Lionel Shriver's anticipated follow-up to The Post-Birthday World tackles a tricky subject: health care in the United States. Not exactly the most engaging topic for a novel—but then neither is school violence, which Shriver managed to make into a gripping page-turner (2003's We Need to Talk About Kevin). Though So Much for That does occasionally groan under the weight of its heavy subject, overall it is a thought-provoking novel that goes beyond the managed care/private insurer debate to explore the ways we face and respond to illness in people we love.

Shep Knacker (Shriver has a fondness for Dickensian names) has sold his business to fund a retirement escape to a tropical island. With hundreds of thousands in the Merrill-Lynch account, Shep thinks he and his family are all set—until his wife Glynis comes home one day with a cancer diagnosis. But they are insured, so Shep trusts that the treatments will be paid for and Glynis will be cured. It isn't long before their premiums and Glynis' body are both maxed out, leaving the disillusioned Shep to watch their retirement fund dwindle and wonder whether a dream should be sacrificed to fight a battle that may not be won.

So Much for That showcases Shriver's deep understanding of family dynamics. One of the most moving relationships in the novel develops between Glynis and Flicka, the daughter of Shep's best friend. Each is facing death, but due to the cheerful jargon and "we'll beat this" philosophy of the medical establishment (ably lampooned by Shriver), no one they meet will acknowledge that fact.

 

Near the end of the book, Shep has his first honest discussion with Glynis' doctor and discovers just how much extra time their nest egg bought his wife. It's a poignant moment that highlights the limits of even the most modern science in the battle against death, while acknowledging our human need for hope against the odds. Though So Much for That might not be the best introduction to Shriver, it is a wry, astutely observed book that delivers all the way up to the unexpected conclusion.  

This month’s best paperback releases for reading groups feature notable authors and bestsellers.

MITCHELL’S JAPANESE EPIC

In his fifth novel, The Thousand Autumns of Jacob de Zoet, David Mitchell focuses his prodigious narrative powers on Japan in the late 18th and early 19th centuries. A small Dutch trading settlement on an island in Nagasaki Harbor is where readers first meet Jacob, a representative of the Dutch East Indies Company. Jacob hopes to make his fortune and impress his fiancée back home, but instead he falls in love with Orito Aibagawa, a Japanese midwife. Theirs is a tenuous relationship, as Jacob isn’t allowed to visit the mainland where Orito lives. The pair encounter greater obstacles when Jacob is treated unjustly at work, and Orito’s conniving stepmother sends her away to a sinister nunnery. Their stories provide the foundation for Mitchell’s most ambitious work to date. He populates his tale with a cast of memorable characters that includes Uzaemon, an old flame of Orito’s, and various seamen, slaves and government officials. Author of the critically acclaimed Cloud Atlas and Black Swan Green, Mitchell, as always, pushes boundaries to create an epic and richly rewarding reading experience.

IN SICKNESS AND IN HEALTH

Taking a swing at America’s health-care system, Lionel Shriver’s latest novel, So Much for That, is a humorous and insightful examination of the patient-caregiver relationship. After selling his business for a million dollars, Shep Knacker plans to retire and travel the world with his wife, Glynis. But when she’s diagnosed with a malignant form of cancer, Shep finds himself serving as live-in nurse. Glynis makes for a terrible patient, but Shep endures her demands with the support of his best friend, Jackson, whose teenage daughter is also terminally ill. The two patients strike up an odd friendship as the men in their lives struggle to maintain some sort of status quo. Shep’s retirement fund dwindles quickly as he pays for chemotherapy and hospital stays, and Jackson is basically broke. Shriver depicts their plight in lively prose that’s meticulously crafted. She writes with delicacy and a unique understanding of the ways in which illness can transform lives and relationships. This is a funny, angry, compassionate novel that’s sure to resonate with readers.

TOP PICK FOR BOOK CLUBS

In this vivid mix of science and biography, Rebecca Skloot tells the incredible true story of Henrietta Lacks, a victim of cervical cancer whose cells made possible some of medicine’s biggest discoveries. Lacks, a mother of five, came from a poor African-American family. When she died in 1951, doctors took samples of her tissues without having secured her consent. Her cells endured in the lab, allowing researchers to formulate a vaccine for polio and treatments for AIDS. Henrietta’s husband and children had no knowledge of her invaluable contribution until many years later. Skloot becomes involved with various surviving family members, who had passed the intervening years in poverty and bad health, helping them discover the truth about Henrietta. This poignant story about the invasiveness of medicine is also a deeply intimate look at one family’s efforts to claim its legacy. 

Copyright 2011 BookPage Reviews.

Shep Knacker believes in the "Afterlife" and has spent every moment of his adult life planning for it. But he's not a born-again Christian. Shep's version involves a hammock on a sandy beach in a Third World country where he and his wife, Glynis, can retire and live like royalty for dollars a day. Poised to set his dreams in motion, Shep learns that Glynis has cancer. Now every penny must go to medical expenses not covered by an inadequate health insurance policy. Shriver's (The Post-Birthday World) latest novel is both a realistic portrait of a family dealing with terminal illness and a thorough critique of the American health-care system. VERDICT Shriver's strong, clear writing is marred by several complex subplots and lengthy rants by Shep's best friend, Jackson, who is anti almost everything and dealing with a botched surgery himself as well as a daughter with an incurable disorder. Readers who prefer a more focused plot will want to stick with Jodi Picoult, but Shriver's fans and others willing to follow the author's turns will find themselves thinking about the novel long after they've finished it. [See Prepub Alert, LJ 11/15/09.]—Christine Perkins, Bellingham P.L., WA

A risk taker with a protean imagination, Shriver (The Post-Birthday World) has produced another dazzling, provocative novel, a witty and timely exploration of the failure of our health-care system. Shep Knacker's long-cherished plan to use the million dollars from the sale of his handyman business to retire to a tropical island receives a gut-wrenching blow when his wife, Glynis, is diagnosed with a rare cancer. Transformed into a full-time caregiver, the good-natured Shep is buoyed during the illness of self-centered, vindictive, and obnoxiously demanding Glynis by his working mate and best friend, Jackson Burdina, whose teenage daughter, Flicka, also has a terminal disease. Ironically, Glynis tenaciously clings to life, while Flicka, with whom she bonds, wants to end hers. Jackson, meanwhile, acutely conscious that he's going broke, rails pungently against government regulations and the insurance industry. A mouthpiece for the plight of middle-class workers, Jackson's diatribes about contemporary society—the medical, educational and banking systems, exorbitant taxation, political chicanery—ring painfully true. As Shep's Merrill-Lynch account dwindles and further medical calamities arise, Shriver twists the plot to raise suspense until the heart-lifting denouement. (Mar.)