Lionel Shriver has a lot to say about the American health care system. She has a lot to say about how illness changes relationships, too, and how money determines one’s quality of life. And she’s not the type of writer to beat around the bush. So you’d think her latest novel, So Much for That, might be a bit worthy, like Michael Moore turning his hand to fiction, morally untouchable and politically astute but tedious. You’d be wrong.
It’s true that Shriver’s characters are vessels for her message, and that this book bristles with outrage, but there is an insightful and dignified story wrapped around her mountain of research.
Shriver’s novel is set in 2005, so the changes brought by President Obama’s recent health care bill were just a distant dream. Shriver’s story revolves around two families who have first hand experience of the health care system. It’s not a happy one.
Shep Knacker and his wife Glynis live in New York. Shep is an employee at a hardware chain he used to own, waiting for the right moment to move his family to a third-world paradise to begin what he calls their Afterlife. Shep has been researching destinations for years, slumping as each candidate is shot down by his wife, who has no intention of moving anywhere. Shep’s teenage son Zach is eye-rollingly dismissive of his father’s Afterlife plan, his daughter Amelia is simply disinterested. Then one night Shep comes home clutching four one-way tickets to Pemba, an island off the east cost of Africa. When he presents his wife with an ultimatum – come now or I’m leaving alone – she delivers news of her own. She has cancer. Rather coolly, she says she would prefer it if Shep didn’t quit his job since, ‘I’m afraid I will need your health insurance.’
The marriage was under stress before Glynis became sick, but now Shep has to shelve his dream and put everything into Glynis’ health. And while he’s a compassionate man, this is not easy to do. Glynis is feisty, and soon becomes resentful of her aggressive illness and how meek her husband becomes as he works to keep her alive. As well as causing the couple considerable financial hardship, Glynis’ illness causes a change in the marriage as the power balance shifts and Shep watches his wife simultaneously evolve and disintegrate.
The novel addresses how little we understand the psychology of sickness, too, with friends and family stumbling over how to relate to Glynis, and doctors resorting to the language of war. Shep says to Glynis’ doctor: ‘The battle against cancer. The arsenal at our disposal… You make her think there’s something she has to do, to be a good soldier, a trooper… I know you mean well, but after all this military talk she now equates – dying – with dishonour. With failure.’
Shep and Glynis’ closest friends, Jackson and Carol, have health woes of their own. Their daughter, Flicka, has a severe congenital condition and requires around-the-clock care. Flicka is a spunky teenager who makes it clear she finds her life pointless, an endless line of painful procedures to keep her alive for no reason she can discern. Her mother is stoic while her father finds relief by railing against the wrongs of big brother government, and insurance companies that profit off misery.
About half of the novel’s chapters begin with an account of how much money is in Shep’s dwindling bank account, a pragmatic reminder that no matter how dear an unwell person is to you, if you can’t pay for the treatment they need to stay alive, they won’t get it. Human life does have a cost it seems, and it’s frighteningly high. The funds from the sale of Shep’s company shrink as he hands money to health care providers, his selfish sister, his son’s college, his father’s nursing home, and he realises if he doesn’t stop bleeding money soon, his Afterlife will be gone forever.
This is a dark story, but out of the soup of misery Shriver finds a way to craft a happy ending for at least a few of the characters. Which is a miracle in itself really. And while they’ve been a fairly cantankerous lot throughout the novel, by the end you really want the best for them.
So Much for That is Shriver’s ninth novel. Her book We Need To Talk About Kevin won the Orange Prize in 2005 for its tale of a teenage mass murderer. Like her other books, So Much for That is full of fire and resolve. It’s a fearless, poised book, and while some of it makes for difficult reading, there is an important truth here about how much we still have to learn about managing the end of our days.