I knew this book was different to the author’s usual genre, and after reading the author’s note (I always read these before the book) I also realised it would be a heart-wrenching story. What I wasn’t prepared for was putting everything on hold as I found myself gripped for hours on end as the characters worked their way into my heart.

Split into two parts, part one has a triple narrative that draws the reader into the shoes of Pip, Max, and Leila. Pip and Max are a happily married couple whose lives are turned upside down when their two-year-old son, Dylan, is diagnosed with a brain tumour; Leila is Dylan’s paediatric neurologist. As the main bread earner, Max juggles his demanding career (and unforgiving wanker of a boss), whilst Pip gives up her job to spend every waking moment at Dylan’s bedside. Geographically the couple are miles apart for the best part of the week, but the bond between them is stronger than ever as they hold each other together, willing their boy to get well. As well as Pip and Max both having their own voice through first-person narratives, we also see how they are perceived from the outside world through the limited third-person perspective of Leila. Leila is a well-drawn out character where we also see how the everyday strain of working as a doctor for the NHS impacts on her life and relationships as a young woman.

But when Dylan’s condition takes a turn for the worse, Pip and Max’s relationship is put to the test when they have different ideas of what the best treatment options are for their son, and when the couple aren’t able to agree, the hospital steps in and takes the case to court. With Pip, Max, and Leila, each having individual voices through their own designated chapters, this allows the reader to empathise with their different perspectives: what it is like to be them and how they reach the decision they have regarding what is best for Dylan. Part one of the narrative ends as the judge gives his verdict.

With the world and his wife having a view on what the right decision should be, part two of the story is where the author really ups her game. Although a bit confusing at first, this part of the narrative has a sliding doors structure where the different outcome scenarios of the court-case are played out. It is these kind of stories where I do prefer a real book rather than an e-book, so I can flick back and work out what’s going on. Anyway, once I’d figured out that this was actually a sliding-doors structure, and that I wasn’t going mad, this made the story all the more compelling. During this part of the story, chapters alternate between the perspectives of Pip and Max, and there are different time periods as the cleverly structured plot, addresses the question as to whether one decision is any better than the other. It also makes you consider whether fate is a factor: no matter what route you take will you end up in the same place?

The story also explores the theme of unconditional love. Not just the love between Pip, Max, and Dylan; but maternal love between Max and his mother, Pip and her mother, Leila and her mother, Blair (no spoilers as to who she is!) and her children.

One of the first things I was taught as part of my English Literature and Creative Writing degree was to ‘write what you know’ in a fictionalised way, adding elements of ‘what if’. After the End by Clare Mackintosh is an absolute masterclass in this, and should be considered essential reading material for every serious creative writing student. I’ve long admired the work of Clare Mackintosh, her first book I Let You go, in particular, is one that years later has still stayed with me; After the End will be no exception.

As I said earlier, After the End is very different to the author’s usual style of writing, and this beautifully written narrative reminded me of Carol Mason, Kit de Waal, and Emma Cooper.

What an amazing book! Incredibly sensitive subject matter which I thought was handled perfectly and very thought provoking.
I also loved the way in which the book was written to give two endings, handling the “what if?” question brilliantly.
Very different from the author’s usual genre, but just as good. Highly recommended.

A book that can't help but affect you emotionally. Two year old Dylan Adams is terminally ill with a brain tumour. The hospital recommend all treatment is withdrawn, and only palliative care offered. He has been in PICU for a few months at this stage. His parents end up on opposing sides of the case which is taken to court. Max, Dylan's dad, undertakes research and decides he would like Dylan to undergo Proton Beam therapy in his native USA. as he's not ready to let Dylan go. Pip, his wife, agrees with the hospital that all that could be achieved is slightly more time with a brain damaged son who is suffering constantly. She makes the impossible decision to let her son go, and end his suffering. From the minute the court verdict is given the story splits, sliding doors style, into a future for each verdict. Neither are perfect and I don't know which one I wanted to be real. The whole story hit me emotionally and made me so glad of my health and my family. #netgalley #aftertheend

Ive always been a fan of Clare Mackintosh and this book confirms why. This book made me laugh and cry and will stay with me forever. Subject matter was tough but I'm so glad I read it. Loved it so much and would highly recommend.

Such a beautiful thought provoking book! I have been a fan of Clare Mackintosh's psychological thrillers and was intrigued at this change in genre. The thought of any parent having to make such a heart breaking decision on their child's life is heart-breaking. I loved the "Sliding Doors" split in the story and seeing how both decisions regarding Dylan's future played out for the family. This book will stay with me for a long time - highly recommend!

I really enjoy reading anything by Claire Mackintosh and After the End is another I can wholeheartedly recommend. This is totally different to the thrillers I have previously read but I found myself picking up my kindle at any opportunity. The story revolves around 3 main characters – husband, wife and son who share a beautific life until a life-changing medical condition sends everything awry. The story is told from both parents individually and also the doctor in charge of the case which at first can be slightly confusing but the author joins all the dots effortlessly and the book really flows. This is a thought provoking and emotive book, even more so once you read the author’s note at the end. Wonderful!

