I first came to Clare Mackintosh’s work when I had the chance to preview I Let You Go several years ago. Until now, I’d only read her work that might be considered thrillers or suspense. Her upcoming After the End is different from what I’ve read by her in the past, but in an incredibly moving way. While I’d wavered after reading Let Me Lie last year, I couldn’t put After the End down. From the unique narrative approach to a difficult topic, through the emotional upheaval of such well-developed characters, After the End is unlike anything I’ve read before (or am likely to read again for a very long time).

Philippa “Pip” and Max Adams are trying to make the best of a bad situation. Their son, Dylan, was diagnosed with a brain tumor at two-and-a-half years old and he’s been in the PICU following treatment. Just when they’re hoping to be able to take him home, they receive worse news: the tumor is back and growing again and the medical staff believe that the best course is to stop treatment and limit their efforts to palliative care. The final decision is up to Pip and Max. But they disagree on what they should do and the issue ultimately ends up in court.

Divided into “Before” and “After” as well as switching perspective between Pip, Max, and their son’s primary doctor, Leila, the narrative approach Mackintosh takes to her subject matter completely blew me away—mostly the way she wrote the “After” half of the book. The “Before” half of the book looks at how not just Pip and Max deal with the emotional and logistical strain of Dylan’s being sick, but how a wider range of couples deal with it (individually and as a pair). It’s in that first half that a lot of the themes surrounding strength—visible, demonstrable, personal—and doubt are introduced. But it is in the unexpected but brilliant way Mackintosh presents the “After” half that the themes are more directly and effectively explored (and as much as I want to gush about how brilliant that section is, I feel like doing so would be a kind of spoiler so I shall refrain).

Despite their divided opinions on what to do about Dylan, they never doubt their own feelings about each other (though there are moments when doubt about having that love returned creep up). Seeing the impact of their devastating situation on their marriage is brutally compelling, whichever way you slice it, and I’m inclined to believe it’s because the issue isn’t how they feel about each other but how their experiences have changed them individually—what fears and doubts have been planted, what wounds are still healing and where do they inadvertently (or unavoidably) bump into each other’s bruises.

I’m usually pretty horrible about reading Author’s Notes and other appendices and things of that nature; generally, I like to focus on the story at hand and what it actually says rather than look at whatever it is the author says they were trying to say. But I do think everyone should read the “from the author” note at the end of After the End. Mackintosh emphasizes that the story is not about loss, but rather is about hope. Though it has its moments where the pain of loss transcends the characters and their struggles, I believe Mackintosh has completely succeeded in realizing the quiet resonance of hope in the novel.

After the End will be available beginning June 25, 2019.

Oh, Pip... What a story! Cried like a baby several times, especially when she is allowed to take her child outside the hospital to sit on a bench and have a quiet moment. Oh... I love how Ms. Mackintosh laid out the story by showing how the two parents make different decisions after finding out their child has a terminal illness and the courts have to pick one. It was so interesting to see things from both Max and Pip’s viewpoints and how the two different decisions could alter their lives. So well done. And then I finish the book and read that the author lost a child herself and it makes so much sense to me how well she described every emotion. (I’ve also lost a child, my son Aaron). Brilliant. Thank you for this.

Great read! Heartbreaking and gut wrenching, this is a story about a couple with a terminally ill toddler, what happens during his illness and afterwards.Deep grief and coming out the other side. A surprising twist had me shaking my head in wonder. A tearjerker well worth reading.

I don’t have words to describe what I think about this book, other than WOW, bloody, WOW! This is not only a book about a very sick little boy, but also about the unbelievable strains a marriage must endure, especially in the case of Pip and Max. There is no relief, not even after the end, but as the author says, there is hope.

Clare Mackintosh has based this story on her own painful experiences, so be prepared for a tough and emotional ride. As painful as it is, this book is one to be savored. Every single chapter brings a new awareness of how parents feel when faced with an impossible decision to keep their children alive or to remove all life support and let them die. After having read this book, I can say I’m a little better acquainted with the courts and legal decisions in such a tragedy, and the courageous path both doctors and parents must sometimes take.

I loved the characters, especially Leila. Her acute senses, her experience, her observation of the relationship between Max and Pip is beautifully drawn. When research is of such a high standard, it makes a difference to the reader. You learn something and that’s time well spent on a book.

