I have read a few other of Clare Mackintosh's books. This one is starkly different from the others I have read, which are primarily mystery. Overall, I enjoyed the majority of the book which was more of a family drama than mystery. After the End tells the story of Pip and Max as they deal with their son Dylan's terminal illness. They're both at odds about what to do - go for a new therapy that could prolong his life (though he may deal with being handicapped) or end his suffering. The book is told is two parts: Before and After. I really enjoyed the Before part but the After part was actually a little confusing as it alternated perspectives between Pip and Max and jumped between years (the Before part also alternates between Pip and Max's perspectives - as well as the perspective of the Doctor treating Dylan). I felt like even in the Before parts they skipped time and it wasn't clear in some parts how much time had passed.

This book became that much more emotional for me after I read the author's note and found out that although this is fiction the idea behind the family dealing with a child with a terminal illness had been born from the author's personal story of dealing with a terminally ill child.

Be sure to grab some Kleenex as you tackle this book!

In this remarkable story, Clare Mackintosh shares the story of Pip and Max, parents of nearly three years old Dylan and seemingly the most solid, stable, connected couple anyone knows even when challenged by a horrific diagnosis for their son. It took three tries for me to become absolutely enthralled with this wonderfully well-wrought, heart wrenching story. It could have veered into sentimental and predictable and issues-driven, but it never did. Always, always, the story is centered on love, on intelligence and doing the best that we can possibly do under high pressure and no easy solutions. The story felt so real, the moments so wrenching and powerful that I could not believe it was entirely fiction -- and when I read the back matter, learned that Ms. Mackintosh knows Pediatric intensive care units intimately. Somehow, she has taken her own experience and distilled it into a powerful story that resonates for the reader, causing us to question who we are, what love means, what choices we might make under the same circumstances. I read the book in one day and am so very glad that I did.

The comparison to Jodi Picoult is immediate. A loving couple whose son is gravely ill. The likelihood of improvement is so dim the hospital wants to shift to palliative care. The mother who has been by her child’s side throughout his ordeal feels he should be released from the torture and pain of treatment and agrees . The father, a businessman who looks for solutions to every problem, wants to take their son to America and subject him to experimental treatments. The decision lands before a judge. So far we have the ripped-from-the-headline story that Jodi Picoult does so well. This is where Mackintosh takes the story to another level. The title After the End refers to all the possibilities that might occur depending on what the judge rules. The second half of the book flips back and forth between one story where the boy dies and a multitude of others in which experimental treatment works or doesn’t work. In each case what happens to the husband and wife and their marriage becomes the center of the story. It was a fascinating concept and the author handled it well. My only complaint is that we didn’t have a chance to know the child very well when he was healthy which thus makes it harder to be fully invested in his future. Even so, it is a gripping story that will make you ask yourself some hard questions.
Make sure you read the Afterword to learn why Mackintosh was drawn to this story.

This is a very painful, personal story, but not one I would want to read again. It is such a personal, painful story that I feel like a terrible person by not liking it, but the second half just did not work for me. I wish, when the second half started, that we stayed on one path to the end, and then re-started that second path. The back and forth of different worlds with the same characters doing the same things but slightly different in a slightly different timeline... it was just CONFUSING. And a lot of the second half was just uninteresting, maybe because we were constantly repeating everything. And the wedding at the end... was that a *PLOT TWIST* of characters getting married or did I just misread it? Because no where in either of the different timelines did I see any hint of a marriage between the people I think were getting married.

So I'm going to be a bad person and say that while the first half of the book was good, and the subject matter was excellent, the entire second half of the book was a mess and I would never really be able to recommend this to anyone. That said, we all know Clare Mackintosh is an excellent writer and I would still read any future books by her, and I hope she achieved some sort of release/closure/happiness from writing this one.

