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Book review: "With the End in Mind" by Kathryn Mannix

Death, or the end of life, can be said to be the one thing that is inevitable in a lifetime filled with uncertainties. Even with the leaps and bounds medicine has made in recent years, science cannot find a way to preserve consciousness in a failing body. Similarly, no matter what religion one follows, not a single higher power is able to guarantee eternal life on earth.

Interestingly enough, it seems as though we as a society have collectively decided to shun the one eventuality of life instead of embracing it. Aging, and with it, the rapidly-approaching spectre of death, is shrouded in darkness and mystery, everyone turning away and casting it into shadow rather than bringing it into the light. What happens after the end of life is an unknown, but stepping over from life into death does not have to be.

As a fourth year medical student myself, my meaningful experience with death, both in a personal and professional setting is limited. When reading “With the End in Mind” and listening to Mannix’s retellings of the patients she’d encountered over her years of training, I felt as if I was there with her, learning about breaking bad news and the natural physiological progression from life towards death.

Dr. Mannix is a palliative care consultant, having trained in cancer care before becoming one of the first NHS doctors to specialise in this relatively new field of medicine. As such, she has had years and years of experience talking about and witnessing death, but that wasn’t always the case. “With the End in Mind” contains 30 anecdotes about patients Dr. Mannix has seen and interacted with at different stages of her medical career, the first being from when she was a medical student, witnessing a consultant counsel a patient about what to expect when she entered into the end of her life.

However, despite the book being about death and dying patients in a medical setting, the content is easily accessible to all, not just those in the medical field. Mannix tells the stories of her patients with open honesty and compassion, not shying away from the visceral parts of the experiences. It can be all too easy, especially with the passage of time, for the retelling to be clouded in the hazy wash of memory, but Mannix has gone to great lengths to ensure that the emotions of the situation come through as clear as day.

She has also included several “interludes,” where she encourages readers to actively think critically about the learning points from her experiences and how they can be applied to the reader’s life. Mannix is also a qualified Cognitive Behavioural Therapy practitioner, and this comes through clearly in the way she supports the reader into structuring their thoughts and arriving at their own conclusions about the ideas presented in the book.

I closed the book with a sense of comfort - I, too, had had anxieties about death, and although they had not disappeared, I now understood them far better. In all honesty, I had expected to be in tears while reading it, but it was not as I’d thought it would be. It is sad, but in the way that a loss of a precious being always is. Death is an eventuality, and we would all do better if we were able to make peace with that knowledge.

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