So Much For That

Lionel Shriver's 9th novel is an indictment of the American health care system. The first half of the novel struck a pedantic tone I didn't care for and I almost put it aside without finishing it, something I rarely do, but I persevered and am glad I did. Glynis and Shepherd Knacker (I know, what a name!) are a long married couple and the parents of two, a daughter who has flown the nest and a teenaged son who spends most of his time alone in his room playing video games. It has always been Shep's goal to retire to some island paradise. After years of research he decides that paradise is Pemba in East Africa. He sells the household repair business that he has built up over the years and is ready for "The Afterlife". Glynis has shown a reluctance to pick up stakes but Shep has bought 3 plane tickets and is prepared to leave without her if he has to. Then the shit hits the fan. Glynis informs her husband that she has peritoneal mesothelioma, a rare and deadly form of cancer caused by exposure to asbestos. Shep's plans for retirement are suspended and he is forced to work for a nasty little man who once worked for him. He has to keep working to be  eligible for the health insurance that Glynis needs. But if they think the insurance will cover the cost of Glynis's treatments they are in for a rude awakening.
Their best friends, Jackson and Carol, have a daughter suffering from congenital familial dysautonomia, a rare condition that wreaks havoc on the digestive system. They have amassed enormous debts because of the cost of health care for Flicka (what's with that name?) and Carol works day and night to keep their sick daughter alive. Their younger daughter suffers emotional problems, feeling neglected because of her sister's high level needs.

Jackson, Glynis and Flicka are all angry. Shep is angry too but less overtly so. Given the hands they have been dealt their rage is logical.

Shep is forced to face a new reality: out of pocket costs that skyrocket with alarming speed, eating away at the profits from the sale of his company. And despite all the money that is going into her care, Glynis is not getting better. Then Shep's elderly father becomes ill and has to be admitted to a care facility. Shep coughs up the dough for that too because his father and sister never put anything aside for a rainy day and are flat broke. His care of his wife is exemplary yet she resents his "saintliness". The situation is impossible and can only get worse when the money finally runs out.

Jackson and Carol have similar pressures. Jackson opts for an elective surgery which is a failure and several reconstructive surgeries are required. This is the straw that breaks their marriage's back. 

It is hard to imagine that this novel about fatal illness and marriage breakdown will end happily but it ends well given the bleakness of the subject matter. In the end So Much For That leaves us grappling with the question of how much one life is worth. It's not for hypochondriacs or the faint of heart.