It took me a lot longer to read this book and to comment than I have with any other. It is with some reservation that I say I ‘enjoyed it.’ It was harrowing and draining, but I couldn’t put it down. A departure from this author’s usual thrillers, it initially threw me for a loop. But I wouldn’t have missed it for the world. A book like this is definitely going to be a women’s fiction classic. I had read her book, I Let You Go, so I knew I was in for a very intricate, powerful read.

The only thing I didn’t like was the timeline, but in hindsight, how else could the author have done it? There were places where I had to go back and read sections over again as I did get lost along the way.

I can’t thank the author enough for writing it, and special thanks to Netgalley and to Penguin Group Putnam for an advance copy of this deep and and moving book.

This was such a heart wrenching book but I did like it. Dealing with a sick child has to be the hardest thing and deciding on treatment is a difficult decision. I really felt for the characters. I have to admit this book stuck with me and depressed me..

A riveting exploration of what happens when the seemingly perfect relationship is challenged by heartbreaking--and heart-changing--choices. These characters are wonderfully compelling and their dilemma will haunt you.

Oh man. This book was emotionally exhausting. When I receive Advanced Copies, I like to go in fairly blind to the plot except for knowing the genre and basic concept. For that reason, this book hit me hard in the heart. The relationships were so believable that I could practically picture myself in their position, making it even more emotional. I was delighted and surprised by the second half of the book, which alternates chapters between two different realities based on which decision they made. That was a huge risk, which I think many authors couldn't pull off, but it was executed beautifully.

I was already emotional, but was blown away by the author's revelation at the end that she experienced something very similar in her life. I can't imagine the strength it takes to write something so personal - I applaud her. I'm used to her as a thriller author (I actually listened to Let Me Lie on audio while reading this) and am truly amazed by her ability to navigate different genres. Well done!

Clare Mackintosh should always be considered a first buy for general adult fiction collections. Another gem that will attract both her loyal fans and new readers alike.

This book was beautifully crafted, touching on a controversial topic of palliative care. It brings out the humanity in the parents, and in the tough decisions that family members are forced to be confronted with in situations where their loved ones are suffering and dying.

This is a story about relationships, about family, about love. It is about the love that one parent has for their child and how that can manifest in different ways in how they want their child's future to be. It is touching, and a one of a kind story that definitely hits you in the heart.

I tried to read this one a few times. It just isn't holding my attention. I most likely won't finish this one.

(Free review copy)
I loved Clare Mackintosh's previous book. This one is different because it's not a thriller but her style is the same: engaging and personable. I loved the premise of the story of 2 parents who want to make different choices for their very young ill son. I loved the characters and the way they grew with the story and it's paths. I don't know whether I enjoyed the way the book took a turn or ended (which is why I give it 4 stars and not 5), but I thoroughly empathized with each parent and with their experience. Mackinstosh again draws the reader in with her compassion, style, and gentleness -plus a really great story- and we cannot let go. And the author's note makes this book even more special.

This is a fascinating book because of its structure, a bit of which I will talk about here. A British/American couple have a two year son who gets terminal cancer. One parent wants to end all care, the other wants to pursue extreme treatment. Their son's case goes to a judge to decide on the best path. That isn't very unusual, but in the middle of the story it branches into two different endpoints, with each one the result of the court deciding one way or another. What happens to the family? How does the marriage change and does it eventually survive or not? The execution is finely drawn, and you get to see the differences in the emotional connection between the couple as the wrestle with the consequences of the court's decision. I think it is a very courageous book, once you realize that the author is writing from her own perspective having had a terminally sick child of her own. Highly recommended. I think this will be a book club favorite for years to come.

What a roller coaster! I spent the first half of the book worrying about little Dylan, and the other children at the PICU. I spent the second half of the book wondering if I wanted Pip and Max to stay together, divorce, go their own ways or make it work. A truly satisfying book that sticks with you "after the end," because like all good books, the characters keep coming back to your mind, and you think about what they must be doing now?

I wasn't really impressed with the way the story was written. It was difficult to figure out what actually happened. Even at the end of the story I still was confused as to what actually happened.

