With The End In Mind: Dying, Death, and Wisdom in the Age of Denial - Kathryn Mannix

My Review - 4 Stars

Why do we struggle to talk about death and dying?

This is a question I’ve often asked myself in the past 15 or so years. Because my maternal grandparents were both one of thirteen children, I grew up in a large extended family and, as such, I grew up going to funerals. I learned how to mourn from my relatives and how to have hard conversations. It was a sad part of life. But it was part of life.

When I started my first fieldwork placement at hospice as a social work intern, it quickly became clear I had an unusual upbringing compared to many of my patients and their families. Many were not as well-versed in talking through these issues. From the fieldwork placement, I went on to be a hospice social worker and child and teen bereavement specialist.

My mantra became “hope for today, plan for the future.” Yes, we can hope that this decline will reverse but we can make things easier on ourselves and our loved ones by discussing advanced directives and funeral plans now.

Kathryn Mannix and I have a lot in common in this regard. Mannix is a palliative care and hospice doctor in the UK. I was particularly fascinated that she founded the UK’s first palliative care cognitive behavior therapy (CBT) clinic. I love the idea of using CBT in this context!

Mannix’s goal with this book is both to promote conversation about dying and to show that those who are dying are still living. This often surprised people when I still worked for hospice, that there was so much light and laughter in my days. Yes, there were sad, hard, and frustrating days- how could there not be?- but more often than not, my days were filled with life.

Mannix shares stories to illustrate what happens when people are dying and at various stages, as well as people’s reactions to their or their loved one’s decline. She shares stories from early on in her career when she was a student on up to the present. She doesn’t always get it right and I appreciate how she owned up to her mistakes and learned from them. This helps us learn too. She also shares how her colleagues helped her improve her practice.

This could simply be a collection of stories but Mannix also includes questions at the end of each section. These are questions to think through and then to discuss with family. You’re able to follow the process modeled by Mannix and her team.

French Resistance included one of the best, most compassionate descriptions of the dying process I’ve ever encountered. Mannix observes her trainer walking a patient through it at the new hospice. “Few have seen a death. Most imagine dying to be agonizing and undignified. We can help them to know that we do not see that, and that they need not fear that their families will see something terrible.” p. 30

Talking About The Unmentionable is about how to talk to children about death and dying, whether it’s due to pets or relatives. It helps normalize the idea of death and shows the importance of our need to grieve our loved ones, plus details about what children understand at various ages.

Last Waltz was about death of Mannix’s 99 yo grandmother. I especially appreciated her insights on how waiting is not a passive experience when it comes to our loved ones who are declining. She notes how this loss made her a “better servant” to patients’ families and more patient with repeated requests for her to make sure their loves weren’t in discomfort or distress.

There are two chapters that puzzled me. Wrecking Ball may need a trigger warning. The description of the death might shock or be disturbing to some and the caution does not come until the end of the chapter. While it’s a good example of an unanticipated death, proceed with caution.

Please Release Me - B side, is an odd chapter loosely about euthanasia. The patient was originally from the Netherlands where it’s legal but he came to England instead where he went on hospice. Euthanasia is a complex issue and I felt she did it a disservice with her commentary. We don’t know whether hospice exists there, what the cultural understanding of death is, or whether the patient's account was biased. Don’t take this to mean I’m advocating for euthanasia. But it requires more nuance than we were given in this chapter.

Overall, this is a solid resource on end of life issues, whether you’re a family member facing the loss of a loved one or someone who has worked in hospice for years. The stories are often heartwarming and beautiful and even the hard ones illustrate some aspect of death and life we need to better understand.

Synopsis

Through stories from her own practice, a palliative care doctor takes the reader on a journey through dying.

Modern medical technology is allowing us to live longer and fuller lives than ever before. And for the most part, that is good news. But with changes in the way we understand medicine come changes in the way we understand death. Once a familiar and gentle process, death has come to be something from which we shy away, preferring to fight it desperately than to accept its inevitability. Palliative care has a long tradition in Britain, where Dr. Kathryn Mannix has practiced it for 30 years. In this book, she shares beautifully crafted stories from a lifetime of caring for the dying. With insightful meditations on life, death, and the space between them, With the End in Mind describes the possibility of meeting death gently, with forethought and preparation, and shows the unexpected beauty, dignity, and profound humanity of life coming to an end.

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Disclosure: I received an ARC from NetGalley in exchange for an honest review. Affiliate links included in this post.