What happens if you have a very sick child and you and your partner can’t agree on whether to let them die or try potentially life-prolonging treatment?
Borne of Mackintosh’s own experience, this visits this incredibly difficult subject, and what happens after the decision is made.
There is a ‘sliding doors’ effect, in that we see what would have happened, whichever way the decision went. I found it slightly tricky keeping a hold on which story I was following and - hand on heart - I’m not entirely convinced I’d get 100% in an exam on this - but it didn’t affect my enjoyment!
This makes for a heartbreaking and very touching novel that approaches a decision that can never be right or wrong, from the point of view of all involved including the doctor, Leila.
I don’t have children but still found it very poignant and personally affecting.
A novel like this could never be an easy read but it’s a compelling and well-executed one. Recommended.

Max and Pip have a toddler called Dylan. Sadly he has been diagnosed with a brain tumour of which surgeons couldn't remove all off. Then they are given the devastating news that the Timor is growing again. There is nothing more the surgeons can do but give him palitive care and make sure that he is pain free. Max, not wanting to give up on his son, researches the disease, hoping to find a cure for his son. He finds that it can be treated in America. But first he has to take the hospital to court so that they will keep Dykan alive until they get to America.

This book reminded me so much about Charlie Gard, a young boy from England whose parents fought to keep their young son alive so that he could be treated in America. My heart was on my sleeve reading the first half of this book. I couldn't get through it quick enough. The second half has a duel storyline. The first being Pip's senario, she just wanted the palitive care for her son, she did not want to see him suffer any longer than necessary. Max's story is where his where the court grants him his wish to take Dylan to America to receive more treatment. The senario sare told in alternative chapters and at times, this was quite confusing. Though they are both written about beautifully. If the author had stuck to one conclusion, this would have been a 5⭐️ read.

I would like to thank NetGalley, Little Brown Book Group UK and the author Clare Mackintosh for my ARC in exchange for an honest review.

Totally engrossing, brilliantly constructed and beautifully written, this book cannot fail to move and haunt the reader. It is any parent's worst nightmare to have a child become so gravely ill that they need intensive care and may not survive despite all that modern medical science can achieve. And, if death is thwarted, what of the quality of life remaining? Clare Mackintosh puts us into the shoes of one couple facing that nightmare, and through them we experience some of the possible consequences of the situations and decisions that need to be made. When you want the best for your child, just what is that best? And with a child who needs everything you've got, what is left for each other? It is a brave and carefully researched story, which is both entertaining and thought-provoking. I cannot recommend it enough.

After the end by Clare Mackintosh should come with a waterproof mascara and a huge box of tissues, There aren’t many books that made me bawl my eyes out like this one did, in fact it’s rare for a book to have such an extraordinary impact on me! This book is heartbreaking, moving, tragic, a powerful story of love, grief and life-changing decisions. After The End is one of those rare books that you will haunt you long after you reached the last page. It’s one that will find you questioning what you would do if you found yourself in a similar situation.

Thank you to Netgalley and Little Brown Group for an advanced reading copy in exchange for an honest review and feedback. I've really enjoyed Clare's other 3 books so immediately requested this book without reading the blurb. Once I received approval I wasn't sure whether I'd enjoy it as it's not the normal type I'd book I would go for, but it was fantastic. It was such a compelling and difficult story told with sensitivity. However you still felt the raw emotions and consequences of the characters struggles.

Dear Clare,

When we, book bloggers, finish a book, we often start thinking about the best way to review it. We want our opinion to be clear. We want to convey what happened to us between the opening and the ending page of the author’s work.
When I put down After The End, I understood a review wouldn’t do. This is why I am writing you a letter. Not as a book blogger. Not as a serial reader. As a woman talking to another woman.

Thank you.

I escape life through crime fiction. I find it easier to face dead bodies and monsters rather than life’s unfairness and hardships. There is a protective wall between me and the rest of the world. Well, actually, this is no longer true. There was a wall. After The End attacked it, each word hitting the stones, creating a hole. A small one at first. A mouse escape. Just enough for me to feel my heart tighten when I met Pip and Max. It grew bigger when the antiseptic smells of the hospital reached my nose and Dylan appeared in front of my eyes. Rain passed through the hole when I got to meet Leila.