Heart-wrenching, topical and indelible story of one family's ordeal and its consequences.

No parent will be unaffected by this story, with echoes of Charlie Gard and similar cases. It's the inside look at how a child's illness affects their parents, and the decision those parents must make.

Dylan has been in hospital for months, with round-the-clock care, his condition closely watched by his loving parents. Max and Pip both want what's best for their toddler of course, but they come to different conclusions about just what that might be.

In a Sliding Doors-esque move, Mackintosh shows us the consequences of different actions, I don't want to say any more than that. The book is split neatly into two halves, the first absolutely devastating for anyone who feels emotionally invested in a child's welfare, but with the similarities to a recent high-profile medical court case adding even more sensitivity.

The second half splits the narrative between two different possible futures timelines, moving the focus to how actions can affect a family, a partnership. It made me think about the decision-making process as well as what I might have done and why, in this situation. No choice is an easy one.

A very emotional read about two very real, flawed, normal people in an impossible position. I cried more than once reading this, the story hit a nerve, the parents' plight and decisions not my own, but still something I could empathise with.

The narrative style worked well, the differing time periods easy enough to distinguish from each other.

I would have liked a clearer-cut ending, but the author's decision has to be respected here.

This will upset many readers, I suspect. But the scope for debate is immense.

With thanks to Netgalley for providing a sample reading copy.

Powerful, moving and poignant book full of contemporary topics and gritty writing
I was moved by how emotive this story was

Absolutely incredible book. I am a huge fan of Clare Mackintosh's books but had to admit that I was slightly wary of how this book would be, as her other books are thrillers. Needless to say, I was not disappointed. This book was beautiful and poignant; I laughed and I cried. Truly beautiful and highly recommended.

I've read all of Claire's other books and we delighted to receive an eARC copy - thank you Netgalley and publisher.

This was very difficult to Claire's previous books and I was quite surprised. I have to admit that at first I wasn't sure but I was really drawn into the family drama and the emotions of the book - the circumstances were difficult to say the least. The book is face paced and very well written and I didn't want to put it down (I actually an afternoon off work to finish it!).

You can feel the pain of the characters and it is based on a true story. The author's note confirms it comes from the author's heart.
The second half of the book was clever and well written and something different.

A great read and I would highly recommend.

Pip and Max have to face every parent’s worst nightmare. Their young son, Dylan, is terminally ill and they face a tough choice...to let him go or fight for treatment in the US. Split into 2 sections, Before gives voice to Pip, Max and Leila, Dylan’s doctor, as they hope, care, fight and despair taking turns to tell their ‘side’ in each chapter leading eventually to a courtroom. After tells Pip and Max’s story after they lose their son, an inevitable heartbreak whatever the outcome of the court case. (This is so hard to summarise without giving anything away!)

‘Enjoyed’ is not the word I can use to describe this read, but it was definitely my kind of story! I think I cried in every chapter but I adored this book. I felt so strongly for all of our lead characters and could see the point of view of both parents. This book broke my heart and it will stay with me for a very long time. I think it will make me look at any cases in the news in a different light in the future.

I'm not sure where to start with this beautiful novel, but I do know that I haven't been able to read for a few days after finishing it, because it has left such an impact.

From her very first novel, I Let You Go, I have been a Clare Mackintosh fan, and I have to admit, I was slightly worried that I wouldn't enjoy this departure from the usual psychological thriller genre. I couldn't have been more wrong.

Meet Max and Pip, they are the strongest couple, facing the most difficult and important decision of their lives. Their three year old son Dylan is battling a brain tumour, but requires further treatment in order to survive.

The prognosis is bad enough, but then they are hit with another blow. The treatment Dylan requires to stand a chance of survival is not available on the NHS.

Max and Pip must decide whether to let their son go and release him from further pain, or to battle for treatment in the USA. After a period of time, it becomes clear, that they must battle - against each other.

Max and Pip's perfect relationship is suddenly, brutally torn apart by each parent believing they know what's best for their son and his future. They must go to court to decide, with their doctor and the hospital trust on one side, and one parent alone on the other.

So, what happens 'After the End'?

As the book's tagline suggests, anything can happen after the end. We are treated to two alternate versions of the future after the court hearing, mostly from the perspective of Max and Pip, but with an occasional chapter from Dylan's doctor.

I really can't say any more without giving anything away, but I urge you to read this novel - including the author's notes. It is heartbreaking, yet beautiful and one of my reading highlights of this year so far.

I was very excited to read a book by Clare Macintosh as I love her psychological thrillers, however this is a total break from her usual genre and in my opinion probably the best book she has ever written. The huge amount of emotion which flows through the book, must be in no small part due to the author’s own experiences.

Pip and Max are the perfect couple, and have a wonderful, unshakable bond where they finish each other’s sentences. Their happiness is complete when they have a little boy, and Dylan is the light of their lives.