Pippa and Max are the parents of two-year-old, Dylan. He has a brain tumor and is taking chemo. He has also had surgery which left him with some brain damage. Now, the doctors are saying the tumor is growing again. Dylan may have mere weeks to live. Pippa and Max are beside themselves with worry and are searching everywhere for another treatment for their son.

The doctors treating Dylan in the UK want to give him just palliative care for the time he has left. However, Max, who is an American citizen, wants to take Dylan to Texas for a special treatment only available there. However, Pippa disagrees and doesn’t want to put him through it. Thus, the dispute goes to court.

The citizens of the UK get into it as well and set up a GoFundMe page for Dylan to pay for his trip to Texas.

Is it worth what may be more pain and confusion to put Dylan through the overseas trip and the added treatment if they can only gain maybe a few more years of life for him?

This terrible decision tears Pippa and Max and their marriage apart. Can they stay together with this awful future facing them? And what will the court’s decision be?

I sure readers will have their own opinion here. As an American citizen, I had to laugh when one character said that the medical care in the UK is the best in the world. I lived in France for many years and am very familiar with the type of socialized medicine available there. For instance, it’s pretty sad that hospitals have to wait for a wealthy donor to give them another defibrillator. I feel very blessed to have the outstanding medical care that we have here in the US. But, that’s just my opinion here.

There is confusion here because we don’t know for sure when Dylan died. Was it right away in the UK or after he had been taken to the US for extended treatment?

Pippa and Max grieved terribly and we read about that ad nauseam. I know that sounds cold, but I feel that the author added many of those super heart wrenching scenes to add more pages to the book. Not necessary. More dignity should have been exercised.

I think the reviews and opinions about this book are all over the place and I suggest that readers think hard if they want to read this.

Copy provided by NetGalley in exchange for a fair and honest review.

This book is tough, but not overly so. What would you do if your child was terminally ill? Would you make the decision to let them go or would you fight to give them a little more time, even if that time is spent confined to a wheelchair, and unable to communicate? Max and Pip have different opinions on what would be best for the their son Max. This leads to court hearings and a huge strain on their marriage. There doesn't seem to be any right decision and about halfway through the book Mackintosh shows you what would happen with Max and Pip if the ruling went in their favor - two different outcomes with similar results. Its not a happy book but its a book that makes you think. Some have compared it to books written by Jodi Picoult and I have to agree. There is a moral dilemma that doesn't have a definitive answer. I was a little confused when the book branched off into two different directions but once I got the hang of it, it was interesting to see what the author felt the outcome of Pip and Max would have been if they had made different decisions.

{My Thoughts}
The bit of the blurb from the publisher above perfectly sums up the basic premise of After the End. What it doesn’t tell you is just how much you’re going to like both Max and Pip, just how much you’re going to hurt for them, just how thankful you’ll be if you’ve never been in their shoes. This is a couple that loves each other madly, and equally adores their not yet three-year old son, Dylan. They’ve been dealt a terrible blow in a cancerous brain tumor. Dylan has already had surgery and radiation, and has slipped into a coma as the tumor has again begun to grow. There’s already been brain damage and a second surgery is not an option.

I’m giving nothing away when I tell you that Max and Pip differ on what they believe is best for Dylan, nor that they end up in court. The book’s prologue begins there, seen through the eyes of Dylan’s doctor. From there the story goes back, moving forward to that day in court. Max, Pip and Dr. Khalili alternately tell it, and do so beautifully. Each has a different voice that resonated well with me. At the onset, I found Max’s chapters a little choppy, but quickly grew used to them. Near the end of part one, the three have taken you right back to court.

From that point, After the End, took a path that I wasn’t expecting, but found absolutely brilliant. I don’t want to give much away, but I will say the second half of the book had a “Sliding Doors” quality to it that really made the book. Throughout, I found myself completely sympathetic to both Max and Pip. Each had the noblest of intentions and carried on as best they could, but there were consequences, devastating consequences.

