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With the End in Mind: Dying, Death and Wisdom in an Age of Denial

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Having qualified as a Cognitive Behaviour Therapist in 1993, she started the UK’s (possibly the world’s) first CBT clinic exclusively for palliative care patients, and devised ‘CBT First Aid’ training to enable palliative care colleagues to add new skills to their repertoire for helping patients. This was not because I wasn’t enjoying it, but because it was a two-week loan and I was conscious of needing to move on to other longlist books.

It’s written with such warmth, compassion, and integrity, and it contains just the right amount of humour. As her children told her when they visited her dying godmother, “you and Dad [a pathologist] have spent a lifetime preparing us for this. From the shrinking circle of his life, from his frail body drowning in itself, he reached outwards towards the friends he was leaving.

And secondly, Mannix and all of the wider NHS staff that we meet along the way are nearly all calm and happy and lovely. Yes, the book’s full of sad stories, and occasionally I swallowed a lump, but it’s a book about death and dying, and how people cope in/with their final moments, so it never was gonna be much of a hoot. Her mission is to “reclaim public understanding of dying” and to bring individuality and joy back into our dealings with the dead – and so, in From Here to Eternity, she embarks on a journey of discovery: to the only open pyre in America; to a sky burial in Tibet, where the body breaker slices the corpse into parts, pounds the flesh with a mallet, mixes it with barley flour and yak butter or milk, and leaves it to the shrieking vultures to consume; to burial towers in India; to the people of Tana Toraja in Indonesia, where mummified bodies are cared for in their home (offered food, dressed, even given a bed with the living) over months or years until the family can sacrifice an animal and put the dead to their final rest; to Barcelona’s mass bone pits; Mexico’s Day of the Dead. In her introduction, Mannix states that in the book, 'the experience of several people is woven into a single individual's narrative, to allow specific aspects of the journey to be depicted'.

Even with that, the stories were well written, easy to read, and believable, as were her commentaries. They say that the Victorians were happy to talk about death, but not sex, and now we’ve reversed that as no conversation about sex seems too much, and yet we can’t even bring ourselves to use words like died/dead/death, only passed or lost or late.I've also seen a couple where I believe the people were in a nightmarish state even as they were in their final unconsciousness. No es más que una colección de historias diversas sobre un montón de gente que vivió sus últimos días.

Now Kathryn Mannix joins this distinguished group and her voice, though quiet and calm, is distinctive. I was particularly touched by the stories of Sally, a young woman dying from melanoma who refused to accept that her condition was terminal, and Holly, a mum of two teenagers dying from cancer of the cervix, who suffered from a last bout of restless energy before passing away. This outstanding book, which was shortlisted for this year's Wellcome Book Prize and was written by a palliative care physician in the UK, describes several remarkable people she cared for at the end of their lives, their families and other loved ones, and her experiences and lessons learned during her four decades in clinical practice. What she is a big advocate of is communication, telling people what is wrong with you, getting them to ask sensitive questions, finding out if people want to be at home for their last moments, or have no real preference.Again, I would have found this less troubling if Mannix had been upfront about it: instead, she claims that 'many of us in palliative care roles are exasperated by the trenchant, black-and-white opinions of the campaigners for either view [on euthanasia]' but makes her own views pretty clear when she says at the end of the chapter on the Netherlands that 'Once the euthanasia genie is out of the bottle, you must be careful what you wish for', echoing familiar 'slippery slope' arguments.

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