The subtitle of With The End In Mind is “Dying, Death And Wisdom In An Age Of Denial”. So yes, this is a book about death and dying, and I can’t recall a tougher read.
Author Kathryn Mannix’s premise, in which she is surely right, is that the whole subject of dying in our times is taboo.
We can barely bring ourselves to use the word death but talk instead in euphemisms – passed away, late, lost, departed.
Partly, of course, we have modern medicine to blame for this, with its relentless determination to preserve life at all costs and frequently to the detriment of any quality of life for the patient.
For our forebears, death was commonplace – mothers died in childbirth, children died in infancy, there were no antibiotics, disease destroyed whole communities. Now we like to think ourselves practically immortal. It is not so.
Mannix is on a self-proclaimed mission to reclaim public understanding of dying. She is in a very strong position to do so. Her entire medical career has been spent working with people with incurable diseases – cancer features heavily, of course.
She has worked as a palliative care consultant and as a cognitive behaviour therapist. She has attended the bedsides of literally thousands of dying patients. If anyone is qualified to educate us about dying, it is her. And her “weapon of choice for this campaign is stories”.
Many are heartbreaking but many are also heart-warming. The moments that brought me to tears repeatedly were not the facts of death (we already know how each story will end) but the incredibly moving moments of kindness and generosity by both dying and bereaved.
Take the case of Sylvie, 19 years old, a drummer in a band, with a rare form of leukaemia. Sylvie’s concern is not her dying but the effect it will have on her parents, and especially her mother.
“She’ll be tough, but it will be so hard for her, being on her own while Dad stays busy. We sit here by the stove in the evenings, Mum and I. Just snuggle down, a chair each, a cup of tea. Just chatting, or thinking. That’s when she’ll miss me most, I reckon.”
Sylvie’s “solution” is to make her mother a cushion from fragments of cloth that have shared meaning: “I’m trying to choose all Mum’s favourites. This bit is from one of my old sun dresses. That’s one of my baby vests. And this is from a T-shirt I painted at Guide camp when I was 12. That button is from my school uniform … ”
The final cushion will sit on her mother’s rocking chair, “It’s my way of saying, when I am not here any more, ‘Come and sit on my knee, Mum’. And I can rock her, and she can feel my arms around her, as we rock together in front of the stove.”
This particular story has a twist. When Sylvie’s hands refuse to work any longer, she coerces the author into sewing to her instructions during the time it takes for her blood transfusion.
“Pins and needles spike my fingertips as I gather my bags; they have less in them than when I arrived, but somehow they feel heavier. They are filled with admiration and awe for this almost- woman, this great-hearted human, who has lived and loved so fully in a lifetime cut short, whose cup is half full – no, in fact, so full it is running over.”
I have referenced this story at length because I want to stress that this is not a dry, drab, depressing read about death. It is an emotional one, certainly, but also full of wonderful moments of trust, compassion, love and humanity. I could have chosen many other examples.
With her aim stated clearly to enlighten us, Mannix divides her book into sections: “Patterns”, dealing largely with how most people die; “My Way”, the different ways people find to cope; “Naming Death”, reclaiming the language of death and dying; “Looking Beyond the Now”, what you see is not always what you get; “Legacy”, what we wish to leave behind; and “Transcendence”, the importance of spirituality.
Each of these is prefaced and most conclude with some “pauses for thought” in which the reader is invited to consider the implications of the preceding stories.
The book concludes with references to further resources and a template letter should the reader feel the need to write things that they find difficult or impossible to say to loved ones – or enemies!
I firmly believe that this is not only a very good book indeed but a very important and timely one. We like to pretend death does not exist but of course it does, and when it occurs it is unsurprising in the current climate that we feel helpless to deal with it. Mannix offers guidance and wisdom.
Beautifully written, deeply moving and never patronising, With The End In Mind leaves the reader not only better prepared for dying but more alive to the positive aspects of humanity and the everyday joys of living.
With The End In Mind
Author: Kathryn Mannix
Publisher: William Collins, nonfiction advice