A Novel Tallies The Real Cost Of Health Care

So Much For That
So Much For That
By Lionel Shriver
Hardcover, 448 pages
Harper
List price: $25.99

Read An Excerpt

My knee-jerk reaction to hearing a novel touted as "topical" is to think "opportunistic." And most times my skepticism is justified. Novels on so-called topical subjects like terrorism and illegal immigrants often feel derivative, mere fictional shadows of the serious issues they aim to tackle. But then along comes a gifted novelist like Lionel Shriver, whose new book, So Much For That, makes me shut my mouth, swallow my cynicism and respectfully acknowledge the dramatic depth that fiction can bring to debate over current events. Shriver's 2005 award-winning thriller, We Need to Talk About Kevin, was inspired by the Columbine massacre; she reaches to the headlines, again, for this satirical novel, which is about the price — emotional and financial — of health care in America. Far from being rendered moot by the passage of the health care bill, Shriver's glinting novel of ideas about the lengths people will go to avail themselves of advanced medical care is all the more topical now that more Americans have the chance to do so.

Shriver's hero here is a middle-aged everyman named Shep Knacker; for years, Shep ran his own successful handyman business in Brooklyn. He eventually sold it for a million dollars to fulfill his dream of what he playfully calls "The Afterlife" — early retirement in a Third World country. But Shep's wife, Glynis, a mostly self-employed artist, has been dragging her heels about this life change for the eight years since the sale of the company, and so to avoid depleting their savings, Shep has been working as an employee for the oaf who bought his company. When the novel opens, Shep has had it. He's just bought one-way tickets to the clove-scented island of Pemba off the coast of Tanzania, and Glynis can make up her mind to join him ... or not. When Shep throws down the airplane tickets on the kitchen table that night, however, Glynis makes her own punch-in-the-gut announcement: She's been diagnosed with mesothelioma (a particularly virulent type of cancer associated with asbestos exposure). Shep can't quit his job. They'll need his employee health insurance.

What follows is a complex social satire that rips apart the machinery and the psychology of the American health care industry with much of the vigor, wit, and empathy that Dickens ladled on the law in Bleak House. Inventive medical subplots abound. Shep's work partner has a young daughter who suffers from a genetic degenerative disease. Shep's own 80-year-old father, a mystery addict, was absorbed in a Walter Mosley novel when he fell down the stairs and broke his femur. Into the nursing home Dad goes! Shep's sister, an unemployed documentary filmmaker, had been living with the father and could conceivably care for him but, as Shep sourly reflects, "[his sister's] immediate ministrations had quickly drained her wading pool of Clara Barton altruism and ... the cardboard bookcase of her character had already collapsed under the strain."

Lionel Shriver i i

In addition to writing novels, Lionel Shriver is a widely published journalist. Her work has appeared in The Guardian, The New York Times and The Wall Street Journal. Eva Vermandel hide caption

itoggle caption Eva Vermandel
Lionel Shriver

In addition to writing novels, Lionel Shriver is a widely published journalist. Her work has appeared in The Guardian, The New York Times and The Wall Street Journal.

Eva Vermandel

What's really striking here is the way Shriver's juiced-up language and droll social commentary never flag once throughout this long and deliciously involved novel. The book's chapters contain brilliant riffs on, among other things, sex and sickness; the nitty-gritty of mopping up the bodily excretions of the sick; and the cocktail of drugs needed to counteract the side effects of chemotherapy, which then generate their own side effects, requiring another cocktail of different drugs, ad infinitum. As his investment portfolio sinks into bankruptcy in the effort to arrest Glynis's cancer, the normally temperate Shep delivers a rant to her oncologist about the medical fondness for relying on military metaphors when talking about cancer treatment:

Arsenal. ... Struggle. [Shep says.] Surmounting the odds. ... You make [Glynis] think that there's something she has to do, to be a good soldier, a trooper. So if she deteriorates anyway, then there's something she didn't do; she didn't show courage under fire. ... [A]fter all this military talk she now equates-dying-with dishonor.

So Much For That elegantly tackles the twin questions about cutting-edge medical treatments of life-threatening illnesses: "At what cost?" and "To what end?" None of us really wants to think about those questions, but it's illuminating, entertaining and horrifying to watch Shep go through the process.

Excerpt: 'So Much For That'

So Much for That
So Much For That
By Lionel Shriver
Hardcover, 448 pages
Harper
List price: $25.99

Chapter One

Shepherd Armstrong Knacker
Merrill Lynch Account Number 934-23F917
December 01, 2004 — December 31, 2004
Net Portfolio Value: $731,778.56

What do you pack for the rest of your life?