Page after page, I felt my defenses fall. How do you protect a child from an invisible illness leaving traces on a frail and pale body which should be hitting a ball in a park or eating cookies while playing cards with his parents? We never hear from Dylan himself, and his silence, contrasting with his presence, immensely felt throughout the novel, dug a winding path on my cheeks for my tears to follow.

I am not one for crying. I read Me Before You without even blinking. I remember thinking ‘What kind of monster am I?’ But I now know I wasn’t at fault. Neither was the book. I just needed a voice, faces, roads written in a different way. I needed a key to open the door to the fears I was keeping at bay. Your writing is that key.

I sound very dramatic, don’t I? After The End is dramatic. It is a tragedy. It is one of life’s coins. And like every coin, it has two faces. Tragedy can’t happen without happiness. Pip and Max cling to this happiness, holding those moments as weapons against Dylan’s tumor. They hold on to each other in the most beautiful and heartbreaking way. They gave me hope, even in the darkest chapters. You breathed life into them, you surrounded them by it, then threw them in the coldest night. Car trips. The exhaustion of caring for someone. The rain. The meals. Long nights. Love. You crafted them so well I could almost touch them. They left the pages to sit next to me as I was reading. No one can make me believe that you didn’t pour your entire heart into this novel. It shows. It shines through.

A power couple faced with an impossible decision. A terminally ill son, and its fate in their hands. Is life with constant medical support worth living? Is there hope? Is it torture? Is it selfish to wish for more time? The tragedy of our human condition. We don’t have the answer. There is no right answer.

It doesn’t mean that you don’t have to choose. It only means you will carry a weight for the rest of your life. A red scar burning your soul. What happens when parents disagree? Then the court comes in. Law talks. Like medicine and science, the law must look at the facts, at the best decision at a given time.

Oh, I had never wished for a man and a woman to find each other again more than I did for Pip and Max. The way you handled their differences, the slow and inevitable gap forming between them. The bridge left by the love they have shared, share, and always will.

Am I rambling? Probably. Pardon me, for my mind is crowded with thoughts and my chest is filled with emotions threatening to make me explode. (I am writing this right after having finished the book. Before I change my mind and chicken out.) I don’t want to chicken out. I want to earn a millimeter of the courage the novel holds, a milligram of the strength it took you to write After The End.

Because it needs saying. Thank you for dealing with such a current, painful topic. Thank you for creating amazing parents, fascinating second characters, and a door to a world that is just one step from any of us. Thank you for the respect with which you treated both sides. Thank you for walking both sides of the argument with a clear mind, moments and thoughts so spot-on they scared me.

The blogger inside me wants a word… Would I recommend After The End? Yes. A million yes.
Why? Because the writing can pierce the hardest armor. Because everyone needs a Pip, a Max, a Dylan, a Leila, to try and understand, to ponder, and most of all, to feel. This book is the closest you can get to the topic of survival, and what it means to live.

But you, dear Clare, doesn’t stop there. Because life doesn’t stop, does it?
No, you give us the unpredictable, insane, and indestructible chapters of the After. Pip’s choice. Max’s choice. Parallel roads never to cross path. Each offers its load of tears, grief, doubt, and struggles. But then the unthinkable happens. Hope. Survival. Again, this word. My heart, after having slowed so much during the pivotal time, started beating again. It hurt, it smiled, it jumped, it stopped. With a prose I can’t praise enough, you gave me a taste of what a phoenix goes through when it rises from the ashes. It is not new, it carries its past, and it goes on. Life may not be what you wanted it to be, but it is what it is.

June 2019. I have found a profoundly moving novel, a stunning and tragic tale. My favourite book of the year.

Thank you for breaking my wall and reminding me crying is okay, feeling is okay, and that turning your head the other way doesn’t make it disappear, it only pushes your further away from reality. I didn’t know I needed this kind of book until I found yours. I am glad I read it. I will read it again. I will talk about it and ask my friends, acquaintances, and even strangers to give it a chance. Because a beautiful book needs eyes to dance its choreography.

This review will be posted 13 June 2019 on chocolatenwaffles.com

With After the End Clare Mackintosh has produced an emotional rollercoaster of a book that will result in you being hooked in and unable to put it down until you have finished it.

