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.

After the End is the story of Max and Pip, a happily married couple with a young son, Dylan. But one day Dylan gets ill and a decision has to be made about what to do next, about what might be best for him and they just can’t agree.

After the End is a stunning novel. It looks at Max and Pip and how they cope with looking after a very ill child, how they cope in their different ways and how they view things so differently. Max needs to earn money so he continues to go to work, often this involves travelling but he is always thinking of his family. Pip has given up everything to be there with Dylan. She is always with him in the hospital, she looks after him there and she is the one that bears the brunt of seeing how ill he is day in, day out. They both adore him, they both want what’s best for him but they’ve had such a different experience of his illness that when the time comes to make the ultimate decision, they are just completely unable to agree.

I knew going into this book that it was going to be emotional but I wasn’t prepared for how much it would make me cry. The exploration of what it is to deal with a loved one being so ill was written so incredibly well. I don’t have children but I cared for my mum in the final months of her life and I know how much of a toll is takes on a person. Because of this I was on Pip’s side for the most part because, for me, it’s the person who is there the most that really understands the suffering, who understands that however much you love someone you sometimes have to step away and think what’s best for them. What I didn’t expect was how much reading Max’s point of view would affect me. At first, because of my own experiences, I thought he was selfish for not listening to his wife more. But then I could see that he loved Dylan every bit as much as Pip and he believed that what he wanted for their son was right, just as much as she thought she was right. It really made me pause.

The novel follows Max and Pip’s perspectives but we also get to hear from Dylan’s primary doctor, and that was really interesting. It added to the novel for me to know how she experienced the situation and how she felt about it all. The things that she goes through felt very real and believable.

So many issues are raised and dealt with in this book that are so relevant to modern society. Clare Mackintosh sensitively and intelligently deals with all of them so well, she covers so many angles and really makes you think about how you feel about these things, and what you would do in a similar situation.

After the End isn’t an easy read but it’s such a stunning novel and I’m so glad I read it. I definitely recommend this one, but I also recommend keeping a stash of tissues nearby to soak up the tears that will inevitably fall.

What a powerful read. I have been completely blown away by this book. Most of the reading was done with tears in my eyes as I could feel the heartbreak that Pip and Max were going through. I am a big fan of Clare Mackintosh’s books and this book is very different from her psychological thrillers but after reading Clare’s notes I realised what a lot of courage and heartbreak it must have taken her to write this book. We meet Pip and Max who are the parents of a two year old son Dylan who is battling cancer. The parents are heartbroken but have different opinions on what treatment Dylan should have and the case ends up in court. The second half of the book explores how the court decision could go two ways and what the outcomes of both would be. I think one of the things that makes this book so compelling is that you try and put yourself in their position and consider how difficult the decision must be to choose the right path. I can’t recommend this book enough, it will stay with me for a long time. One of my best reads this year. I wish I could give it 10 stars!
Thanks to NetGalley and the publisher for giving me the opportunity to read and review this book.

This book is so emotional and beautifully written.
A family divided over a heartbreaker decision, and the after effects this as on couple
Loved how it is spilt into two potential outcomes

An excellent read, need plenty of tissues

Thank you netgalley, Clare Mackintosh and Little Brown Book Group for allowing me to read and review this book.

This story is completely different from Clare Mackintosh's previous books, which all fell in the psychological thriller category. After the End is all about a family and how their son being terminally ill changes their lives forever, especially when they cannot agree what the best course of action is.

This is a very emotional story, I cannot even imagine what these character must have felt going through such a hard time, but the author makes an exquisite job of describing their thoughts, their feelings, their fears and their hopes. You become one hundred per cent invested in their story and wonder, in every single page, what you would do in their shoes.

The book is divided in two parts, the first one centers its action in the hospital, during the months leading to the decision on their son's future and the second expands a few years after it. I had already fell in love with this story during the first part but it was the second one that left me completely in awe. It was so cleverly written and although it was hard to read sometimes, I loved following the characters' lives.

In After the End, Clare Mackintosh managed to break my heart and put it all back together. This story surprised me until the very last page and it will stay with me for a long time.

This is such a departure for Clare Mackintosh, I wasn't sure she'd be able to do it but what a moving, joy of a book.

