With the End in Mind by Kathryn Mannix

‘With the End in Mind: Dying, Death and Wisdom in an Age of Denial’ by Dr Kathryn Mannix is a collection of anonymised patient case studies (or “stories” as Mannix calls them) drawn from her thirty years of experience as a palliative care clinician and consultant. It has been shortlisted for this year’s Wellcome Book Prize which I am shadowing with fellow book bloggers Rebecca, Laura, Annabel and Paul and is notably similar to one of the previous winners It’s All In Your Head by Suzanne O’Sullivan in that it seeks to demystify one of the most misunderstood aspects of medicine. In this case, it is death – the event that we will all one day meet (unless the transhumanists Mark O’Connell wrote about in To Be a Machine have their way…).

It is evident that a lot of thought has gone into the structure of this book to achieve the right balance between the life-affirming stories and some of the more upsetting ones. Some of the most memorable include Sally, a young woman who remains completely in denial that her cancer is terminal right up to the end, Billy, a prisoner who visits his dying mother in handcuffs, and Joe and Nelly, a couple who have been married for 50 years who both think the other doesn’t know that Nelly is dying. There are some “pause for thought” interludes inviting readers to reflect on the themes each section raises and there is also a chapter detailing how Mannix introduced the concept of death to her own children when they were young.

While more people are having open conversations about mental health and bereavement, the actual event of dying is still very much a taboo subject and few people really know what to expect. Through a variety of around 30 different cases involving people from all walks of life and age groups, Mannix explores what a “good” death is, and although the outcome of all of these stories is inevitable, most are positive in the sense that many patients are able to have their final wishes fulfilled. Mannix refers to palliative care teams as the “deathwives” or midwives of death, who guide people through the process and she discusses how treating mental health is as crucial for patients as managing their physical symptoms.

The focus on “stories” means that some of the most contentious debates surrounding religion and the funding of the NHS were mostly absent from this book. Euthanasia is addressed, although I think it probably should have been left out as it requires much more than a single chapter to unpick all of the issues surrounding that particular debate. On the other hand, I was surprised that patients with dementia were not featured in the stories here given that it affects so many people in an ageing population. I expect it would be challenging to write about patients who have little awareness of their surroundings, or perhaps it isn’t Mannix’s area of expertise, but it would have been interesting to know more about how clinicians approach these circumstances.

I read ‘With the End in Mind’ relatively quickly over about four days but some might prefer to dip in and out more slowly depending on personal circumstances. For me, this enlightening book is a strong potential winner for the Wellcome Book Prize and I hope it brings comfort and guidance for those who need it.