The story centres on the perfect couple who face having to make the impossible decision. The first half shows how the couple face their dilemma whilst the second half shows what may or may not happen.

The book is superbly written and clearly from the heart and is recommended unreservedly

Dylan is a little boy who is in hospital long term. He is brain damaged after a tumour and remains in a long term coma. His parents Max and Pip have been with him in hospital, sitting by his bedside hoping for the day that he will improve, and eventually come home.

Unfortunately, the hospital needs a decision from both parents. Normal parents who love their little boy (and each other), more than anything. This part was heart wrenching. As a mother and a wife, I was challenged to think about what I would do in this situation, and how I would handle it if my husband disagreed with my choice.

I really felt for everyone involved and the author pulls no punches on how difficult this is for everyone. The family, the hospital, other parents of children in hospital, and how the Joe Public gets involved with Facebook pages, Twitter hashtags and public demonstrations.

I found a lot of this very difficult to read, and really felt for both Pip and Max when the decision was made for them.

The second novel follows the outcome of the decision, following the two different directions and the stories are told in alternating chapters after each outcome. I felt this part dragged on a bit and went on to long for me which is why its 4 stars not 5.

Watch out for the epilogue though when I did have to bring out the tissues.

A sensational and powerful read, heart-breaking and emotional story which sets you thinking when you are faced with such life or death decisions you need to make for your 3 year old son.Robert Frost's poem puts a feel to the story to it's entirety.
Cleverly written to reflect how life would have been taking the route of each parents decision.
The part that struck me emotionally was when I realised the author was narrating her own personal experience in the story.It is a brave and courageous step to have taken to open up in her novel and I completely empathise with her throughout the book.

Message to author,I am so sorry you had to go through that path of choice in life.

This was an incredibly hard book to read especially as a parent and one which made me hold my little girl that little bit longer. Two parents forced with an impossible decision told authentically.

The book is a story of hope and how you can never know if the path you are taking is the right one. You can never know how one decision can impact the rest of your life. The fact the author has been in a similar position shows throughout the book with how raw, heartbreaking and honest the portrayal of this situation was.

Yes a box of tissues is needed but there is so much more to this book than expected. I loved the second half of the book just as much as the first. I felt the second half really brought home the authors message by showing what would happen in the future with either decision that they made and I loved it.

This is a thought-provoking book, that doesn't just focus on the parents but also the effect it has on the child's doctor. This is a must read book that will tug at your heartstrings, make you cry and also uplift you when you least expect it.

Thank you to NetGalley, Little, Brown Book Group UK and Clare Mackintosh for an advanced copy in exchange for an honest review.

Jodi Picoult fans, eat your heart out!

When it comes to writing a compelling, engaging, insightful story, Claire Mackintosh can do no wrong in my book, and even though I knew going in that this was going to be completely different from her usual domestic suspense thrillers (which I love) I was still desperate for the chance to read it.

After the End is the story of a terminally-ill toddler with multiple deliberating disabilities. Dylan is not yet three years-old but as the result of a brain injury is paralysed from the neck down, unable to communicate or swallow, unlikely to have any awareness of his surroundings, and without medication would be in constant pain. His parents are forced to make a decision no parents should ever have to make – stop all treatment, except pain relief, and allow him to die, or opt for an experimental treatment that may extend his life. With mother and father on opposing sides it's up to the courts to decide.

‘Before' incorporated the days leading up to, and directly following, Dylan's parents receiving the devastating news that his tumor had grown to such an extent that they needed to make a decision regarding his future treatment. We were offered three differing, equally valuable perspectives – mother (Pip), father (Max) and one of the consultants looking after Dylan (Dr. Leila Khalili).

Clare Mackintosh did an incredible job of showing what life is like in the PICU (Pediatric Intensive Care Unit) section of the hospital – the day-to-day, and overall struggles of dealing and coping with a severely ill child, the support system including medical staff, and other parents in the ward, and the environment, treatment, and equipment. Glimpses into what Dylan was like when he was healthy, and when he first started developing symptoms gave us an overall picture of life before, and Dylan's personality. Max and Pip's resilience and love for each other, and the effects on their relationship and marriage was evident throughout. But at its core of course was their all encompassing love for their son.