Who are the humans behind the medical ethics case studies? Max and Pip are in love and dealing, in their own ways, with their beloved son Dylan’s major illness. When their trusted consultant tells them that Dylan, only two, won’t pull through, a schism appears. And the only way forward is with barristers, a court case, and a social media campaign.

This is a moving study of the dynamics of grief. The judgement from the courtroom is a turning point in the novel, which leads us to the ‘what ifs’. Is it even possible to move on, whatever that means, when the worst thing a parent can imagine, happens. Can you keep it together - and stay together - when lashing out and resenting is what you’re feeling?

This is a novel not for the faint hearted, but one which which leaves you a little wiser and a lot more forgiving of human frailty and understanding of how we behave when tragedy strikes. .

Wow. I had just mentioned to a fellow book addict that I wasn't finding 2019 an outstanding year for new releases, thus far, and while I had read some great books I wasn't already questioning how I'd whittle down a top ten...then I read After the End.

This isn't the first Clare Mackintosh book I've read, and I've raved about her writing since I discovered her with an advance copy of I Let You Go, but After the End takes her storytelling and emotional resonance to another level.

Pip and Max are the strongest, most perfect couple you know, but now they have reached the most important decision of their life, and they disagree. What do you do when your beloved child is terminally ill?

This is a heart-rending and heart-breaking book, and as is possibly now to be expected with Mackintosh it doesn't necessarily take you where you think the story will. Imaginative, thoughtful, deeply felt and gripping, this is a definite contender for book of 2019.

This book totally gripped me right from the start.
I loved it. It was so moving, had me crying in parts, loved the characters,
It was really powerful and in a way has helped me accept a little more and move on a little from my own loss of my dad.

This was a truly heartbreaking read, and although Max, Pip and Dylan are fictional characters the impossible situation they are going through is very true for some parents. As a mum to a toddler myself, I found this a very difficult read, but I thought that Clare Mackintosh handled this incredibly delicate storyline beautifully, it was a well written and powerful read.

5 well earned stars

Such a well-constructed, emotional and gripping read by Clare Mackinosh. I would imagine it must have been such a emotional book for her to write, given her own personal circumstances. The book is so well written and will of course remind readers of cases which have hit the news such as Charlie Gard and Alfie Evans, and Clare has done justice to such cases in showing parents love and that it is never an easy decision in such tragic cases.
Max and Pip are wonderful parents, who both want the best for the very best for their son, Dylan. But when the consultant, Leila Khalil tells them the hospital believe nothing more can be done to prolong his life, what can Dylan’s parents do? What if Dylan’s parents do not agree about the best way forward for Dyan? Who will decide what happens next?
The second section of the book is split into two sections, what would happen if one course of action were taken and what would happen if another were taken. It flows between the two. It works extremely well.
Although the book is obviously sad at times due to the subject matter, it is a truly wonderful book.
Thanks to NetGalley for a Kindle copy of this book in exchange for an honest review.

This book was a stunner, and one of my favourite books in recent years. It touched me in ways that I really did not expect.

The first half of the book is dedicated to ‘Before’, which centres on Max, Pip and their young son Dylan. When they are told that the cancer Dylan has is inoperable, and has left him brain damaged, and with no prospect of walking, talking or communicating his needs to them, they are faced with a choice that no parent should have to make, whether to remove his life support and allow him to die. Unfortunately, Max and Pip find themselves at an impasse, with neither able to agree with the other.

In a situation where parents are unable to agree, the courts must step in, and the second part of the book, ‘After’ takes an almost ‘Sliding Doors-esque’ look at the two options of what would have happened if the judge ruled in favour of removing life support, and what would have happened if the judge ruled in favour of maintaining life support while other medical options are attempted.

I found the characters of Max and Pip, and their love, really believable. They clearly love one another throughout the book, but is their love really strong enough to survive when they cannot agree on the care of their son? It is the kind of pressure that would put a strain on the strongest of marriages, and theirs is no exception. I found that my favourite character was Leila, the Iranian doctor who was responsible for the care of Dylan. I loved her own side story, as she wrestled with her own decisions regarding Dylan, and how the pressure of that decision affected her. I also loved Alistair and Tom, parents of another child in the NICU, side characters whose personalities shone from the pages of the book.

