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Lionel Shriver, So much for that

September 29, 2010
Lionel Shriver, So much for that

Book cover (Courtesy: HarperCollins Australia)

Having had my own rather traumatic experience of the American healthcare system back in the 1980s I was rather keen to read Lionel Shriver‘s latest offering, So much for that. And, I wasn’t disappointed – or, let me rephrase that, I found it an interesting and engaging page-turner though not a top-ten-of-the-year one.

First a quick plot summary. The book starts with 48-year-old nice-guy Shep Knacker planning to escape the American rat-race to his dreamed of, and as it turns out ironically named, AfterLife in Pemba off Zanzibar. Unfortunately, his plans turn sour with his wife’s announcement that she has a rare aggressive cancer called peritoneal mesothelioma and will need him to continue working, for his health insurance. Paralleling Shep and Glynis’ experience of health service and insurance – and told in roughly alternating chapters – is that of their good friends Jackson and Carol whose 16-year-old daughter, Flicka, was born with the degenerative disease, familial dysautonomia.

So, at the start we have a terminal cancer diagnosis and a child with a disease that is not likely to see her making old bones. Through the course of the novel, two more health issues are thrown in to round out the mix – aged care for Shep’s father after he falls and breaks his femur, and elective shall-we-say “vanity” surgery undertaken with disastrous results by Jackson. This all felt a little contrived to me – as did the occasional preachy dialogue that seemed to be there to make sure we got it. (Shriver is not a taker-outer I think!)

But, somehow, Shriver made it all work – right through to the rather surprising and, thus, risky ending. I liked the fact that she balanced the health care polemics with some wider issues such as the psychology and language of illness and the soul-destroying nature of the American (in particular) rat-race. And I liked the way she offset the plot and structural contrivances with a warm but unsentimental regard for her characters. Glynis and Flicka are not “pin-up” patients but “real” people who are angry with their lot and exhibit selfishness and petulance more often than meek forbearance. Glynis, like the character in Helen Garner‘s The spare room, is in denial about her fate pretty much to the end, and Flicka sees little value in living the sort of life she does. Both consequently feel little need to make it easier for those around them.

Most of Shep’s chapters commence with a statement of his net worth, which at the beginning of the novel is around $730K but which decreases with alarming rapidity as the months wear on and his poor insurance cover doesn’t begin to meet the costs of Glynis’ treatment. If you knew nothing before about co-payments, deductibles, co-insurers, out-of-network providers and lifetime payment caps, you’ll know all about them by the time you finish the book. (Apparently the most common cause of personal bankruptcy in the USA is medical debt.) But this is just the background – the polemics if you will – because the more interesting story is that of Shep and Glynis’ complicated but loving relationship, and of how friends and family react to the diagnosis. We feel Shep’s pain as he realises “he couldn’t fix things”. We understand Glynis’ eventual epiphany that “her husband had misguidedly hoarded his pennies, when the only currency they spent that had ever counted was time”. We cringe when we recognise ourselves in the friends who don’t visit often enough, who offer lip-service assistance rather than actual help. And we start to understand the real implications of cancer-speak that encourages an unrealistic belief in positive thinking, that suggests you can win the battle if you fight hard enough:

I know you mean well [says Shep to the oncologist], but after all this military talk she now equates – dying – with dishonor. With failure. With personal failure.

Near the end Shep asks the doctor what the $2 million spent on Glynis’ treatment (to date) had bought:

“Oh, I bet we’ve probably extended her life a good three months.”
“No, I’m sorry, Dr Goldman,” Shep said on the way out. “They were not a good three months”.

… leaving the real question, which Shep had previously asked his father, hanging:

“is there also a limit to how much you should pay to keep any one person alive?”

Lionel Shriver does not specifically answer this question in the novel but – despite the ending – you know exactly what she thinks.

There is more I could say about the novel. The story of Jackson and Carol, for example, offers the book more than a simple confirming parallel. There are some genuinely funny moments, particularly those between Shep and his free-loading sister Beryl, and those when Jackson pronounces yet another long-winded title for the book on “mugs and moochers” that he never will write. And there are some interesting discussions about art and artists, and about parenting in modern USA. But I’ve said enough I think to give a sense of what this book is about.

Shep says at the end that he’d “rather live a good story than read one”. I’ll leave you to ponder the implications of a novelist writing that line … and simply say that while this is not a perfect novel, I don’t begrudge having given up a bit of my good life to read it!

Lionel Shriver
So much for that
Sydney: Fourth Estate, 2010
433pp.
ISBN: 9780732287030

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14 Comments leave one →
  1. Sue permalink
    September 29, 2010 10:16 am

    Great review. And yes, I’d have enjoyed the book more if she’d taken out most of Jackson’s rants for example. What was she about with the (I thought) far too neat ending? Maybe she was exhausted too…?

    • September 29, 2010 6:46 pm

      Thanks Sue. You know on my p404 – without giving too much away – Shep says to Glynis “We can still end well”. In my marginalia I wrote “Corny”! And I think it does feel that way and yet when the ending is fully played out I think I see the point. As I say above, it’s a risky ending and we can look at it in a whole range of ways in terms of how it works with her various themes but I think it works ok.

  2. September 29, 2010 9:30 pm

    Interesting.

    The US health system is bizarre to most Europeans I know. It seems so, well, so unfair. It’s extraordinary the US can be so rich and yet have worse care than so many much poorer nations.

    I wonder sometimes if the fact a lot of Americans haven’t travelled coupled with the tremendous patriotism one sees in the US results in people sometimes not recognising that some stuff just plain is better done elsewhere. Not everything by any means, but some things.

