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With the End in Mind summary

Kathryn Mannix

Dying, Death and Wisdom in an Age of Denial

4.3 (82 ratings)
22 mins

Brief summary

'With the End in Mind' by Kathryn Mannix is a compassionate and insightful guide to death and dying. It blends real-life stories with practical advice, helping readers confront mortality and make the most of the time they have left.

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    With the End in Mind
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    There’s a general pattern to the experience of dying, and it’s surpassingly peaceful. 

    From cancer to Parkinson’s disease, terminal illnesses come in many different forms, but there’s a general pattern to how most terminal patients die.

    It begins with a gradual decline in energy, which starts slow and then speeds up over time. At first, you might just feel a difference in your energy level from year to year. Then you’ll notice a reduction from month to month, week to week and, finally, day to day. When you reach that point, it’s a sign that the end is drawing near. 

    But the end itself is something you won’t experience. That’s because the more you lose your energy, the more you need to sleep, as your body tries to compensate for the loss. Eventually, you’re asleep more than you’re awake each day, and while you’re sleeping, your mind dips into unconsciousness for a period. These periods of unconsciousness become longer and longer until finally, you’re unconscious all the time. As you reach the end of this final stage of dying, your breathing rate becomes slower and slower, until it gently ceases. 

    As a result, you don’t experience a surge of pain, a feeling of panic or a sense of life fading away in the final moments of dying. In fact, you don’t experience anything at all. It’s not even like falling asleep, where you can notice the transition from one state to the next. Remember, your mind is unconscious at this point, so you don’t perceive what’s happening. It just happens, and then it’s done. 

    That’s the general pattern, in a nutshell. There are some exceptions, and we’ll look at them in the next blink. But in the author’s professional experience, it’s helpful to know the general pattern for a couple of reasons. 

    First, it can be comforting to patients and their loved ones. It reassures them that the experience of dying will probably be a lot less painful or dramatic than many of them fear it will be. Second, it can give them time to prepare. If a patient has reached the point where his energy is rapidly diminishing from one day to the next, he and his loved ones know it’s time to start saying goodbye. 

    Now, let’s look at some exceptions.

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    What is With the End in Mind about?

    With the End Mind (2017) provides a powerful antidote to the fear, ignorance and misunderstanding that surrounds death in contemporary culture. Through observations and personal reflections, it tells the poignant stories of some terminally ill patients with whom the author has worked over her three-decade career as a palliative care doctor. 

    Who should read With the End in Mind?

    • Friends and family members of people with terminal illnesses
    • Fans of emotionally moving medical stories 
    • Anyone with a fear of death

    About the Author

    Kathryn Mannix is a British doctor and cognitive behavior therapist who has worked with terminally ill patients for more than three decades. Since 1986, she has specialized in palliative care. This branch of medicine is devoted to alleviating patients’ pain and suffering. She’s also a practitioner, advocate and pioneer of integrating Cognitive Behavioral Therapy (CBT) into palliative care. She started the UK’s first CBT clinic dedicated to helping palliative care patients and created a “CBT First Aid” training program for other palliative care practitioners.

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