On a personal level, this book really touched me. Nearly 24 years ago I gave birth to a baby boy who was 9lbs 9oz and full term, but his lungs had stopped developing at 29 weeks. Over the following four weeks we had many moments in the Neonatal Intensive Care Unit (NICU) that were touch and go. The chances of survival for my bouncing baby boy were much the same as for a premature baby born at 29 weeks. He was in an incubator built for tiny babies, not 24 inch long whoppers, on a ventilator (which on one terrible night broke, and the doctor stood for four hours pumping air into our baby by hand while a ventilator was brought from another hospital). Another night we had our son baptised in the hospital, with a Catholic nurse as a witness, followed immediately by last rites, because he was not expected to survive the night. We were told he had had a brain bleed and they did not know how much damage it had caused. We faced a similar dilemma, and with my husband we found ourselves discussing whether we could let our son go, or whether we would fight for him even if his quality of life was compromised. Unlike Max and Pip, we both agreed with one another, but in the end he was a fighter who stuck in there until his lungs developed sufficiently, and is now a strapping 6 foot university graduate, who had asthma through his childhood, but achieved far more than anyone ever thought he would. Our hospital consultant, ten months after his birth, referred to him as his miracle baby, the one he truly thought he would lose. I will forever be thankful that I did not ultimately have to make the decision Max and Pip were faced with.

The reality of the hospital scenes in the book gave me flashbacks to my own experiences, so it was no surprise to read that the author had written from personal experience.

The ‘After’ section of the book, was slightly weaker than the ‘Before’ section because it constantly jumped not only between the two potential outcomes, but also backwards and forwards in time, so I found myself having to concentrate on which storyline I was reading, but all in all I did not think it detracted from what really is a thought-provoking and emotional book. I also think it would make an incredible movie or series.

I was given a copy to read and review via Netgalley, but I will be buying a copy of my own. This book is about hope, rather than loss, and although I shed tears throughout, they were tears of happiness in the end.

This read was a little close to home for me, so the tears were quietly rolling down my cheeks almost from the start. There’s a great suspenseful beginning in a court room that left me intrigued, but without a clue as to what was actually going on. I jumped to a completely wrong conclusion and the truth turned out to be far worse than I could ever have imagined. (I try never to read the blurb of a book just before I read it, so I’m usually totally surprised by the subject matter.)
Clare Mackintosh writes such real characters and approaches the heartbreaking subject matter of this book with empathy, compassion and wisdom. I wondered if she’d lived through something similar herself and it became clear in the author’s note why she was able to write this with such utter authenticity.
To start with, most of the action takes place in the paediatric intensive care unit of St Elizabeth’s Children’s Hospital in Birmingham. The story is desperately sad, but as it progresses, we do get some respite. The glimpses into the personal life of Dylan’s doctor, Leila, for example, are wonderful. Her mum is visiting from Iran, preparing the most delicious sounding meals for Leila and spending her days totally addicted to the shopping channel, which means Leila never knows what she’ll trip over next…
The story is packed with wisdom and we’re reminded how important it is to live in the moment, to enjoy every second with our children right now.
At a certain point in the book I became confused, as my logical brain dictates that we cannot have things both ways. I initially disliked the parallel universe ending, feeling a bit cheated, but then began to quite enjoy the possibilities. The second part didn’t totally work for me as the two stories became blurred a bit in my mind. This didn’t really matter though and in a way I think that may have been the point…
As I’ve mentioned, the start of the story is desperately sad and parents Max and Pip are faced with a decision no parents should ever have to face. But as the author writes: “this is not a story about loss, but about hope. Hope for the future, for a life beyond an unavoidable tragedy. We cannot predict the future when we make difficult choices in life , but we can shape the years that follow. We can choose to live again.”
Despite some misgivings, I do recommend this book as it’s beautifully written and packed with wonderful characters who come alive on the pages, gentle humour and real emotion. It’s also different and brave.

With thanks to Netgalley and Sphere for this ARC in exchange for an open and honest review.