“How can my son be a breath away from death, when evidence of his life is all around me? When I feel him in my heart, as surely as when I carried him in my womb?”

“I blink hard, looking out of the window at the barren fields until I’m sure I’m not going to cry. I’ll need her. Turns out you can hate what someone’s doing, yet still love them so much it hurts.”

In case I haven’t been clear, I loved After the End and highly recommend it to all, especially book clubs for there will be much to discuss. The end was not at all what I expected and in fact I had to read it over a couple times to make sure I had it right. I did and so did Mackintosh! When you finish the book, be sure to read on through the Author’s Note. She went through something similar, which for me always makes a novel extra special. Grade: A

Note: I received a copy of this book from G.P. Putnam’s Sons (via NetGalley) in exchange for my honest review.

If you don't cry during this book, then you simply aren't human. The only way that you can read this book, is because the author focuses on the parents and not on the child (that would make it impossible to get through). It is an interesting concept--start the story and then, using a Robert Frost poem as inspiration), tell two stories that actually (spoiler alert) sort of end up in the same place. It's kind of like a "choose your own adventure book"--and then at the end comes back to the main story. But in between you see the stories of the parents--it may not have the happy ending that most of us want, but it has two more truthful endings.

Thanks to NetGalley for the ARC for my Kindle.
Two choices for a terminally ill child- the father wants one choice and the mother the other.
This story gives you "what ifs" with both choices while keeping the reader thinking about which choice she/he would make if faced with the same situation.
A quick and captivating read involving a strong couple who realizes at the end of the book that "After the End" is "Just the Beginning."

Entirely in the minority here. Because of the subject matter and the author's connection to this story, I thought this was going to be a tearjerker. I never connected emotionally with the characters. The story just kind of fell flat and didn't grab at my heart strings like I was expecting. And once the book switched to the dual outcomes of the story, things were so confusing. It was really hard to keep straight. Also not a fan of the end. That came out of nowhere and felt out of place. I will continue to read this author as I have loved her psychological suspense novels, but this one just fell really flat for me.

This book captivated me from the first page!!

Thank you to NetGalley for my copy of this book.

What a fabulously delicious book. This book has a fantastic story line, excellent characters and is just unputdownable. I would highly recommend this book to anyone and I enjoyed it immensely.

After the End was a gut wrenching novel. In the first half of the book, you get to know Pip and Max and learn all about the struggles their son, Dylan, faces. You love both parents and their doctor and really believe they all want what is best for Dylan. But when what is best is not clear cut, Dylan’s life is set to be determined by the courts. The second half alternates between what Pip and Max wanted the court to choose. At first, it was confusing to remember how each storyline was going but once I got my stories straight, it was so interesting to see where the choices made took their family. Very thought provoking and I still don’t know what the answer should be. I hope I never have to make this type of de idiom.

I was fairly surprised with this one. For starters, it is soooooo beautifully written. We get the story from three perspectives, and they all have their unique voice. However, I got lost about halfway through. It turns in to something of a “choose your own adventure” type story, but you don’t really choose. You just get a story two ways, like the author couldn’t decide which decision should have been made. At times, it was quite difficult to follow as to what was happening in whose storyline.

While it was an entertaining read, I don’t think I’ll return to it? I also WOULD NOT recommend this to anyone with children. I don’t see how you could get through it. I don’t have kids, and it ripped my heart apart.

Parents with a terminally ill baby disagree over the course of treatment, so the case goes to court for a judge to decide. The book reminds me a lot of Picoult's My Sister's Keeper where you can put yourself on both sides of the disagreement. What's unique about this one is that the book goes on to give us the future of both decisions with unexpected twists occurring in both. Picoult fans will enjoy this.

I always get a little nervous when authors who write a particular type of book very well decide to try something new. Sometimes, it ends up working out well, but there are also those times when it turns out to be a flop. Fortunately, After the End, the latest novel from renowned thriller writer Clare Mackintosh is an example of a departure done extraordinarily well.

