After the End is my new favorite book by Clare Mackintosh. This book reads like a Jodi Picoult novel for the first half. There is family drama, alternating narratives, and a legal battle. Then you get to the second half and it has you shaking your head in absolute confusion. Keep reading! It'll sort itself out. Be sure to read the author's note at the end. It left me devastated. Read and enjoy!

After the End will leave you thinking well after you finish the book about the wonder and fragility in our everyday lives. This is the first book by Clare Mackintosh that I have read, and I could not put it down. At times this book was not easy to read, my feelings were all over the spectrum, I went from feeling joy to deep sorrow, and everything in between. This author has dug deep in her soul to have written such a beautiful heartfelt story.

Clare Mackintosh gives us a story about two people, Pip, and Max Adams, who live a life built on love, trust, and mutual respect. Two people devoted to each other and their toddler, Dylan. They share a life where they are in sync with each other, and then tragedy strikes. Their son is diagnosed with a terminal illness. This illness is monumental, crushing, and it becomes a force all its own, turning their world upside down. Then, they are faced with making an impossible decision; do you let your child pass away with supportive care or do you do everything medically available, which will only delay the inevitable and possibly sacrifice the quality of their life? After the End addresses this very controversial, complicated issue with love and grace.

Ms. Mackintosh cleverly writes this book in two parts, "Before" and "After," and the "Before" and "After" can be looked at in different ways. For me, it was not just about before the trial and after the trial, but moreover, it was about before the loss and after a loss how people cope when confronted with the same situation.
The "Before" part leads us through the heartbreak of finding out that Dylan has a brain tumor and is subsequently losing the fight against this horrible disease. The doctors have nothing more to offer Dylan but supportive care. However, Max doesn't agree with this, and he finds an alternative treatment. A decision must be made on the future of Dylan's treatment, and a lawsuit ensues between Pip and Max.

The second part of this book describes what happens "After" the court hands down their ruling. The twist that Ms. Mackintosh throws at us is the two different scenarios that come from the two different outcomes of the trial, from Pip's point of view and alternating with Max's point of view. Each viewpoint is giving a different perspective and where it leads their life. I enjoyed reading the two different views; each one was equally as heartbreaking: two different roads, two separate decisions, two different outcomes. This book shows us that life is full of choices, but how do you know what the correct choice is. Sometimes you never know.

When you finish this book, please read, "from the author." I found this book at times challenging to read and was unsure of how to processes it. However, what helped me understand where this book was coming from was the "from the author" section. One thing I have always said about parenting is that; parenting is the hardest job you will ever love with your whole heart. This book, for me, was about hope and no matter what life hands us, it is always worth living it the best possible way. I highly recommend this book.

***I kindly received this galley by way of NetGalley/publisher/author. I was not contacted, asked, or required to leave a review. I received no compensation, financial or otherwise. I have voluntarily read this book, and this review is my honest opinion .***

How far do you go to save your child’s life? Is too far such a thing? This is the division between parents Pip and MaX as they decide what to do next for their 3 year old son, Told from multiple points of view, including dr treating the boy and it’s affect on her, this book moves quickly. Emotional. A must read for book clubs.

I have enjoyed Clare Mackintosh’s first books immensely. They are thrillers you can’t put down. This is totally different but you won’t put it down until you wipe that last tear.

Max and Pip’s 3 year old son Dylan has been battling cancer. When he is taken off of a ventilator he has been on for a while, the doctor tells them the cancer has grown. They have the decision to try and continue treatment to maybe give him a little more time, or end it and let him die. Max wants to prolong it and Pip wants it all just to stop. It ends up in court and as we await the decision, we are taken along the two separate timelines, the whatifs.

I loved how we got to see it through the lens of both sides. You always wonder in a story what would happen if only it went the other way. Neither was perfect. Neither was wrong. You put yourself in their place. What would you do? I loved both characters very much. I wasn’t angry at either. I was sad an awful lot while reading. I think the book might be tear-stained now.

I also love how we got to look into the doctor’s point of view, as well. Leila was exactly what you would want in your doctor. She was straight and to the point, yet she cared so deeply about them, even as she dealt with her own life struggles. I loved how observant she was while watching Max and Pip. She picked up on the subtleties.

You will feel everything when you read this lovely book. You will feel it deep into your soul, especially if you are a parent. Even if you are not, we all have to make decisions that we wonder about. I know I did when I had to decide on what to do with my mom at the end of her life. When you reach the Afterword and find out that the author had to make this decision for her child, you will really understand the depths of what you just read. This is a lovely, sad, uplifting book. You need to read it.

Thanks to Netgalley and Putnam for an advance copy of this lovely book.

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 Thoughts: After the End is an emotional story that spotlights a family in crisis. Alternating between the perspectives of Pip, Max, and even Leila, the doctor in the middle of it all, we follow the before and after moments of Dylan’s life.