The ‘After’ section of the novel used dual POV's (Pip and Max) and parallel-timelines to show the different directions their lives might've gone in, depending on the Judge's ruling. This format didn't work as well for me as the first half, as things became somewhat repetitive, but I understand what the author was trying to achieve, and appreciated being given both outcomes of such an agonising decision. Even though I knew logically that neither option was going to end favourably for little Dylan, in my heart of hearts I would've been left wondering “what if?” so to be offered up both timelines gave me a sense of closure I wouldn't have gotten otherwise. The only other small issue I had with the last half was that I dearly missed Leila's viewpoint – she was a wonderful character that I would've liked to have heard more from.

Even though I personally prefer her thrillers, Clare Mackintosh has penned something truly special in this moving story of love, loss, guilt, grieving and hope.

I loved this book so much. It's a tear jerker but also a book that helps you to remember that life is short and so precious.
I just felt compelled to keep reading.

A truly heart-rending story of a young boy with a terminal condition. The story is told from the points of view of his mother, father and Doctor. There have been a couple of such cases in the news in the last year or so and this story really makes you feel all the emotions the parents go through in such trying circumstances.

Firstly I need to say how very different this book is to the authors others. Having loved her other books which are under the psychological genre, this one couldn’t be any further away in terms of genre.

Max and Pip are a loving couple who find themselves having to make one of the hardest decisions I think anyone can be faced with when it comes to their son. All through the story in fact I was so torn as to which direction I would have gone. It’s one of those scenario’s where you wish you could see what the future holds. In a way this is what the author brings to the reader. We get a chance to see which direction the couples lives take, depending on which decision is made.

This really is such a hard review to write as, as you can see, the blurb doesn’t give a great deal away. There are so many things I want to say about the story or talk about but think it may spoil it for anyone who hasn’t read it so I really am trying to be as vague as I can be.

The story alternates between Max and Pip so we get to see what is going on inside their heads. These two characters were just fabulous. I loved both of them. The more I got to know them the more like old friends they became. It felt at times like I was right by their side going through everything they were going through. I know it’s only fiction but you really couldn’t come across a nicer couple.

After The End is a thought provoking, at times heart wrenching and emotional read. The author has written about a topic that I am sure could split many of us. People will certainly have their own thoughts on the matter but this story is more than that, it’s about the aftermath and how you live with that decision. It’s certainly something I don’t envy anyone and at the end I felt so bereft at having to leave these characters behind. I shed so many tears through out the story and I don’t regret one of them. The sign of a very talented story teller and a story that will definitely stay with me for a long time to come.

Wow oh wow!! I have never wanted to rush and write a review straight after reading it. I usually ponder on what to write.

What if..... Absolutely beautifully written. Touching. Heartbreaking. Thought provoking. I'm really impressed with how this is told. I've never come across this method before, I loved it. Although I didn't shed a tear during the book, I certainly did when I read the author's note at the end of the story. Clare, you have my total respect. Very brave of you to write this as I'm sure it must have been so difficult and heartbreaking for you. Thank you from the bottom of my heart for telling this topical story.

This has to be my favourite book of 2019 and my favourite of Clare's. You should be very proud of yourself and your family.

"Max and Pip are the strongest couple you know. They're best friends, lovers—unshakable. But then their son, Dylan, 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?"

PART 1 -
Dylan has a brain tumour that the Medical Team at the Hospital decide would be pointless to operate on any further. In their opinion, the best and kindest path would be to offer Dylan palliative care full of love, tenderness, calm and comfort. Pip, as a Mother has seen Dylan go through so much pain and suffering and agrees that this would be for the best. Dr. Leila whose opinion they trust is also of the same mind and knows how much the whole family has gone through as a result of Dylan's illness and long stays in hospital. Pip knows if Dylan dies it will hurt for ever, but she can no longer let him suffer. She wants for him no more pain, no drugs and no more suffering in a hospital bed.
However, Max does not want to give up on his son and wants to take him to America for further radiation treatment and hopefully prolong his life. But this would still mean that Dylan is still unable to walk, talk, grow up as a healthy young boy but Max feels any life is better than letting him die, regardless of the quality of that life. Ultimately the parents cannot agree and they take the case to Court for a decision on their son's future.

