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Review 25: With the End in Mind: Dying, Death, and Wisdom in an Age of Denial by Dr. Kathryn Mannix

With the End in Mind: Dying, Death, and Wisdom in an Age of Denial
There’s not much more predictable than death. Not the exact nature of anyone’s death, but the fact that we’re all going to hit the doom saloon at one point or another. And yet we fear it; avoid preparing for it; create unhelpful taboos around it. On a scale of dopey things to do, this ranks right up there with Morris dancing.

This is one of the key messages of Dr. Kathryn Mannix’s With the End in Mind. Through a number of examples from her time working in palliative care, she explores what death really looks like and how to come to terms with it in an age increasingly concerned with preserving life at all costs.

There are some genuinely moving points in the book, but for me none was more so than the first time she watches a consultant describe the dying process to a woman with a terminal condition, who is scared of the pain and loss of dignity she believes it to include. Mannix carefully recounts the process for us to benefit from too: gradually increasing tiredness, regular cycles of fast-then-slow breathing, gentle periods of unconsciousness, ending with one from which you don’t wake. Pain, nausea, worry – all of these are completely managed and manageable, even in the most severe conditions.

All this gave me a deep sense of relief from a worry I didn’t even know I’d been carrying. I think we all, in some way or another, are scared of getting a terminal disease. Live fast, die young, and so forth. But actually, if it’s going to be painless and gentle at the end, then that can change our perspective. Live at an appropriate speed, die when you feel like it, maybe.

On that: Mannix is clearly of the belief that death shouldn’t be prolonged for the sake of a life of poor quality, with which it’s difficult to disagree. She also – although she tries not to – makes it clear that she is not a supporter of euthanasia, which I had some difficulty with, but I do respect her position, and the overall message she gives is that the comfort of the patient should be paramount.

It is a little longer than it needs to be, and it has a leaning towards sentimentalism that can come across as patronising at times, which does undermine the message of removing over-emotional sentiment from the idea of death. I would also recommend reading with your eyes, not your ears: Elizabeth Carling, who narrates the audiobook, really hams up the sentimentality and becomes more irritating over time with overemphasis and dodgy, bordering-on-racist accents.

So it’s not a perfect book. But at a time when we’ve never avoided confronting death more, it’s important and fascinating to meet it head-on.

Finally, the other key message in the book is: don’t let your reticence to talk about death prevent you from talking about it with your loved ones, and making preparations. After all, it’s inevitable, and the more prepared you are now, the easier you can make a painful time.

Plus you get to write your own epitaph, if you want, and who’s gonna stop you from including the full lyrics of Ghostbusters? After all, it’s your funeral.

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This is my twenty-fifth book review of 100 to raise money for Refuge, the domestic abuse charity. If you liked this review, or just want to help out, please donate on the link below!

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