Not quite sure how to rate this/what to say except I found this well-written book SO DEPRESSING that I often wanted to stop reading it and walk away. Very tough to read, but I persevered.


Husband and wife Max and Pip disagree over treatment [or not] for their three-year-old son, Dylan, who has a medulloblastoma.

"From the author" [at the end of the novel] reveals that Mackintosh and her husband also had a crtically ill child and faced the same decision. So, I'm sure this book was a cathartic experience for her.

Structured as before and after with timelines and voices jumping back and forth [disliked]. An emotional story of love, marriage, parenthood, hope--and after. What if? Mostly told from the point of view of Max and Pip, but also their doctor, Leila. With intervening parental drop-ins [Mostly Max's mom].

I'm going to have to read blurbs more carefully before requesting. This one was tough.

So I can't write more. I can't necessarily recommend as it was a chore to read it. As I noted, WAY TOO DEPRESSING. Colored everything I might write.

I have read Clare before, I really liked 'Let Me Lie', the others were good.
I saw this book was coming, but I was reading other books, so let it go by me.
I kept hearing about and seeing it - so I decided to read it. I am glad that I did.

2 parents -- 2 different approaches
Becoming a parent changes people.
Becoming a parent of a sick child changes people more!
2 people who are strong as a couple - now have opposing desires...
who is right? Does that make the other wrong??


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

This book was a tough one. If you're looking for something upbeat and cheerful, don't pick this up. However, it was a beautifully written story about marriage and loss, and I couldn't put it down.

Max & Pip are devoted to their young son, who has terminal cancer. When they can't agree on his treatment, they are forced to fight one another for what they feel is best for their son. The story is painful and heart-wrenching, but just when you think it's all too gloomy and depressing, the author sprinkles in a little bit of hope to keep you going.

This is not really a story about their child with cancer, which is what I was expecting when I picked up this book. Of course it centers around him, but the story is truly about the marriage and relationship between Max and Pip, and what having a sick child can do to a marriage. I know that many couples end up splitting up when they go through traumatic events like having a terminally ill child, and it's not necessarily because there's a problem or they don't get along - they've just dedicated all of themselves and their energy to their child and have nothing left to give to their spouse.

The author did something very interesting in the middle of this book that I have never seen in a novel before. There are two different endings, two different outcomes, each of them shared in alternating chapters. I won't lie, I found it a little clunky at first. But I got it after a few chapters and it didn't end up bothering me too much. I applaud the author for trying something new and different.

I was saddened to read about the author's story, that she herself had dealt with a terminally ill child, and that's what inspired this novel. It must have been absolutely devastating to write this book and relive the experience, but she did a wonderful job doing so. I recommend this book and will be ordering it for my library when it's released.

This book was rewarding and difficult to read at the same time. It told the story of a family that had a very ill young child. It was sad, upsetting to read but the story lures you on. There are two different endings possible and the author explores them both.
Highly recommend this book.

What I expected: another tense psychological thriller from Mackintosh. What I got was something quite different and quite remarkable.

Pip and Adam are happily married and delighted with their son Dylan. He's perfectly normal...until he isn't. At two, Dylan begins having headaches and stumbling and falling frequently. A brain tumor, surgery, chemotherapy, and more problems.

Handled with such skill and sensitivity, the heartbreaking story of a child and his parents never becomes maudlin. When the hospital decides that only palliative care is needed, both parents are devastated.

This is the story of Pip and Adam and Dylan. There is no hope of a good outcome--Dylan cannot be cured. Both parents love the child to distraction and have endured exhausting months of fear and sadness watching their son deteriorate. The dilemma they face is appalling, and when Pip and Adam can't agree on the way to proceed, the matter moves to the court system.

An unusual twist takes place after the court decision, "after the end." A powerful book that was nothing like what I expected, but was an emotional exploration of all the repercussions of love and loss and resilience.

(The tenderness with which Mackintosh writes is enormous and has something to do with her having lost a child to meningitis.)

Read in April; blog review scheduled for June 12.

NetGalley/Penguin Group
Literary Fiction. June 25, 2019. Print length: 400 pages.

Alert Alert you will need a full box of tissues .A heart wrenching story of life altering choices painful decisions people way of coping.So beautifully written such a difficult topic Highky recommend.#netgally #penguinputnam