With the End in Mind

By Philippa Cahill, Director

When With the End in Mind came out before Christmas I thought long and hard about putting it on my Christmas reading list, but decided it might just be a bit too sad. Books about death aren’t generally thought of as festive fare. So I saved it for a January read instead, figuring I might as well go in for a penny, in for a pound with the gloomy winter blues. But, I’m happy to report that we were wrong, With the End in Mind is not a sad read at all but actually a joyous, life-affirming one.

Written by Dr Kathryn Mannix, who has a thirty year career in medicine, beginning in cancer care and moving into palliative care when it was a relatively new discipline, With the End in Mind is a collection of individual stories of people facing death. Unsurprisingly shortlisted for the Wellcome Book Prize, this is a fascinating read. Mannix brings us stories of wildly different people, young and old, ready and less ready, facing death alone or surrounded by family. Each story is quite short, but perfectly crafted, and written with such empathy and insight that you feel you get to get to know them even in the space of a few pages. There is a resolution to each story. Maybe not so much a traditional happy ending, but without exception a peaceful one, in one way or another.

These are personal stories focused on individuals and family units but for anybody interested in social history there is much food for thought. Mannix talks about how societal changes mean we have become far less familiar with the processes of dying. A few generations ago, people, even children, were much more intimate with death because they lived alongside it. Mannix makes a good case for how more honesty can prepare us better for our own demise and those of our loved ones. She makes a case for us to talk about death the same way we talk about birth. Talking is clearly a positive. One of the things that stands out from this book is the power of language, stories, and human connections to help make sense of the world and our experiences in it.

This book gives due credit to the life-extending medicines that give people time with those they love, to resolve issues, create a legacy, or simply to ‘come to terms’. But brilliantly, palliative medicine, so misunderstood by the public, is the star of the show. In these stories we witness the wonders it can achieve in liberating people from symptoms, how it can give time, space and peace to achieve what matters. The artfulness and compassion of the healthcare professionals who work in palliative care is plain for all readers to see. Yet palliative medicine is sadly much misunderstood and feared. Perhaps it is one for us healthcare communicators, the ‘p’ word is long overdue an image change.

It’s not just the general public that get palliative medicine all mixed up. Mannix tells of colleagues from different specialities wondering at how she does her job. But the impression you get is that palliative medicine is an extraordinarily rewarding speciality to work in. That’s another message to shout about as we surely need junior doctors to choose this speciality. Let’s hope they all read this book.

At the very end of this book Mannix makes an compelling case against immortality, drawing on her own experience alongside traditional wisdom passed through the generations. It’s uplifting and comforting stuff.

So what have I learned? Well not to judge a book about death by its cover for one. I was expecting gloom and I found hope. I’ve lost count of the number of people I’ve recommended this book to as a life changing read. From clients to BBC Breakfast presenters to my local taxi driver. And I’ve gained a sense of happy inevitability. As a society we may love and prize health, but let’s face it, none of us are getting out of this alive. The human condition is to live and then to die, so we’d better find a way of coming to terms with it sharpish. Perhaps we can all start by reading this.