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

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Like those romantic portraits of Florence Nightingale holding her lamp aloft as she walked between beds of maimed and dying soldiers, Mannix’s aim is to shed a soft, clear light on a subject she feels is too often avoided. This awareness, which can feel vertiginous, unendurable, is also what gives us selfhood, and life shape and meaning. Due to the issues involved in one story the book also looks briefly at the legalities and ethics involved in dealing with patients who are approaching the end of life. I got to the end of Kathryn Mannix s book with just one thought I wish I d been a palliative consultant.

They say that the Victorians were happy to talk about death, but not sex, and now we’ve reversed that as no conversation about sex seems too much, and yet we can’t even bring ourselves to use words like died/dead/death, only passed or lost or late. Her purpose is to describe many forms of death – the young man with testicular cancer treated in the room dubbed “the Lonely Ballroom”, the dying mother in the hospice who manages to walk her daughter up the aisle, the 22-year-old with cystic fibrosis, the teenager with leukaemia – and to show how in each case, while a death may be emotionally harrowing, it need not be intolerably painful; while it may be tragic, it need not be ghastly or full of the chaos that accompanies too many ends.It was a chapter about a dying person in Holland who felt he was pushed by his doctor into ending his life with euthanasia.

Many of us won’t read a book like this because we don’t want to look at death, think about death, speak about death, let alone read about Mr Grim and his rusty scythe. An emotional journey through one woman’s experience working in palliative medicine that challenges pre conceptions about the field while encouraging thoughts and discussions around our own mortality. Death and dying should no longer be a taboo issue in modern society, we should all have discussions with our loved ones about what-ifs and what our own wishes are. I truly believe each person should read this book; the stories are heartbreaking but the lessons are forever.Mannix’s introductions to each section and chapter, and the Pause for Thought pages at the end of each chapter, mean the book lends itself to being read as a handbook, perhaps in tandem with an ill relative. Dr Mannix demystifies and humanizes the experience of death for her patients, their families, and especially her readers, as people who have or very likely will care for a dying person, and will ultimately succumb to death themmselves.

I’ve been thinking about death a lot lately as the subject is likely to become one more familiar with me as my father is in the final stages of ALS. I really liked her narrative style, which was sufficiently descriptive but always compassionate and with a touch of humour. Doctors in The Netherlands (and in Belgium) do not see euthanasia as a default or standard procedure, but as a last resort.

It sounds kind of harsh, yet one out of forty chapters made me lower my general score with one star. In With the End in Mind , she shares beautifully crafted stories from a lifetime of caring for the dying, and makes a case for the therapeutic power of approaching death not with trepidation, but with openness, clarity, and understanding. My life in palliative care has shown me that the process of dying is made less frightening and more peaceful, the better prepared we are.

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