After the End, by Clare Mackintosh (Review)

After the End
by Clare Mackintosh

Genre: Fiction, Contemporary

Length: 400 Pages

Release date: June 25, 2019

Publisher: G.P. Putnam’s Sons


Max and Pip are the strongest couple you know. They’re best friends, lovers—unshakable. But then their son gets sick and the doctors put the question of his survival into their hands. For the first time, Max and Pip can’t agree. They each want a different future for their son.

What if they could have both?

A gripping and propulsive exploration of love, marriage, parenthood, and the road not taken, After the End brings one unforgettable family from unimaginable loss to a surprising, satisfying, and redemptive ending and the life they are fated to find. With the emotional power of Jodi Picoult’s My Sister’s Keeper, Mackintosh helps us to see that sometimes the end is just another beginning.


My thanks to G.P. Putnam’s Sons for sending me an advance copy of this book in exchange for an honest review. All opinions are my own and are not influenced by the publisher. 

“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 not my usual choice for a book. I was asked to review it by the publisher and was a little hesitant about accepting; parenthood is central to the story, and I worried that, as someone with no kids, I would struggle to connect with the two main characters. I found myself pleasantly surprised; Mackintosh has brought Max and Pip to life in these pages, and I found my heart aching for them as they struggled with their son’s illness.

The novel alternates perspectives between Max and Pip, and it is basically divided into two sections. The first half of the book explores one cohesive story: Max and Pip have been dealing with Dylan’s illness for quite some time when the novel begins. Things have been starting to improve, but he takes a sudden turn for the worse, he suffers brain damage, and the chance of recovery drops to essentially zero. Max and Pip are asked to decide how to handle Dylan’s care given this development: continue treatment to try to extend his life or offer palliative care only? For the first time in Dylan’s life, Max and Pip cannot find a way to agree on what’s best for him. Because there is no parental consensus, Dylan’s case ends up in court.

This leads to the second half of the novel, and Mackintosh made an interesting choice to allow the plot to diverge here. The second half is telling two separate stories: one exploring the aftermath of the court ordering that Dylan be allowed to continue treatment, and one where Dylan was given hospice care. Both parents are forced to doubt their choices, as anyone would in such a situation. There was something really powerful in seeing each character struggle with all the “what ifs” while seeing those “what ifs” play out in a parallel story.

One of the central messages of After the End is that often there are no easy answers or right decisions. Max and Pip both wrestle with immense regrets no matter how they choose to care for Dylan. The struggle within their marriage was also portrayed beautifully. They love one another fiercely, and they seem to know that they both want what’s best for Dylan, despite disagreeing vehemently about what that means in practice.

After the End is thoughtful and poignant. It asks us to think about a lot of difficult moral questions without pointing us towards any particular answer, and I feel this is something a lot of the best books should do. It’s a heartbreaking but somewhat cathartic read for anyone who has struggled with the loss of a family member after a prolonged illness.


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