Clare Mackintosh is one of my favourite authors and I am always excited When she releases another book. Although I am a fan of psychological thrillers I also enjoyed A Cotswold Family which was a selection of Clare`s column pieces.

I feel a bit conflicted with this review. In Clare`s author's notes she explained that the story was based around her son who was critically ill. Clare and her husband had to make the same decision as Max and Pip in the story.

After The End was beautifully written and my heart ached for Max and Pip. I enjoyed reading about Leila Khalil who was Dylan`s consultant, and her mother Habibeh who had arrived to the UK from Tehren. It was also nice to read about the other patients in PICU and their different stages of recovery. My favourites were Tom, Alistair and their daughter Darcy.

I had a lump in my throat when Leila explained the hospital would only offer Dylan pain relief and palliative care. What a terrible situation and I could understand why Pip wanted to let Dylan slip away painlessly. I could also understand why Max wanted to take Dylan to America for treatment.

The book was split into before the courtcase and after. In the after section the story split into two different endings, if Pip won the case and Dylan passed away shortly after. Of if Max won and he took Dylan to America for protom beam therapy. I personally didn't enjoy this which I have awarded three stars. I thought it made the story more complicated with the new characters in each scenario. I think more could of been written about the court case and the relationship between Max and Pip beforehand.

Overall I enjoyed this book and it certainly made me think. Congratulations to Clare for her effortless transfer to a different genre.

This was a hard read, as I suppose was to be expected of a book with a child's terminal illness at it's centre. The book follows parents Pip and Max, and is split into two(ish) bits: before and after their son Dylan's death.
I enjoyed the second half considerably more than the first half, though I missed (if that's the right word!) Dr. Khalili once I passed the halfway point. The first half felt, at times, drawn-out and overwhelmingly sad, probably because I knew where things were headed for Dylan. The second half felt far more hopeful, and did a better job of showing off the way that Mackintosh mixes observational humour with heartbreak. Setting the two stories alongside each other worked really well - I think most people obsess over 'what-ifs' after the smallest decisions. And the ending... well, I thought the ending was perfect.

This is an emotional read that pulls on the heartstrings.
It’s any parents worst nightmare to have a child become so ill that they may not survive.
Clare Mackintosh tells the story in such a sensitive way it’s clear she’s got experience of such a tragedy. The couple in the book are facing a dilemma about the life of their child and when they disagree on what’s best for their him, we see their lives crumble around them.
An emotional read that had me engrossed from start to finish.
Thanks to Little Brown Book Group and NetGalley for the opportunity to read this book.

This is a very well written emotional story. It was a hard and heartbreaking read in places. There is so much pain and love and heartache in this story. It is beautifully and sympathetically written.

Thank you to Netgalley for my copy.

This story is a heartbreaking, thought-provoking tale that is very well written. I wasn't sure whether I would be able to finish, just because the subject is so gut-wrenching. But it is very sensitively done.

"After the End" was a powerful and emotional page-turner of a novel, beautifully executed by Claire Mackintosh.

There are some authors whose books you just want to read because you already know from experience that you will be reading a winner. For me, Clare Mackintosh is one of those authors. I found 'I See You' to be a really gripping thriller that I found hard to put down. This book was very different, Rather than being a psychological thriller like the author's other novels, "After the End" was more of an emotional family drama.

When I first started reading I was a little unsure whether I would find the subject too uncomfortable and I certainly spent some time pondering what I would do in the same situation. This was a very cleverly written novel and an utterly heartbreaking story but also really compelling and ultimately hopeful. It was a powerful portrayal of a couple pushed to breaking point and a gripping and convincing story of loss and love.

"After The End" was a truly beautiful story and it is a book that will stay with me. An absolute must-read that I highly recommend.

I received a complimentary digital copy of this novel, at my own request, from Little, Brown Book Group UK via NetGalley. This review is my own unbiased opinion.

Max and Pip are the strongest couple you know. Only now they're facing the most important decision of their lives - and they don't agree.

As the consequences of an impossible choice threaten to devastate them both, nothing will ever be the same again.

But anything can happen after the end . . .

No spoilers, but what a heart breaking book this is … so sad. I can not imagine being in that situation, and don’t want to be. Also love and laughter. I did not want this book to end. Loved it! 5*