Book Review: With the End in Mind by Kathryn Mannix
For most of us, the end of life seems both terribly far away and needlessly morbid to think about. But no matter how many life extension tricks you pursue, the truth is that everyone has to face the D word – death – eventually.
Former palliative care doctor Kathryn Mannix’s mission is to make this D word not something to be feared and hidden but rather seen as a biological process that we approach with clarity and compassion. She argues that our modern and scientifically advanced society has shifted towards over-medicalising the end of life. In many instances, it doesn’t need to be. Decades ago, ailments that would have been treated in the home, with family by the patient’s bedside as they slipped away, are now patched up with man-made devices and pumped with morphine in intensive care. That is not to say these medical advances are not important – often essential – treatments, simply that they cannot work independently from holistic care. We seem to keep death at arm’s length, such that we don’t even know what it looks, sounds, smells, tastes or feels like anymore. In some ways, death is a modern taboo as sizeable as sexuality or mental health.
In Mannix’s arsenal are three decades of clinical practice and hundreds of case studies, thirty of which she has selected for this book. These stories are distributed throughout the text with the same precision and care Mannix would afford her patients in real life, her impeccable bedside manner coming across quite clearly in print. Indeed, I can only hope for someone as insightful and caring as her when I am approaching the end. Each case plays a role in its section of the book, but there are two that particularly struck me at the time of reading and that I can still conjure with remarkable clarity a year later.
Holly – a pseudonym to ensure anonymity – opens the section on patterns of death. This terminally ill mother had an energy boost that enabled her to dance away the final hours with her teenage daughters, Mannix explaining that unexpected leases of life like this are not uncommon towards the end. Later on, in the section on naming death, we meet elderly couple Nelly and Joe, who both quietly confess to Mannix they don’t want the other to know Nelly has cancer, in the hope of saving them from the distress of knowing she is going to die.
Both stories explore the mundanity of everyday life and death, yet they speak volumes about what it means to be human, highlighting our common quirks and deepest fears. In an ironic way, Mannix’s patients bring her mission to life, persuading us of the need to approach death more openly better than she could in a medical lecture or palliative care textbook. In fact, I’m so glad her work isn’t only being shared within the profession; these are truths everyone should be schooled in. Amidst the medical memoirs currently dominating the popular science shelves – Adam Kay’s hilarious diaries of a junior doctor and Henry Marsh’s thoughtful chronicles of brain surgery immediately spring to mind – Mannix and her pioneering career are a refreshing take on the trend.
That is not to say this is a perfect book. Minor gripes include the ‘Pause for Thought’ pages, which frame each section with simple questions for readers to ask themselves and have been described by some reviewers as patronising. Yet for others they might be a welcome break from the emotional labour of reading 350 pages about palliative care. Because, although we are given these stories with Mannix’s calm tone and assurance of natural death, all of them are still a gut-wrenching, sob-on-the-sofa type of tragic. Unless you have an impenetrable heart of stone, I would avoid dipping into this one on the morning commute. And rightly so, With the End in Mind is far too important to be skimming on a tube journey.