New York Times, March 2, 2010
America’s Health Care Crisis Visits Families, and Stays
By Michiko Kakutani
SO MUCH FOR THAT By Lionel Shriver
A novel about the health care crisis in America? Well, Lionel Shriver’s new book, “So Much for That,” doesn’t tackle health care head-on, but in recounting the intertwined stories of several characters suffering from medical conditions — ranging from the most grievous and deadly to the more cosmetic and absurd — it creates a harrowing picture of the fallout that the current health care and insurance system can have upon regular, middle-class families struggling to care for their loved ones.
This description might suggest that Ms. Shriver has constructed a didactic or lugubrious novel, willfully topical and laboriously relevant. She hasn’t. In fact, she’s managed to take an idea for a kind of thesis novel and instead create a deeply affecting portrait of two marriages, two families, as cancer in one case and a rare, debilitating childhood condition in the other threaten to push their daily lives past their tipping points.
Though there is one farcical plot development that is poorly woven into the emotional fabric of the story, and though some of the asides about health care feel shoehorned into the narrative, the author’s understanding of her people is so intimate, so unsentimental that it lofts the novel over such bumpy passages, insinuating these characters permanently into the reader’s imagination.
When we first meet him, Shep Knacker is contemplating the Big Escape. For years, he’s fantasized about what he calls “The Afterlife,” about using the money he made selling his handyman-home repair business — some $700,000 — and taking his family off to a faraway, third world country, where his savings will last them forever, and they can lead the good life.
His wife, Glynis, has made him postpone these plans for years, and now he’s decided that if she tries to delay their departure again, he will proceed without her. He hates working for the man he sold his business to; he hates the daily commute from the suburbs; and he likes the image of himself as a guy willing to press the Eject button — someone with the guts to get off the New York City treadmill and chase after his long-held dream.
Shep’s pipe dream is blown to smithereens when it turns out that Glynis has an announcement of her own: she’s been diagnosed with mesothelioma, a type of cancer associated with exposure to asbestos, and in her case, a deadly form with terrible survival odds. Glynis’s cancer turns everything in their life into a Before and After, and it indelibly alters their relationship.
Glynis, usually the pessimist, embraces every shred of hope she can find, convinced she can beat the illness, while Shep scrolls through the Internet late at night, reading up on mesothelioma and brooding over the terrible side effects of chemotherapy. He determinedly focuses on her care: not only serving as her nurse, but also cooking their meals, cleaning the house, filing her medical forms, while kowtowing to his hated boss because he knows that if he is fired, they will lose their precious medical insurance.
“He would do anything to make Glynis more comfortable,” Ms. Shriver writes, “or to keep her from going to any trouble. He would do anything to save her.”
Always headstrong and critical, Glynis turns her rage at getting sick on her husband. She cruelly suggests that the asbestos that caused her illness came from his work as a handyman (when in fact her own career as an artist who worked with metal is what brought her into contact with that dreaded insulation material); snippily sends back the meals he’s thoughtfully cooked for her; sends him on wild goose chases to pick up things for her in the city; and mocks every effort he makes to accommodate her as patronizing and insulting. She rages against her mother and sisters, denounces old friends, and takes perverse, schadenfreude-like interest in the woes of others — including the victims of Hurricane Katrina.
Just as Ms. Shriver created an uncompromising portrait of a killer and his mother in “We Need to Talk About Kevin,” so she does little in these pages to whitewash Glynis’s anger — and often appalling outbursts. Instead she manages to convey Glynis’s fear and bewilderment and isolation. What it’s like, especially as her illness progresses, and the chemo takes more and more of a toll on her body, to have to stop thinking about the future and simply focus on getting through that afternoon or evening. What it’s like to see others jogging or working out when it’s a struggle for her simply to walk up the stairs to her bedroom. Disasters reported in the morning newspaper, relatives’ difficulties and complaints, the weather outside that day are all equal to Glynis:
“There were no big things and little things anymore,” Ms. Shriver writes. “Aside from pain, which had assumed an elevated position of awesome sanctity, all matters were of the same importance.”
At the same time, Ms. Shriver uses the gift for psychological portraiture showcased in her last novel, “The Post-Birthday World,” to give us a nuanced understanding of Shep’s state of mind as he copes with troubles that grow more Job-like every day: an increasingly critical boss, who is sick of his taking days off to tend to Glynis; news that his elderly father is in the hospital and will need to be moved to an expensive nursing home; worries about how his two children are coping with their mother’s illness; and rapidly dwindling savings (once meant for the Afterlife), which could lead him into bankruptcy. His sense of duty and responsibility are made palpable to the reader — not in a trite or sentimental manner, but as the strivings of a decent man to take care of his family, to do the necessary thing.
The travails of Shep’s best friend and colleague, Jackson, are no doubt meant to serve as a sort of narrative counterpoint, but there is something self-consciously contrived about his dilemmas. Jackson is an autodidact and a noisy libertarian, continually — often comically — ranting about the government, insurance companies, people who game the system.
His wife, Carol, like Shep, is one of those people miraculously capable of stoically handling whatever life throws at them; years ago she took a stultifying job at I.B.M. so they could get medical insurance that would cover their daughter Flicka, who suffers from a genetic nervous system disorder called F.D., or familial dysautonomia, which requires enormous amounts of special home and medical care.
“Though outsiders would never have guessed,” Ms. Shriver writes, “Carol was much more of a nihilist than her husband. She sat for hours numbly at her computer doing sales outreach for I.B.M., filled the humidifier in Flicka’s bedroom before fetching a new roll of Saran Wrap for their sadly plastic version of tucking their daughter in, and for years had risen wearily at 1 a.m. to pour the first of the night’s two cans of Compleat into Flicka’s feeding bag — all without any sense of mission. She just did it.”
Jackson’s abrupt decision to have some expensive and ridiculous cosmetic surgery are never made plausible to the reader — it’s hard to imagine anyone of his intelligence taking such a risky and impulsive step, especially without consulting his wife — but Ms. Shriver does manage to make the snowballing consequences of that terrible choice emotionally real. It remains clear to the reader that Ms. Shriver has set up all these medical story lines — involving Glynis, Flicka, Jackson, and Shep’s father — to explore the plight of middle-class Americans squeezed by the current health care system, but it’s a testament to her gifts as a novelist that she turns this schematic outline into a visceral and deeply affecting story, a story about how illness affects people’s relationships, and how their efforts to grapple with mortality reshape the arcs of their lives.