    I’ve known many who praised the US educational system (and many who’ve deplored it too, but views differ on what’s desirable). I’ve yet to meet anyone who praised its health system.

    All that aside, the book sounds a touch didactic. Is there a point to it that wouldn’t be satisfied by a good essay on the US healthcare system and its challenges?

    • September 29, 2010 11:23 pm

      Thanks Max. I think you have a point re travel. It’s an excellent way of opening one’s eyes to the fact that different peoples/cultures do things differently and that they can sometimes be better than your own and, as you suggest, Americans do tend to travel less (it seems to me anecdotally) than some other Western nations. In Australia travel overseas is a significant thing for most people and pretty much seen as a rite of passage for young people.

      I must say, having experienced the American educational system – kids in elementary school, daughter on exchange at university – I am not one who’d unreservedly praise it. The kids had some wonderful teachers (school and university) and there are some things about the system that I like but there are a lot of things that could be better too.

      Re the book … while its healthcare polemics are a major part of the book it does look at some wider issues which gives the book some life but I wouldn’t say it is one of the must reads of 2010. In other words, it’s a well-written and rather passionate story but it doesn’t excite the intellect in the way that great literature does.

      • September 29, 2010 11:27 pm

        I probably shouldn’t start on my rant about the American college system here, should I? Because, as you say, I did have some wonderful teachers there who, come to think of it, were partly great as a result of going against the grain of the majority of teachers… How would you rate this Shriver against the others of hers you’ve read?

  3. September 30, 2010 1:25 am

    I’ve got this book at home and completely forgot about it! Thanks for reminding me, I’ll have to dig it out. Though in some respects it hits a little too close to home since my husband has MS and we are always finding out something we didn’t know about with his insurance coverage, what’s covered, what’s not, what’s covered after a deductible and how much is covered (80/20, 60/40?), in network and out of network. It’s such a pain in the backside!

  4. September 30, 2010 4:16 am

    A very good review as always. I am surprised that Obama’s proposals for healthcare were described as “socialist medicine”, as though they were a front for a take-over of the US by extremists. We European’s (and Australians I assume!) are used to decent health provision for rich and poor alike. It seems like Shriver has hit a sensitive subject here and deals with it with characteristic insight. I am pleased to hear that she covers the “psychology and language of illness” as a balance to the polemics. You make this sound like a book I would like to read – but as always, pressure of time will be an issue!

  5. September 30, 2010 10:12 am

    Hannah: I’ve only read one other, We need to talk about Kevin. It was a much more intense and, I think, tighter work.

    Stefanie: Oh dear, that is a challenge. I hope you aren’t also facing things like lifetime caps? The insurance must be a real headache and worry to manage, on top of the worry of a managing a chronic condition. You may or may not want to read the book.

    Tom: Thanks. It shows what a pejorative term “socialism” is in the US that the opponents of Obama would know that to trot it out would set the hares running. As you say, we are used to decent health care for all. The principle that all deserve decent health care is in place here even if there are problems in the implementation. We need to keep ever vigilant but no-one here argues against the principle that good access to health is a right AND that government has a major role in ensuring that. I think you would enjoy the book. As I say it’s not perfect but it is a good read.

    • October 1, 2010 4:30 am

      Nah, I want to read the book. I’m a glutton for punishment 😉 We don’t have lifetime caps to worry about at the moment. He’s mobile and all is under control but it seems like every few months the cost of medication changes which makes it hard to budget for. Still, our problems are minor compared to so many others. At least we have insurance!

      • October 1, 2010 6:19 pm

        Great … I’ll keep an eye out for your review. (No pressure though!) And I’m glad you are positive about your health insurance situation but I can well understand that it’s not totally easy either.

  6. October 2, 2010 1:06 am

    Agree with Tom C’s comment – I was shocked that so many Americans were oppose to a national healthcare scheme. I don’t know all that much about it (except the money money money part) but just reading your review makes me so glad for the system we have here, however flawed it may be many can still access relatively cheap care compared to the U.S. I guess all those T.V. medico shows only depict really, really wealthy patients!

    I remember watching Lionel Shriver on the First Tuesday book club and she seemed like a very intimidating woman!

    • October 2, 2010 5:49 pm

      Hi Mae – yes it is shocking to us isn’t it? We cannot understand how their bills keep being defeated, what the fear is all about. And LOL, yes I saw that show and thought exactly the same!

  7. Carol permalink
    October 9, 2010 9:27 am

    Wow! I hope they allowed this to be published in the US. Our new Health care bill got watered down because of misguided opposition. Morgan and I have state insurance which has been great (He even got to have heart surgery at the Mayo Clinic), but is now being cut back, in other words, we pay more, but it is still not bad. I am one year and three months from medicare. Morgan longer. I have a child who is a lawyer and “uninsurable” because he is an alcoholic and I sent him, at my total expense to a rehab center. Now, he will not be able to get any medical insurance for five years! I find this absurd. My grandson who is living with me is also uninsured. He gets free mental health treatment and drugs, but if he becomes physically ill, well, I don’t know. I have a daughter who has a good job, and so does her husband, but they have insurance with an enormous up-front deductible, burdensome, but better than nothing. I can’t believe, people here are so ignorant. I don’t know if I want to read this book or not.

    • October 9, 2010 12:44 pm

      Wow, back! Thanks Carol for sharing those personal examples. It’s hard sometimes to believe these stories can be true. You hear them, and you think “Surely not, surely this can’t be in a progressive nation?” And yet, we deeply fear that what appears to be a huge fear in the US of government and tax is creeping in here by slow degrees. I think you want to read the book!

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