With the End in Mind: Dying, Death, and Wisdom in an Age of Denial

"Kathryn Mannix is a palliative care doctor. In the introduction, she writes, “There are only two days with fewer than 24 hours in each lifetime, sitting like bookends astride our lives: one is celebrated every year yet it is the other that makes us see living as precious.” With over 20 years of experience being a palliative care doctor, she set out to write a book (with the approval of the relevant ethics committee) which collects her experience of being a doctor in those final days of life. It’s possibly the most useful book that I’ve read, in terms of grief. It’s an accretive book; she goes through death story after death story, starting with an extraordinary, striking account of being the on-call palliative care doctor going to attend a woman with very late-stage liver cancer. She’s become very agitated due to the drugs she’s been given, and experiences an almost euphoric need to just get out . She’s carried out of the house by her friends and family on a little wheelchair with beer and cigarettes. Mannix is responsible for being there while it happens: being present, holding the family together, giving her more medicine. “There are only two days with fewer than 24 hours in each lifetime, sitting like bookends astride our lives” This woman has what might be seen as a ‘good death’. But then we have another story about a different death, and then another. We’re told a story about someone who’s receiving treatment and then dies very suddenly. We hear accounts of a young mother dying. We hear about a man who moves from Holland to England to die. In Holland, there’s the offer of euthanasia which, while not imposed, raises important questions about who makes decisions about what quality of life is. From the perspective of the bereaved party, I found the book intensely helpful. My father wasn’t someone who wanted to talk about dying at all. Admittedly, I was 13. Perhaps he felt I was too young. But I didn’t receive a book like Kate Gross’s. You hear of parents writing letters for their child’s every birthday, or talking to them through recording videos, but that wasn’t very big in 1988—the idea of memory boxes or any kind of legacy. Still now, I think, people have great difficulty talking about death, difficulty talking about what we know we’ll encounter. We will all lose each other at some point. It’s our bookend. This book usefully talks about the realities of death and what it feels like from a doctor’s perspective. There’s also a good section on how some people choose to deny talking about it, and how that’s okay, too. She made sense of the experience that I had. It’s extremely elegant and eloquent. What struck me was the humility of it—I finished the book having half-forgotten that it was written by a doctor. It’s not driven by the idea of ‘doctor-as-hero’; she says there are midwives and ‘death-wives’. In this book, death is a natural process, and grief is one of the many processes we all follow. Whether we feel that leaving this world is a long way off or we’re in the middle of being in a caring role, there’s courage to be gathered from reading this. It’s a manual of narratives, stories that we can hold so that we have something to hold onto, and an extremely brave book."