PART 2 -
This is where the book takes the Reader on a completely different journey, where we are rewarded with the gift of experiencing both scenarios. The Author allows us to see what would happen if the decision went in Max's favour, but also in a sliding doors moment, what would happen if the decision when in Pip's favour. The emotional turmoil that they both still go through, continually questioning their own judgement and wondering if ultimately they let their heart rule their head and had really done the best for their son.

I loved the bit where Pip explains how sometimes you only know for certain if you have made the right decision once you've made it. Either it slides smoothly into place or sits spiky and misshapen in the corner of your mind saying This isn't right- you've made the wrong decision.

The hospital scenes are written with an insider knowledge of such situations, especially the Paediatric Intensive Care Unit which is somewhere no parent ever wants to have to spend time in, and later I discovered Clare Mackintosh did have first hand experience. This shows in her descriptions of the bleeping machines, fluorescent lighting, smells of disinfectant, feel of the anti-bac hand gel and endless hours sat by the side of your child wishing things were different. Experiencing the bitter jealousy whenever another child was well enough to leave PICU and you silently scream "That's not fair, why them and not us, when will it be our turn?"

The part where Leila tells them there is nothing more they can do and they ask the ultimate question of "How long?" broke my heart, how many parents before and after Pip and Max were to be given bad news in the crying room and told there is no hope for their child.

I sobbed by the time I was only a little way into the book when Leila explained that the centimetre of tumour left behind after surgery (because removing it completely was impossible) was growing back slowly. I have spina bifida occulta and have a tumour at the base of my spine with the same prognosis and have had and will continue to have endless operations while Surgeons do their best, but I am an adult and I cannot imagine a child and it's parents experiencing something similar.

I applaud Clare Mackintosh for allowing us to see what was in the future if we were able to go down both forks in the road, even though the dual timelines and narratives did become confusing in places, but nevertheless I loved this book and will treasure it for a long time.

This will go live at the link below on 12 June.

Hi and welcome to FromBelgiumWithBookLove where I’ll be talking today about Clare Mackintosh’s new book baby. I’ve been a fan of Clare’s ever since I Let You Go, which, like Clare’s other books since, was an outstanding psychological thriller. With After the End, she goes down a different road, and frankly, one I most likely wouldn’t have joined her on if she were not the author I know her to be. Sometimes you pick up a book because you’re drawn to its premise, because the synopsis is right up your street; sometimes the premise is more like a side alley off your street but you pick up the book anyway, because you love the author’s writing and you have faith in the author’s ability to capture and hold your attention. The latter is exactly what I did and I didn’t regret it for a second.

After the End is the story of Dylan. He’s just a toddler, but he has a brain tumour and he is being treated for it in hospital. That fact alone broke my heart. There is just something so unfair about someone so small having to go through all that.

The first part of Dylan’s story is told from the perspective of his parents, alternating with the perspective of his doctor. It is really quite refreshing that the focus is not only on the desperate parents of this very ill little boy, but also on his doctor, who is just as desperate and equally powerless, especially when it turns out that the treatment is not working, on the contrary, the tumour has grown.

The pivotal moment in the story is when Pip and Max have to decide what to do: let their boy go and make sure he doesn’t have to suffer, or go to whichever lengths necessary to prolong his life, regardless of what kind of life that would be. I’m pretty sure that the toughest choice for a parent is whether to keep their child alive and quite possibly suffering, or to say goodbye earlier. As an outsider, my choice was pretty straightforward: stop the treatment, don’t have the surgery that will cause at least some brain damage, you can’t save your child, you’ll only postpone the inevitable and sure he’ll live a bit longer, maybe even a lot longer, but odds are that he’ll have to live with pain, he’ll never be independent, he’ll never be happy. To my mind, the choice to continue to fight a lost cause is a selfish one. But then I am not a parent, let alone one with a terminally ill child.

For the first time, Dylan’s parents don’t see eye to eye, and in the end, the case is brought before court and an impartial judge must decide. Here is a sliding doors moment where the story becomes two stories: one where the judge rules in favour of further treatment and one where the judge orders all treatment to be stopped, except palliative care. It was both fascinating and heart-breaking to see what happens in each story, with Dylan, and with his parents as a couple. I kept wondering if in the end they would end up in the exact same place, if there would be some kind of serendipity, is there such a thing as “meant to be”, are things written in the stars, is there any kind of providence.