Everyone who knows Max and Pip considers them to be strongest couple they know. Not only are they husband and wife, but they're also best friends. Together with their three-year-old son Dylan, they embody the perfect family, until tragedy tears them apart.

Dylan has been battling an aggressive form of brain cancer for quite some time before the story opens, and when we first meet Max and Pip, they're spending long stretches of time in the Pediatric Intensive Care unit of a local hospital. Dylan has not been breathing on his own for several weeks, but his doctors are cautiously optimistic they'll be able to take him off the respirator soon.

Unfortunately, things don't end up going as well as Dylan's medical team expects, and further testing shows that Dylan's tumor has continued to grow in spite of the treatment he's been undergoing. To make matters worse, the tumor itself plus the surgery necessary to remove a part of it has left Dylan with irreversible brain damage. Now, Dylan's medical team puts a terrible question to Max and Pip. Do they want to stop treating Dylan's cancer, allowing him to die with dignity, or do they wish to continue pursuing forms of treatment that might extend his life?

For the first time since they got married, Pip and Max find it impossible to agree on what comes next for their son. Max is desperate to extend Dylan's life for as long as possible, even if that means leaving the UK and seeking treatment in the US. Pip, on the other hand, isn't sure that's the right thing to do. Although she hates the thought of losing her son, she's not convinced that exposing him to more treatment that has little chance of getting rid of the cancer is really in his best interest. And so, the courts get involved, propelling Pip, Max, and their tragic fight into the public eye.

If you've ever read one of Ms. Mackintosh's thrillers, you know she has a definite way with words. Her writing is incredibly vivid and evocative, making me feel as though I was experiencing this crushing sadness right along with Pip and Max. There is a stark beauty in her descriptions of days spent on an ICU ward that choked me up on more than a few occasions.

About midway through the story, Ms. Mackintosh throws in a twist that will completely blow your mind if you're not expecting it. Rather than exploring the actual outcome of the legal proceedings, she begins writing two different time lines, each of which examines what the lives of the characters might look like if the judge decides in their favor. So in Pip's timeline, Dylan does not undergo further treatment, while in Max's chapters, he and Pip move to Texas in order to obtain a specialized radiation treatment for Dylan's cancer. This might be difficult to get your head around at first, but if you just surrender to Ms. Mackintosh's moving prose, all will eventually become clear.

Pip and Max aren't our only narrators. We also see events from the perspective of Leila, one of the doctors looking after Dylan. I enjoyed spending time in Leila's head, because not only is she a fascinating character in her own right, but she allows the reader to see how difficult cases can forever change a medical professional's outlook on what it means to actually lead a meaningful life.

This is not a happy book. In fact, it's honestly one of the saddest stories I've picked up in quite some time, but it's also one of the most beautiful. It touches on difficult issues with so much sensitivity, and I found myself fully empathizing with everyone involved in making a decision about Dylan's future.

I'll always be a fan of Ms. Mackintosh's psychological thrillers, but I'd also like to see her write something else that packs the same type of emotional punch as After the End. It's a masterful story that is sure to touch the hearts of readers everywhere, and I'm so glad to have read it.

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When their toddler’s virulent cancer returns, Pip and Max have to decide between treatments that will cause further brain damage, or doing nothing. But when they don’t agree, the decision goes to court, and they’re on opposite sides. Mackintosh’s heart-rending family drama—a departure from her usual thrillers—will leave you wrung-out and pondering life’s what-ifs.