On research trips — he and Glynis had never called them "vacations" — Shep had always packed too much, covering for every contingency: rain gear, a sweater on the off chance that the weather in Puerto Escondido was unseasonably cold. In the face of infinite contingencies, his impulse was to take nothing.

There was no rational reason to be creeping these halls stealthily like a thief come to burgle his own home — padding heel to toe on the floorboards, flinching when they creaked. He had double-checked that Glynis was out through early evening (for an "appointment"; it bothered him that she did not say with whom or where). Calling on a weak pretense of asking about dinner plans when their son hadn't eaten a proper meal with his parents for the last year, he had confirmed that Zach was safely installed at a friend's overnight. Shep was alone in the house. He needn't keep jumping when the heat came on. He needn't reach tremulously into the top dresser drawer for his boxers as if any time now his wrist would be seized and he'd be read the Miranda.

Except that Shep was a burglar, after a fashion. Perhaps the sort that any American household most feared. He had arrived home from work a little earlier than usual in order to steal himself.

The swag bag of his large black Samsonite was unzipped on the bed, lying agape as it had for less drastic departures year after year. So far it contained: one comb.

He forced himself through the paces of collecting a travel shampoo, his shaving kit, even if he was doubtful that in The Afterlife he would continue to shave. But the electric toothbrush presented a quandary. The island had electricity, surely it did, but he'd neglected to discover whether their plugs were flat American two-prongs, bulky British three-prongs, or the slender European kind, wide-set and round. He wasn't dead sure either whether the local current was 220 or 110. Sloppy; these were just the sorts of practical details that on earlier research forays they'd been rigorous about jotting down. But then, they'd lately grown less systematic, especially Glynis, who'd sometimes slipped on more recent journeys abroad and used the word vacation. A tell, and there had been several.

Resistant at first to the Oral B's jarring cranial buzz, at length Shep had come to relish the slick of his teeth once the tedium was complete. As with all technological advances, it felt unnatural to go backward, to resume the fitful scrub of splayed nylon on a plastic stick. But what if Glynis went to the bathroom when she came home and noticed that his blue-ringed toothbrush was missing, while hers, with the red ring, still sat on the sink? Best she didn't begin this of all evenings with perplexity or suspicion. He could always take Zach's — he'd never heard the kid use it — but Shep couldn't see swiping his own son's toothbrush. (Shep had paid for the thing, of course, along with pretty much everything here. Yet little or nothing in this house felt like his. That used to bug him but now just made it easier to leave the salad spinner, the StairMaster, and the sofas behind.) Worse, he and Glynis shared the same recharger. He didn't want to leave her with a toothbrush that would last five or six days (he didn't want to leave her at all, but that was another matter), its weakening, terminal shudder providing a soundtrack for his wife's lapse into another of her periodic depressions.

So having unscrewed the wall mount only a turn or two, he tightened it back down. Restoring his own handle reassuringly to the recharger, he scrounged a manual brush from the medicine cabinet. He would have to grow accustomed to technological regression, which in a manner he couldn't quite put his finger on was surely good for the soul. Something about backtracking to a stage of development that you could understand.

He wasn't planning simply to cut and run, to disappear himself from his family absent announcement or explanation. That would be cruel, or crueler. He wasn't presenting her with a total fait accompli either, a wave goodbye at the door. Officially he would confront her with a choice, one for which, in the service of credibility, he had paid through the nose. Odds were that he had purchased nothing but an illusion, but an illusion could be priceless. So he'd bought not one ticket, but three. They were nonrefundable. If his instincts were all out of whack and Glynis surprised him, Zach still wouldn't like it. But the boy was fifteen years old, and how was this for developmental regression: for once an American teenager would do what he was told.

Anxious about being caught in the act, in the end he had too much time. Glynis wouldn't be home for another couple of hours, and the Samsonite was replete. Given the confusion over plugs and current, he'd thrown in a few manual hand tools and a Swiss Army knife; in the average crisis, you were still better off with a pair of needle-nose Vise-Grips than a BlackBerry. Only a couple of shirts, because he wanted to wear different shirts. Or no shirt. A few bits and pieces that a man with Shep's occupation knew could make the difference between satisfied self-sufficiency and disaster: duct tape; a selection of screws, bolts, and washers; silicon lubricant; plastic sealant; rubber bands (elastics, for N' Hampshire old-timers like his father); and a small roll of binding wire. A flashlight, for power cuts, and a stock of AAs. A novel he should have selected more carefully if he was taking only one. An English — Swahili phrasebook, malaria pills, deet. Prescription cortisone cream for persistent eczema on his ankle, a tube that would soon run out.

From So Much For That by Lionel Shriver. Copyright 2010 by Lionel Shriver. Reprinted by permission of HarperCollins Publishers, USA. All rights reserved.

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