A heartbreakingly beautiful, poignant and thought-provoking tale of love and loss, of guilt, of wanting to do the right thing and not knowing what that is, of life, of losing yourself and finding yourself, of failure and success and finding happiness in the little things, of living the worst possible thing that could happen and fighting through it, of finding a way to pick yourself up and piece yourself together again.

This is a story that makes you ask yourself what you would do, whether you’re a Pip or a Max. The fact that the author has lived through a similar loss, which I knew about before reading After the End, added an extra layer to my perception of the story, and made it even more heart-breaking and poignant.

Highly recommended.

After the End is out on 25 June.

In the UK you can pre-order:
from Amazon
from Awen Meirion independent bookshop (signed, with personal message)
from Waterstones (limited edition & signed, with blue sprayed edges)

In the US you can pre-order via Penguin Random House, in Australia via Hachette Australia and in Canada via Penguin Random House.

Many thanks to the publisher and NetGalley for the free e-copy. All opinions are my own and I was not paid to give them.

This is such a hard review to write but I imagine not nearly as hard as it must have been to write this novel.

Max and Pip face one of the toughest decisions any parent could possibly face. Their three year old son, Dylan, is brain damaged due to complications from a tumour. Max and Pip are one of the strongest couples you're bound to meet but now, they find themselves on opposite sides as each tries to decide for themselves what's best for Dylan.

After The End is a novel I had to read in bits and pieces, for fear of choking on the huge lump in my throat. The author deals with a highly emotional topic and it all feels incredibly realistic, moving and extremely heartbreaking. The story is split into two parts, the before and after. The reader is offered an insight into Dylan's circumstances and the many long days Pip spends at his bedside. The tiny slivers of hope and the plummeting realisations when things go downhill felt like a rollercoaster. There are also the wonderful friendships parents form with each other on the ward, the support they give each other and yet it must be so incredibly hard to watch another child make a recovery and ultimately leave for home when your own child lies unmoving in their bed.

The "after" in the story is split in two. The reader follows both Pip and Max but in alternative storylines. Each has to deal with the decision they made regarding Dylan's future. Was it the right one? How can you ever know? Will their marriage survive when so many do not?

I must admit that my feelings for this novel were also split in two. I thought the first part of the story was exceedingly compelling and I was right there with the characters on the ward, trying to figure out what I would do in that situation. But the second half of the story started to lose me somewhat. It seemed a bit repetitive at times and while I was still rooting for the characters to come through it all, I didn't find this second half as gripping as the first half.

Nevertheless, After The End is a beautifully written story about a marriage put under strain in the most difficult of circumstances and facing an impossible choice. A remarkable departure for Clare Mackintosh, who you may know from some excellent psychological thrillers. This was quite obviously a story that she needed to tell and she did it in the most wonderful way possible. Not an easy story to read, yet one that will remain with forever.

Wow what a roller coaster ride. Heart breaking and thought provoking. Each chapter is written from the perspective of the three main characters, who’s perspective would you relate to! Extremely well written. Highly recommend this book

Pip and Max seemingly have the perfect life. Both with good jobs, plenty of friends and best of all, a beautiful little boy, Dylan. But Pip fears that all is not well with Dylan, he seems very clumsy for two years old and despite Max telling her not to worry, she goes to her GP and soon her worst fears are realised. Dylan has a brain tumour.

We join their story with Dylan in the Paediatric Intensive Care Unit, seriously ill after a lung infection. We sit with Pip when she is at Dylan's side, hoping that one day they will be told he can go home. We rage with Max whose boss seems to have no understanding of what it is like to have someone so close to you critically ill. The story is told from the perspective of both Max and Pip as well as that of Leila, Dylan's doctor who has to deliver heart breaking news to them.

Pip and Max cannot agree what is best for Dylan and end up in court leaving the judge to decide. There have been several cases recently where parents have ended up fighting the NHS over decisions made on their child's future care and these are always heartbreaking.

Clare Mackintosh deals very sensitively with this subject. Personal experience was the inspiration for this book and it is extremely brave of her to write about this. It must have been so difficult for her. Very cleverly she avoids taking sides though she doesn't avoid making telling observations about some aspects of cases like this.

A thoughtful, emotional book which I have no doubt will be a best seller. Thanks to NetGalley and the publisher for the ARC.