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So Much For That ()

A Novel Tallies The Real Cost Of Health Care

Apr 6, 2010 (Fresh Air)

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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."

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.

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