AFTER THE END

A married couple must make an agonizing decision about their critically ill young son.

Dylan Adams, an almost 3-year-old English boy, is in pediatric intensive care when we meet him, having endured several rounds of chemotherapy as well as surgery to remove a brain tumor. His devoted parents—Max, an American business analyst, and Pip, a British flight attendant (the family lives near Birmingham, England)—want nothing more than to bring their boy home. Eventually, though, Dylan’s doctor, Leila Khalili, presents them with an excruciating choice. Pip favors one option; Max, another. This is grim material, and in other hands, the story easily could have turned mawkish. But Mackintosh, a British author of mystery-thrillers (Let Me Lie, 2018, etc.), gets a lot of things right. She’s a natural writer, and her powers of observation are keen: “It takes practice, speaking to a sedated child,” she writes, then goes on to explain why. Everything, at least in the first half of the novel, feels true. (In an afterword, the author reveals that she and her husband were once compelled to make a similar decision.) The book is also briskly plotted, an unlikely page-turner. The story is told in the alternating voices of Pip and Max; there’s also a third perspective—that of Leila, the sympathetic doctor, whose narrative provides some relief from the intensity of the other two accounts. The book falters in the overlong second half. The author imagines dual outcomes to her story, which seems gimmicky—things get complicated (and sometimes confusing) as well as repetitive. Plus, Max’s downward trajectory doesn’t seem entirely credible; neither do some of his personal choices. But the ending, if not exactly happy, is authentically hopeful.

While occasionally overwrought, this is a perceptive, skillfully told story about a profoundly painful subject.