We are thrust into a legal battle, a media circus, and an emotional tug of war that heightens the intensity of the crisis and the family pain.

I couldn’t stop reading the story of Pip, Max, and Dylan, although the leaps on the timeline were a little confusing. We went back and then forward so often that I felt a little lost…until I decided to just flow with the events and immerse myself in the moments.

As the story came to its conclusion, I did feel connected to the characters and will not forget them. 4.5 stars.***My e-ARC came from the publisher via NetGalley.

A brave, soul-baring novel by an author who actually lived through the tragic loss of her child. The first half of the novel explores what happens to a family fighting for health for their desperately ill child. When there is no longer medical hope but the parents cannot agree on the next step, the court steps in to make the decision for them. The parents are effectively and believably described and the situation feels authentic.

The second half of the novel alternates between 2 outcomes: if the judge decides with the mother to not prolong life and what happens for the following couple of years or if the judge decides for the father to pursue every possible medical opportunity and again, what follows. This part was a bit confusing as it jumped between the two scenarios that were so similar in places. The author has achieved the creation of a novel that is not maudlin or overly sad given its tragic premise.

Thanks to NetGalley and Penguin Group Putnam for the ARC to read and review.

A heartbreaking portrayal of life with a terminally ill toddler and the decisions that have to be made regarding health care. In my mind, the most valuable take away from this book is the reminder that we should not and cannot assume we know what we would do in such a situation. The story is told from the perspective of Pip and Max as well as their doctor Leila. For the first half of the book, it is a united timeline moving toward a climax. The second half of the book shows two paths from that climax -- one from the perspective of Pip and one from that of Max. Dual timelines work very well in books like "Maybe In Another Life," but in this one there is too much repetition. I am a big Clare Mackintosh fan since she blindsided me with a massive plot twist in "I Let You Go." This one fell a bit flat for me, but I will still be anxious to read her next book.

A big thank you to Penguin and NetGalley for a digital ARC in exchange for an honest review.

I came into this novel expecting a quiet thriller full of Mackintosh's signature twists. However, this book is NOT a thriller. It's a family drama that follows a couple that is faced with an impossible decision: continue medical treatment for their terminally ill and brain damaged son, or stop treatment and allow him to die. The fallout from the decision is detailed in an intriguing before/after story structure.

For fear of spoiling this book, all I will say is that I really loved this book. It was emotionally wrenching and incredibly thought-provoking, but at the same time, beautifully hopeful. Highly recommend.

After the End is an intimate portrayal of an impossible situation. I found it thought provoking. I plan to introduce this title to my book club. The content is certain to stir interesting discussion. Clare Mackintosh’s writing conveys incredible emotion. From beginning to end I was invested in Pip and Max. The storyline is constructed in such a way that while reading I felt torn in two, unimaginable anguish, uncertain and unsettled, but also incredibly hopeful. After the End should not be missed.

Max and his wife, Pip, are a perfect couple. And added to their perfect lives is Dylan, their son. When Dylan is diagnosed with a brain tumor their lives are forever changed.

Pip spends every minute in the PICU and Max is back to work and struggling with not being with Pip and Dylan. After so many months the news they receive from the latest scan is not good. They have a decision to make and if they can't make one, the NHS will.

This first half of the book was heartbreaking and I can't imagine having to make a life or death decision for your toddler. What would you do? Do you let go? Do you fight, knowing you will lose?

The second half I was confused. It wasn't clear to me that this was a What if? story. What if the judge says no? What if they judge says yes? I was confused right up until the end. That is when I figured out that each of them was telling the story of what their own outcome would be. But I really wanted to know which one happened.

NetGalley/ June 25th, 2019 by G.P. Putnam's Sons

I received an ARC of this novel from Netgalley in exchange for an honest review.

Heartbreaking novel about a couple at odds over end of life decisions for their young son. The story was beautifully written.

Where do I start about this amazing book? Now disclaimer this book will break your heart into a million little pieces. I found myself sobbing at parts of this amazing book. After The End makes you think about things you never thought you would ever ask yourself.
After The End is seriously one of my favorite books of 2019...maybe ever...

This one really got me. Max and Pip, a couple who had struggled with infertility finally get pregnant and are able to enjoy just two sweet years with their little boy before he is diagnosed with a brain tumor. It’s horrible.
And in the beginning they are that adorable family where the parents are invested in their child, make sacrifices and are just cute as pie together. And of course, as we all know when someone gets sick–especially a child, that all comes to a screeching halt.
Things get ugly, people don’t agree. But one thing that never changes is Max and Pip’s intense, searing love for their child. Even if they interpret that differently.
I don’t want to say much. I just want to serve this book to you on a silver platter. You must read it! The book’s description compares it to My Sister’s Keeper by Jodi Picoult, which is one of the best books I have personally ever read. And honestly? I feel exactly the same way.
After the End is a story of how life rarely turns out the way we thought, or hoped. It’s a story of love that endures all. And a story about how the choices we make have lasting effects on the rest of our life. I can’t recommend this book more.
Special thanks to Netgalley and Penguin for an e-galley in exchange for my honest review. This one is out June 25, 2019.

