By Ron Charles
Wednesday, March 17, 2010; C03
SO MUCH FOR THAT
By Lionel Shriver
Harper. 433 pp. $25.99
Once again Lionel Shriver has stomped into the middle of a pressing national debate with a great ordeal of a novel that's impossible to ignore. In 2003, she published "We Need to Talk About Kevin," which relived the horror of a school massacre. Now when many of us assumed we'd be enjoying the fruits of Obamacare, she's released a novel about the ongoing cruelty of American health insurance.
If Jodi Picoult has her finger on the zeitgeist, Shriver has her hands around its throat. Not only does her new book wrestle with actual laws and prices (COBRA! co-pays! out-of-network deductibles!), but it reminds us just how politically argumentative a novel can be. Like Upton Sinclair, she forces us to look at how the sausage is made; if anything, "So Much for That" is even bloodier than "The Jungle."
At the center of the story is 48-year-old Shep Knacker, a small businessman who has spent his life working hard and dreaming of not working, a blissful future he refers to as "The Afterlife." Eight years ago, he sold his handyman business, Knack of all Trades, for $1 million, and since then he's hung around working for the obnoxious new owner, waiting for his wife, Glynis, to give in and join him on the great escape. In the dramatic, if too coincidental, opening scene, Shep announces that he's finally bought nonrefundable one-way tickets to Pemba, an island off the coast of Tanzania. "I would like you to come with me," he says. "But I am going, with or without you." Glynis responds coolly: "I do wish you wouldn't." She has cancer, she announces, and so he can't quit his job: "I will need your health insurance."
The wrenching tale that develops over the next 400 pages drags us deep into the horrors of a life-threatening illness, major surgery and chemotherapy. But that powerful central story must constantly compete with several additional medical nightmares: When Shep's elderly father moves to a nursing home, the novel piles on all the scatological details of geriatric care. A colleague at Knack of all Trades endures a botched penile enhancement procedure that sounds like something John Irving and Wally Lamb came up with on a dare. And then there's the surly teenage daughter of Shep's best friend, who suffers from a "slow-motion disaster" called familial dysautonomia. This rare genetic disorder cripples her, plays havoc with her blood pressure, causes seizures and projectile vomiting, forces her to eat through a hole in her abdomen and requires regular enemas and emergency suppositories.
In short, "So Much for That" is a ghastly parade of physical ailments and inadequate medical responses. It's clearer here than ever before that Shriver has a merciless streak, a tendency to flail her characters and her readers' sensibilities. My reaction to the novel was schizophrenic: There were times, honestly, when I felt I couldn't read another page without getting sick myself. Even when her descriptions of retching, evacuating, twisting bodies aren't shield-your-eyes gruesome, the story is unrelentingly depressing.
And yet I admire that what she's done here is without a dose of sentimentality. Yes, it's gangling and pedantic and far, far too long, but its anger is infectious. If you can take the story's grisly details and Shriver's badgering insight into all things, this is the rare novel that will shake and change you. With these wholly realistic and sympathetic characters, she makes us consider the most existential questions of our lives and the dreadful calculus of modern health care in this country. If the senators so enamored of our current insurance industry conduct their threatened filibuster, perhaps some strong-stomached Democrat should counter by reading this story into the Congressional Record.
The first part of the novel plays out while Terri Schiavo hovers on TV, with Republicans vowing to spare no expense to maintain her brain-dead body even as millions of conscious Americans are denied health coverage. Meanwhile, Glynis's treatment produces a double helix of hospital bills and insurance statements as bewildering as the cancer treatment itself. Shep is willing to spend whatever it takes to heal his wife -- every chapter begins with an updated statement from his dwindling Merrill Lynch account -- but what is the monetary value of a single life? What are another three months of pain worth?
And setting aside the novel's politics and economics, I've never read anything that made me so cringingly self-conscious about the way we respond to friends who are seriously ill. Granted, Glynis is a particularly unpleasant patient, angry and bitter about her feeble artistic career, but that only makes her more real. "Umbrage was her drug of choice," and she delivers a scathing diatribe on the culture of cheer that's built up around cancer treatment. She rages against "these nauseating speeches . . . the upchucking reminiscences . . . All this -- sentimentality!" Echoing Barbara Ehrenreich's similar complaints last year in "Bright-Sided," Shriver rips into the guilt-inducing support-group lingo: "hanging tough. Refusing to let go. Not giving up. Going the last mile. You'd think they were organizing a grammar-school sports day. . . . After all this military talk she now equates -- dying -- with dishonor. With failure. With personal failure."
Shep, meanwhile, notices "with an acrid taste in his mouth" that the initial pledges "to help in any way possible" are never followed by any actual assistance. "Their friends and family alike had poor emotional endurance," he realizes. "No parent had ever sat them down to explain that this is what you do and say when someone you at least claim to care about is deathly ill. It wasn't in the curriculum." If you've gone through this shocking evaporation of human contact, you know how true it is. When my daughter was born with severe brain damage 20 years ago, we were effectively ostracized by our community. My wife worried that we'd be overwhelmed by offers of assistance from fellow church members. None. Zip. One of our best friends told us later, "I sensed something was wrong, so I didn't call." But then as a friend of mine died last year across the street, I was too embarrassed to do anything besides send a brief note of encouragement. This is a novel that irradiates such sins of omission with shame.
As our chronic debate on health care reform drags on -- that hacking political cough that gets no better -- here is a novel that dramatizes what middle-class families are really suffering. "So Much for That" is a furious objection to watching the dream of health, financial security and old-age companionship wither and die. It's a bitter pill, indeed, but take it if you can.
Ron Charles is the fiction editor of Book World. You can follow him on Twitter at http://www.twitter.com/roncharles.