Unfortunately Dylan gets sick and for the first time Pip and Max disagree. The only resolutions to go to court.

The book then diverges. Pip’s chapters show what happens if she won, and Max’s what happens if he did. The final chapter belongs to the Doctor.

A ‘must read’, that will leave you with a book hangover.

This book is beautifully written, thought provoking and touching. Clare Mackintosh has dealt so well with such an emotional topic, that is also so personal to herself.
I loved the way that the 2nd part of the book was written. This is definitely a book that will stay with me a long time and will make me cuddle my kids a little longer when i put them to bed tonight.

I have enjoyed all of Clare Mackintosh’s books.
This one is very different from any of the others I have read and I wasn’t sure I was going to like it, for personal reasons due to the topic.
Oh my goodness this was by far my favourite book she has written.
Sensitively handled, well written, great characters.
I love how the story is in 2 parts and how the second part is done.
Beautifully written and very emotional. I cried my eyes out.
Thank you Clare for this book.
I loved it

An extremely moving book,I wasn't sure this book was for me but as soon as started it was drawn into it,very emotional book,
As always with this author very well told

Wow
What a book
I am speechless
This book was just the whole package. It was perfect.
It wasnt an easy topic to write about, but Clare Mackintosh just nailed it.
I enjoyed the courtroom aspect of the book and I just don't know what I'd have done if Dylan was my little boy.
This book will stay with me for a long long time.

Amazing. Easily 5 stars!

One of the most heartbreaking stories ever told. Dylan had a brain tumor, was operated on, and had undergone chemotherapy. Removing the tumor had caused the normal brain tissue also to be excised. The Dylan they knew no longer was the same. He was quiet with vacant eyes. And the tumor was growing. A chance of treatment which may prolong life was a radiotherapy in America. The hospital objected, wanted Dylan to pass away in dignity. Mom agreed. Dad wanted to fight, and the matter went to the courts.

Clare Mackintosh went a step further showing us what would happen if the courts had decided one way or the other. Their lives post either decision were shown. The story was based on hope and written with a deep poignancy. Dylan was present in every word of the book, his essence could be felt at every corner. Nobody in this world can say what would be the right decision. Both the decisions would hurt the parents.

Clare has shown the NICU authentically, I could feel that I was standing right next to the parents. The atmosphere of the hospital in the first half was perfect. I got to know that the author had to make this difficult decision for her critically ill son. I have no words for the courage it must have taken for the parents to switch off the ventilator.

There are many things I want to say about this book, but the emotions in my heart stop me. I don't have the words to write the review. A brilliantly emotional book which also showed how life could be lived after a tragedy. Pain never goes, it just ebbs and flows.

After The End - Clare Mackintosh

What the publisher said :
Max and Pip are the strongest couple you know. They’re best friends, lovers—unshakable. But then their son gets sick and the doctors put the question of his survival into their hands. For the first time, Max and Pip can’t agree. They each want a different future for their son.
What if they could have both?
A gripping and propulsive exploration of love, marriage, parenthood, and the road not taken, After the End brings one unforgettable family from unimaginable loss to a surprising, satisfying, and redemptive ending and the life they are fated to find. With the emotional power of Jodi Picoult’s My Sister’s Keeper, Mackintosh helps us to see that sometimes the end is just another beginning.
My thoughts:
I don’t usually go in for this sort of novel. But after reading the first chapter, I was hooked. For starters, it uses not only the narrative of Dylan’s parents, it also features chapters written from the point of view of their child’s consultant. Thus providing the medical background and how this can be so diametrically opposed to the emotional concerns of Max and Pip. Everything about it has such a ring of truth to it that I wasn’t shocked to learn that the author went through a similar situation. Here, she’s been able to bring heart and detail to a story that needs to be told.
There were a couple of times where I was confused as to which outcome was being followed. I began to wonder if it was one of those “choose-your-own-adventure” books. I’m still not sure who got the better ending, because they both lost a son and that must be the hardest thing to experience.
Mackintosh not only tackles the topic of a sick child, it also focuses on how women are usually the main caregiver and how this affects the family if they want to go back to work. It touches on homophobia and how that is still prevalent today. A whole host of current issues that surround us everyday. Showing that anyone can find themselves in this situation.
Whilst I didn’t find myself sobbing my heart out, it did tug a few cold heartstrings.

I loved this book and stayed up later than I should have two nights running just to find out more!

The story of Pip and Max Adams and their critically ill son Dylan starts in court, narrated by Leilah, the doctor who has been looking after their son in PICU. It then jumps back to the story of Pip, Max and Leilah in the run up to this critical junction in their lives, narrated by each of them in turn.

Once we return in time to the court date, the style of writing changes providing perspectives I didn't expect. I don't want to spoil the story for you, but I loved this point of the book, how cleverly it was put together, seeing both sides of the story. You really believe in Pip and Max, and feel for their predicament, and hope against hope that you never have to face the same situation they did.

I devoured this book as much as a full time job and a 3 year old allowed me too and heartily recommend it.

Thank you to #NetGalley for the advance copy.