Mixed feelings about Clare Mackintosh's After the end (spoilers)

I am a relatively new fan of Clare Mackintosh, having read the first two of her Ffion Morgan books and one of her standalone novels, an Idris Elba-like hijack story. I am working my way through the remaining four standalone novels, starting with After the end, the subject of this post. I was intrigued to read this one as it has personal meaning to Mackintosh after having lost one of her twin boys some years ago.

I recommend you read the book with no prior knowledge of it as it will make a better reading experience. It is almost impossible to discuss After the end without spoilers so bear that in mind if you continue to read my review.

After the end | Published June 2019 | Read January 2025

The blurb of After the end doesn't give much away and I'm glad I didn't look the book up before reading it. As mentioned above, the book is best read without knowing too much about it. This is what the blurb says:

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?

I was immediately drawn into Max and Pip's world. Mackintosh paints a heart wrenching picture in the opening chapters of their son, Dylan's, serious illness. There is also lots of exploration of the challenges Max and Pip face juggling Dylan's care and their marriage with their demanding jobs. Knowing that Mackintosh has been in a similar situation makes the story feel even more poignant. The description of Max and Pip's support for Dylan while he was in the ICU is powerful and I know it is based on Mackintosh's own experiences. The decision they are forced to make over Dylan's care is one no parent should ever have to make. Even the blackest of hearts could feel the emotion of the Max and Pip's situation in the first part of the book.

When Dylan's condition worsens, Max and Pip are divided over the direction his treatment should take. They end up in court, as one of the pair challenges the other for the right to take Dylan to the US for experimental treatment. The book opens with the court case and the reader knows that they will be taken on a journey to see what happens after the judge's decision is handed down. I had already grown to know Max and Pip by the time I reached that part of the story. Kudos to Mackintosh for quickly drawing me into their world. The vivid picture Macintosh paints of the situation made me desperate to find out the judge's decision, especially since I formed my view on what I thought was the right thing to do for Dylan.

Spoilers ahead...

I was happy to read the first post-decision chapter as it aligns with what I thought I would do in the same situation. It is there that the book takes an unexpected turn, though. Mackintosh then takes the story into Sliding doors territory, exploring the consequences of both courses of action from the court case. I think I get why she did this, as I understand she and her husband still question whether they made the right choice with their own son.

This is where I have mixed feelings. It took me several days after finishing the book to workshop how I felt about it, and I am still not sure. I appreciate Mackintosh's personal investment in the story and the thought-provoking approach that she takes to telling it. I liked reading Max and Pip's perspectives. I also enjoyed reading about the other parents in the ICU. Their stories are nicely done, throwing some important issues around bigotry and identity into the mix. Another character I liked is Dr Leila Khalili, the ICU paediatrician who treated Dylan. Her backstory is included in the book and her Iranian heritage adds some depth to her character, as does her honesty about her doubts over her treatment recommendations. I wish we'd seen more of Dr Khalili, as she is an interesting character, and there could be more insight given into how she coped with either decision along with Max and Pip.

I saw one Goodreads reviewer write that they would have preferred the book to show one outcome and then consider what would have happened had the decision had gone the other way. I completely agree with this perspective. I would also have liked more depth to the consequences of one decision and then read the same about the other pathway. Instead, Mackintosh writes alternating chapters following the fallout of both decisions. It was quite hard to follow the alternating chapters, largely because they are too similar, and the jumping back and forth makes the story feel disjointed. Tackling one outcome at a time might make for a more seamless read, with stronger reader investment in both stories. In both sliding doors scenarios, there were are relationships with the same people and job and lifestyle changes that are too much alike to disentangle.

I felt the approach Mackintosh takes lessens the emotional impact of the aftermath of such consequential decisions and of the concept of second-guessing yourself in these situations. The story lacks nuance and Mackintosh seems to spend more time exploring Max and Pip's post-decision stories in a slightly soap-opera-ish way rather than showing the raw emotion I was expecting. Max and Pip's decisions and actions in the two scenarios are major, but they seem glossed over and disconnected from their consequences and subsequent impact on Dylan's health.

I'm still unsure of my rating of After the end. I applaud Mackintosh for telling a deeply personal and difficult story. The first part of the book is particularly strong. Even though the second part didn't resonate with me, I still understand that Mackintosh is trying to show that neither decision is better. I think she could make this point clearer, though.

I think it was brave to tackle the Sliding doors approach, but my feeling is that Mackintosh doesn't quite pull it off. The two stories become confusing after several chapters of the back and forth. I had trouble distinguishing the two after a while. There isn't much mystery as to where the stories in each scenario are heading, and I felt like the connection I'd made to Max and Pip in the opening chapters was lost. There are so many unexplored consequences of either decision. I wanted to know how Max and Pip coped with the immediate after effects of the judge's decision. I wanted read about the impact on their relationship and how they came back from Max's approach to the dilemma (as it seems selfish to me). Instead, Mackintosh takes the story down two pathways that were are more about new relationships and jobs and houses and less on the emotional fallout.

The ending is also completely left field and I had to re-read the final page several times before I understood it (at least I think I did!). I won't reveal it here, but suffice to say I didn't like it. It felt very jarring after all that had gone on before.

So...a great premise for the book and a strong first half, but the second half is a missed opportunity to truly delve into the dilemma over when/whether to stop medical treatment and how relationships survive (or don't) the stress of this dilemma. There could have been so much more exploration of whether there is ever the 'right' decision to make.

Rating: ⭐⭐⭐