After the End by Clare Mackintosh is an emotional standalone novel. I have read and loved all of Mackintosh’s previous suspense thrillers, and was surprised that this novel was not a suspense, but an emotional tearjerker. After the End is a story that she needed to write, as it was so close to her heart.

We meet Pip and Max, a wonderful couple, happily married, but life changes when their son Dylan, becomes very sick with a brain tumor. They both help each other get through the emotional agony of watching their son go through so many operations and medicine to find a way to cure him.

As Dylan becomes sicker, with the lead doctor, saying that they need to do the unthinkable, since the tumor has grown and his survival rate has decreased, and all they can hope for a few more years. Dylan is at the point where the damage to his brain is irreparable, with him unable to talk, walk or communicate. This is where the story changes, and Pip and Max become divided. Pip does not want to see her son suffer anymore, as ‘it is not a life’, and she wants to allow him to die peacefully. Max is the opposite; he wants to try another procedure that will bring him to the United States that will prolong his life.

What follows is an emotional journey that will tragically divide and separate our couple. A major court case is publicized, with Max using all means to get money to fight, and at the same time Pip will receive bad publicity. Who is right? What would any of us do?

This story has a Before and After POV; before the court case and afterwards. The difference here is that in the After, Mackintosh gives us a what if? Just when the court decision is to be announced, we are thrown into what if Pip wins the case, and what if Max wins the case. At first I was confused, then I realized what she was doing, and it was an interesting and different concept.

After the End was a heartbreaking storyline that was at times depressing, as we felt for both parents. The decision making, the division and pain, as well as the final results can very well destroy marriages. Pip and Max were a great couple & very well portrayed by Mackintosh. After the End was so well written, that even though it was heart-wrenching, it was an excellent story. My heart goes out to Clare Mackintosh, as she had to have used her own heart break to write this emotional story.

This is an extremely emotional book about a couple, Max and Pip. Their son, Dylan, Is diagnosed with a brain tumor as a toddler. The story alternates between the POV of the mom, Pip, the dad, Max, and one of the doctors, Leila. The parents reflect on their life before Dylan got cancer and all of their hopes and dreams for their baby boy. It was sad and difficult to read, but the kind of book where you feel like you should so you can get an understanding of what someone in this situation is going through. The parents reflect on all of the things they could have done differently and it was absolutely heartbreaking.

Max and Pip live in England and they learn of a treatment that may prolong the life of their son, but they would have to travel to America for it. Max and Pip disagree on whether or not to try the treatment, they end up needing to meet with a mediator and the case goes to court to decide the fate of their. It was heartbreaking. You could understand the position of each parent and you knew they each wanted what was best for the child.

The second half of the book takes place after that and is the story of how Max and Pip heal after everything that happens in the first part of the book. How do parents find the strength to move on. Can they love another child? Can they have another child and not always think about Dylan and not worry constantly that the same thing will happen to that child?

The first half of the book was extremely emotional and difficult to read, the second half of the book was beautiful and uplifting and an important reminder about life.

I simply have no idea how to rate this book. The first half probably rated five stars. Max and Pip are parents to nearly three-year-old Dylan, who is terminally ill in a pediatric intensive care unit. Max is an American, transplanted to Britain because his wife's ties were British. Max travels extensively for his work, while Pip cares for Dylan and spends each and every day in the hospital with him. Chapters are told by Max, by Pip, and also by Leila, Dylan's doctor. Dylan's parents disagree on his future care and end up in Court, on opposing sides, to decide his best treatment going forward. Pip wants palliative care, while Max wants further treatment, in the U.S. The emotions and the struggle with a terminally ill child involve the entire, extended family. This comes across as heartbreaking.

Part two of the book goes into two story lines, and deals with the "what ifs" following the outcome of the Court case in both Max's and Pip's lives. One scenario follows Pip's choice of providing palliative care only, while the other scenario follows Max's choice of continuing to try to find a cure for Dylan. The two story lines were very confusing as to whose narrative I was reading, and the years in which the chapters were set. And then the ending was perhaps the most surprising part of all. Part two of this book rates maybe a two.

This is a story about how devastating circumstances can completely change a relationship which had always been strong and loving. Max and Pip, husband and wife, were thought to be the strongest couple anyone knew. Their son, Dylan, not quite three years old, became sick with a brain tumor. Do they seek controversial treatment in another country or give him palliative care and let him die with dignity. Which path would give him quality of life? What happens when each parent chooses a different path? This book also shows each path as if it had happened, which was very interesting. I loved the ending which was a surprise, but oh so satisfying!
I voluntarily read and reviewed an advanced copy of this book. All thoughts and opinions are my own.

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.