Lionel Shriver - So Much For That

Unlike the last book, I can't pretend that I didn't walk into this one with eyes wide open. I've read a couple of Lionel Shriver's books before (her most famous one, We Need To Talk About Kevin, was the best book I read last year) and I have huge amounts of respect for her as an author, but a certain amount of emotional resilience is required to get though her books, and I knew this one would be no exception. Especially because I knew that it is, to a large part, about the American health care & medical insurance system.

Despite watching epic amounts of Scrubs -- for educational purposes, you understand -- over the years, and also hearing about the trials and tribulations of my American friends when it comes to accessing affordable healthcare, I didn't have a lot of nitty-gritty knowledge about how health insurance in the States works. Terrifyingly jargonistic paragraphs like this one worked to shed some light, but it was the kind of light that tells you that you're not alone in the dark creaky house at night, and there's a good chance the bearer of the other light has a knife:

"See," she went on, "this World Wellness Group outfit is the health insurance company from hell. They levy co-pays on everything, including the meds, and we have to fill dozens of prescriptions every month. With their whopping deductible, you're out five grand before you're reimbursed a dime. Their idea of a 'reasonable and customary' fee is that a doctor's visit cost in 1959, and then they stick you with the shortfall. They're way too restrictive about going out of network, and Flicka requies very specialized care. Then there's co-insurance on top of the co-pays: twenty percent of the total bill, and that's in network. And here's the killer: there's no cap on out-of-pocket expenses. Add to that that their lifetime payment cap -- you know, how much they'll fork out in total, ever -- if also pretty low, only two or three million, when someone like Flicka could easily exceed numbers like that before she's twenty... Well, we had to find other coverage."

Living in a country where all hospital care is free and all GP visits and most medications are subsidised heavily by the government (although many people choose to have some form of health insurance on top of this, to get faster access to elective surgeries and more choice of treating doctors, you don't need a cent of insurance or a dollar in your wallet to get care through a public hospital), all this makes me want to claw at my face and scream.

The book centres around two married couples: there's Shep, who saves all his life for early retirement on a tropical island only to find out that his wife Glynis needs him to keep his job -- and dip into his savings -- because she contracts mesothelioma. And there are their friends Carol and Jackson, who live with the fact that their daughter Flicka has familial dysautonomia and will probably die before she gets much older; in the meantime, she's the source of the constant medical and financial strain outlined in the quote above.

I'll tell you straight off, this is not an easy book to read. At times it's excruciating. I had to take frequent breaks from it during which I read less wrenching fare. It also doesn't try to shield you even the slightest amount from the realities of illness and medicine, so if you can't cope with some really blunt descriptions of cancer symptoms and chemo and its side effects, you may not get through it.

But it's worth it not just for those of us who need an education in what a phenomenally unfair health care system looks like, but also because Lionel Shriver has a mastery of human relationships and human behaviour that is unparallelled in my experience. She writes realistic, flawed human beings; she writes them responding to good times and bad; she writes them with a depth of analysis and a keenness of perception that's astonishing; she writes likable people and unlikable ones, and she shows you how easily it is for people to swing between these categories. One of the examples that cut closest to home for me was the use of Glynis to illustrate how perfectionism is the enemy of productivity when it comes to creative pursuits.

It's a book about living within a structured, governed and taxed society, and the ways in which people play by the rules -- or don't -- and what happens when the ground falls out from under you feet and the society you've been supporting isn't there to support you in turn. It's a book about priorities. And although it doesn't say so in so many words it explains, powerfully, why the term 'temporarily able-bodied' has the same usefulness as 'cissexual': pointing out the arrogance of assuming that something is normal.

As a concept, she understood being "well" better than anyone on the planet. For After Glynis had discovered a terrible secret: There is only the body. There never was anything but the body. "Wellness" is the illusion of not having one. Wellness is escape from the body. But there is no escape. So wellness is delay. What had Before Glynis -- Well Glynis, Pre-Inexorably-Going-to-Be-Sick-Any-Minute-Now Glynis, done with her free ride, her gift of the soon-to-be-revoked illusion that she was not, after all, a body -- a body and only a body?

The book asks why we as a society have so little protocol for how to behave in the face of death, when it's the oldest and most inevitable human reality. The biggest question that it asks, though is this: how do you put a price on a human life? And how do you manage when you are forced to do exactly that? In a chillingly effective piece of structure, the start of each chapter gives you the new balance in Shep's bank account. In its way this illustration of the cost of dying, down to the last cent, is just as brutal as the descriptions of rectal bleeding and insomnia.

However, just so you know: the book doesn't leave you broken. It lifts you up. It gives you something back. After Kevin I wasn't expecting even that much from Shriver, so the ending, while it didn't pull too many punches, was certainly a balm for my horrified soul.