Lionel Shriver loves a good tragedy. In the months of soul-searching that followed the Columbine massacre, Shriver penned the Orange Prize–winning novel We Need to Talk About Kevin (2003). The epistolary thriller, narrated by a mother attempting to understand why her dislikable son went on a murderous rampage at his high school, wonders whether to blame herself or society. Or maybe he was simply a bad seed?
In her new finger-on-the-pulse novel, So Much for That, Shriver weaves together four medical dramas, and there is no ambiguity about where fault lies—at the cloven feet of the two-headed monster that is the American health-care system and insurance industry. Shriver creates a cast of complicated, ferocious individuals, including her specialty: prickly, narcissistic women who, if they choose to reproduce, do so at their peril.
At the center of each tale are the Knackers, headed by the good and noble Shep, a hardworking, entrepreneurial handyman who has spent his life scrimping and saving for his dream of "The Afterlife": the day he can chuck it all and, with wife and two children in tow, retire to the island idyll of Pemba. But when Shep finally sells his company for a million dollars, Glynis, his wife of twenty-six years, informs him she isn't ready. Once a promising designer of avant-garde flatware, she blames domesticity and motherhood for quashing her dreams. Her resentment is too great to allow her husband his heart's desire. After eight years of being forced to work for the sadistic jerk-off who bought his company, Shep presents Glynis with an ultimatum: "With no promised land to look forward to, I can't keep it up." This time she has a good reason for wanting him to hold onto his job: cancer. As she mentions coolly, "I'm afraid I will need your health insurance." So much for that.
You might imagine Shep harbors some anger and resentment, but he seems—infuriatingly—incapable of getting mad. This despite the ingratitude of everyone whose life he subsidizes. "Every member of a family has a role, and Shep was the one who paid for things. Because every other party took this state of affairs for granted, Shep took it for granted, too." While his emotional reserves may be bottomless—he bears the worsening of his wife's condition, his sister's greedy scheming, and being forced to put his father into a state-run nursing home—his savings are not. The family's credit lines and lifelines are knotted together. The persistent, sinister drip, drip, drip of their bank account bleeding dry infuses the novel with the terror of a thriller. Beginning each chapter with a record of their account balance, Shriver uses her pen as a cudgel.
Inevitably, Shep must crawl back to his job; he's a pathetic joke to everyone save his best friend and defender, Jackson Burdina, as immature and impulsive as Shep is staid and responsible. Given to long-winded rants against the government and the "Mugs and Mooches" of society, Jackson is envious of his friend's decision to "exit from this travesty of 'freedom.'" Through Jackson, Shriver telegraphs her message most directly: "Health care is about the only thing the fucking government should be good for. And maybe, just maybe, if you could at least go to a doctor without having to take out a second mortgage, people would figure that, okay, they pay taxes but at least they get something back. Right now, you get dick."
Jackson has his own crosses to bear. As cold, unmaternal, and selfish as Glynis is, Jackson's wife, Carol, is warm, loving, and brings home not only the bacon but the health insurance. Given that their sixteen-year-old daughter, Flicka, was born with a genetic disorder, familial dysautonomia, this is crucial. The effects of the degenerative disease are endless and ghastly; the odds of her living to adulthood distant. Meanwhile Flicka, a whip-smart anti-Pollyanna growing sicker and more tired of her parents' refusal to see her life as untenable, lives in a state of barely controlled rage.
Shriver's presentation of Flicka and Glynis as unpleasant and unapologetically pissed off at the world is admirable. While the surly teenager proclaims, "Terry Schiavo is lucky," the bitter would-be artist fumes, "I'm supposed to come across with a blinding vision, a cloud-parting revelation from on high. Shit, on top of chemo, and chest drains and MRIs, I'm supposed to part the waters for everyone else. It's fucking unreasonable."
Given the sheer number of pages she's given to speechifying and descriptions of the myriad assaults on the body these characters endure, Shriver clearly isn't as keen to create characters who feel alive as ones who, through force of circumstance, compel us to ask troubling questions: What would I do in this difficult situation? Would I prolong a life of little quality at the cost of my life's savings and emotional resources?
Shriver's fearlessly candid approach to illness may be laudable, but eventually it begins to feel less like nerviness and more like sadism. She doesn't try to move readers to tears (which is good, since none were shed), but rather to provoke anger. She does this. But by the end of So Much for That, we're not motivated to write our lawmakers to demand better health care; we just want an aspirin. As her unlucky souls' slow march toward death draws to a close, Shriver may have anticipated readers' exhaustion and a need for oxygen. She doesn't produce a miracle, but offers instead a happy—if improbable—ending. And in these pages, that is a miracle in and of itself.
Elissa Schappell is the author of Use Me (William Morrow, 2000) and an editor at large of Tin House.