Thank you so much to @netgalley and @putnambooks for the free review copy of @claremackwrites After The End.
Synopsis from the publisher: 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?
This book was extremely hard for me to read, and led to more than one occasion of me ugly crying a public place. The hardest job in the world is being a parent, not because of the long hours, the cleaning, the cooking, the driving, but because heaven forbid you might be faced with the situation these parents Pip and Max were faced with in this book. I found the beginning of this book all to real and was having flashbacks to being told that my daughter Lilly had no chance of surviving (Thank goodness they were wrong and she is a fighter),The long hours in the NICU and the guilt of not being able to do everything and more to make everything and more to make everything better for my girls. This book shows that these situations put parents in impossible situations where there are no right answers and no winners. The dueling realities that this book plays out in shows how much something like the loss of a child changes your whole universe no matter how it plays out. I really think the unique way in which this story is told and slowly unfold does incredible justice to the experience of grief while showing compassion for the subject that it is covering. ⭐️⭐️⭐️⭐️⭐️

I have to admit that I was gutted by this novel. The first half concentrates on the "Before," before a child falls ill, before a devastating diagnosis, before initial treatments, before the most difficult decisions must be made. We hear from both parents and from a doctor involved in the child's treatment. The realism of the character portrayals, and the clarity of their voices was what I most appreciated.
The premise of the novel is that the parents cant agree of course of treatment, so the courts must intervene.
The second half of the novel is the "after,' and I found it very different in style. The courts can rule in only one parent's favor. We see the scenarios play out for each parent, for each possible decision.
There is so much I wanted to debate and discuss, I needed someone else to talk over this book! I believe it will make a superior book discussion selection. I see that early reviewers have likened Claire Mackintosh to Jodi Picoult, and I would have to agree.
I received my copy through NetGalley under no obligation.

Pip and Max Adams were never happier than when their son Dylan was born. He was a vibrant curious little boy who made everyone he came in contact with smile endlessly. And just before he was to turn three, he was diagnosed with a brain tumor.

Now Pip and Max are faced with a decision that no parent should ever have to make – continue to seek experimental treatment that may only extend his life for a year or maybe just a few months or to let him go.

As shattered as she is, Pip watched Dylan’s tiny body endure so much and she doesn’t want him to suffer any longer. But Max wants to continue to fight for more time. If they can’t agree, the NHS and courts will step in to decide Dylan’s fate. And the world as they know it will never ever be the same.

“In a few moments, the doors will open, and the next act of Dylan’s story will begin. No matter what the judge’s ruling, Max’s and Pip’s lives will be irreversibly changed today, and Leila knows they will forever question the choices they made in the weeks leading up to the hearing. But when you stand at a crossroad you cannot see each destination, only the beginnings of the paths that will lead you there. All you can do is choose one, and walk, and hope that someone will walk with you.”

After the End is one of the most beautifully devastating books that I have read in quite a while. Told in alternate points of view and from different choices made, Clare Mackintosh gracefully captures the hollow pain of loss and the sparks of hope that drive us on.

I understood both Pip’s compassion and Max’s determination. How each desperately wanted a different outcome. Their struggle was so poignant that I found myself on the verge of tears after almost every page. And I will never forget how it felt to stand with them – even if it was for such a fleeting amount of time…

“Two roads diverged in a wood, and I - I took the one less traveled by, And that has made all the difference.
~ Robert Frost”

Many thanks to NetGalley, GP Putnam's Sons, and Clare Mackintosh for the opportunity to read and review her latest novel. I think I have told everyone I know that her novel, I Let You Go, remains one of my all-time favorite books. This one will not disappoint - do not miss reading this book, no matter how difficult the subject matter may be.

An impossible situation - a happily married couple with a two-year-old son who develops brain cancer and has reached the end of treatment possibilities. The story opens in the courtroom where it is up to a judge to choose whether the boy receives only palliative treatment or is allowed to travel to the US for proton beam treatment not available in the UK, because the parents can't come to an agreement. The book veers into the path not taken glimpse into different futures.

Told from the viewpoints of the parents, Max & Pip, as well as from their doctor's, this book will tear at your heart. Reading the author's note, the book is written from the heart. No matter how heartbreaking the subject matter, the book is beautifully written and gives such hope and promise.

An absolute must read!