writes far better than I do. No two people reading them will react in the same way I imagine however I enjoyed (if I can say that about tales of death) them all and some were very special indeed. What I should say is that some are hard stories and "shocking to read" - you have been warned . However the writing is frequently poetic and has a gentle directness that for me made it an excellent read. The phrase a "survival guide to dying ' seems apt and is coupled with a gentle caring honesty.

I did find some stories ambush you - for me Mark's was one of those. It suddenly hit me quite hard. However this book is so well written that it can allow you tears - not of sadness but maybe of understanding and empathy as well as tears of laughter. I hadn't expected to laugh out loud reading this but I did. One passage even made me both laugh AND cry - not something I expected.

This book worked on more than one level for me. As well as the stories and the "guide to dying" it is a level a great insight into palliative care and hospices generally; on what they do or hope to do. Due to the issues involved in one story the book also looks briefly at the legalities and ethics involved in dealing with patients who are approaching the end of life. At the end of each batch of stories there is a "pause for thought" section to allow people to consider their own positions. At the end of the book there is a good resources section.

In some ways it was a privilege to be able to read this book. It managed to be both personal & general and profound & trivial however it was almost always powerful and always deeply human and humane. I really would hope that this book would be widely read and not simply by those directly interested from a medical perspective - as the author tells us we will all die one day.

This is a hugely important book that covers new ground.
For most people death is the final taboo. Mannix sketches in the historical background in which (in Western Society) death has been shunted off from the community in which it was once part of the process of living and dying. Now death usually takes place in a medical setting and often our only observation of it is seeing a passing funeral cortege. Death has become caught up in euphemism "she passed away" he "lost" his partner. etc.

There have been more books about bereavement lately (The Grief Handbook by Jeff Brazier, Grief Demystified by Caroline Lloyd , Grief Works by Julia Samuel ) as well as important books by Cathy Retzenbrink, Atul Gawande and Paul Kalanithi etc.
However this book comes from a very "practical" angle from the direct experience of a Doctor of Palliative Medicine. Part of the narrative is how Mannix develops as a professional. How through time she is able to cope with new and difficult situations .

Mannix uses case studies to illuminate general points in her Pause for Thought sections at the end of each segment of the book. There is also useful Resources section of the book.

The case studies vary from Holly who uses her last spurt of energy before she dies to dance, to the long married Nelly and Joe both trying to protect each other from the truth. There are cases from different faiths and classes of society bearing witness to the fact of death as the great leveller.

On a personal level I have not sat with someone as they died so the detailed explanation of the patterns of breathing etc was really informative.

Most of all as someone with a terminally ill close relative, I have found the explanations of the dying process to be really helpful. This book has become a sort of "handbook" for me

I work as a grief counsellor so have heard many accounts of dying but from a post death perspective. so it is invaluable as a "professional" too.

Mannix's compassion shines throughout the whole book. We would all hope that when we die that there is someone like her or the other amazing nurses and doctors she mentions around.
A hugely important book for all us mortals to read as well as those grieving, those with dying family/friends as well as professionals.


This is a book that gives hope rather than despair.

WITH THE END IN MIND is written for the public perspective and not professionals working with the grieving, in my opinion. It takes an anecdotal story approach to representing a variety of death, dying and grieving situations and conversations that many might find potentially helpful.

I tried to read it from a dual perspective, as a professional and academic in this field but also as a person inquisitive about their own death and those of my loved ones. However, I found as a professional it didn’t engage me, dare I say I find my own examples and experiences more interesting and representative. I do realise however, that I am not the reader this book is aimed at. Nevertheless, I am drawn to investigating books that might engage and aid people I work with searching for understanding and meaning around their loved ones death.

Readers will find stories about patients from different ages, stories of difficult conversations and a build in the narrative to questions a reader might have about what their own death might be like physiologically and psychologically. I felt more thought could have been given to questions such as resuscitation. The quick move from self-searching topics to stories wasn’t always a welcome shift in the narrative.

Overall, this book wasn't to my taste, but some readers will engage with the approach to this topic.

A copy of this book was provided by the publisher through netgalley in return for a honest review.

Kathyrn Mannix is not a philosopher who has focused on death and what it means and how to approach it. As a palliative carer her experience has been gained from working on the front line, whether that is in oncology or in other fields for many years. Her wisdom has been honed and perfected, assimilated from colleagues and more importantly from patients and their families. She suggests that the birth process is akin to dying with one difference. When a family anticipate a birth they gather, discuss and support the expectant mother with a team of experts. Not always so with a death which is often surrounded in tears, fear and suffering – or at least that is the common perception. Kathyrn rejects this view; her experience has given her a unique perspective and this she shares with us.

Earlier this year I witnessed my first death. My Mother-in-law aged 87 died in hospital. Yes, there were tears but I must attest that her death was as Kathryn has described in this book. As I stroked her head and spoke to her of her family who were waiting for her, telling her she was loved, she seemed to relax and just fall asleep; no struggle; no fear. Yes, we were sad but also relieved for her. Everybody always says that the staff was wonderful and I would echo that. What I witnessed were quite young women, professional, compassionate who were there to support us and give us as much time as we needed. This support was repeated as we dealt with matters with the bereavement office.

How I wished I had read this book before her death. She was brave, we found little notes advising what music she would like. Yes, we had discussed matters very loosely before but she was obviously aware of approaching death – whilst we were not. She was tired; she was struggling; she had accepted and welcomed death.

So with this in mind, I was interested to read this book; a sequence of stories to illustrate Kathyrn’s views. At times, incredibly sad but also so uplifting. In reality it could be hailed as a return to old wisdom; a time when the family would surround the dying, accepting the encroaching death ready to prepare the body and to revisit stories of their life and mourn and take strength from each other. Most of all though, I think the real message, is ‘communicate’.

I found this book to be a great comfort not just because it does not necessarily mean there will be pain and suffering but because now I am aware that there are teams of qualified, caring staff who will access my doubts and fears and let me find my way to a better understanding. Thank you Kathyrn for this book and for leaving me with the image of you, a gentle health professional sitting on the floor by your patient rather than looming over them as the expert.

Thank you to the publishers and NetGalley for providing an ARC via my Kindle in return for an honest review.

This book is amazing. The author talks so compassionately about her patients and their struggles to face their deaths, and isn't afraid at all to talk about the practical side of the end of life. You can tell she really cares for every one of her patients and has an enormous amount of skill and empathy. I could have cried so many times while reading this book, and did while in the comfort of my own home! It is very moving and yet a practical and important topic, written beautifully by a very talented woman