"So Much For That" deals with the issues of cancer, health care and dying in America. The lead character is Shep Knacker. Shep once owned a successful handyman service in Brooklyn NY, but sold the business 8 years ago for a hefty sum. This nest egg he has carefully sat on since then in the hope that it will sustain him and any willing family members in the "AfterLife", which is retirement in a yet-to-be determined low cost paradise. For the past 20 years, Shep and his wife Glynis have done research in a multitude of exotic locales, but the research has had an unreal quality, as most of the people who know Shep don't think he will ever follow through.
As the book begins, Shep, in an uncharacteristic moment, impulsively buys 3 one-way tickets to Pemba, a tropical island off the coast of Zanzibar. As Shep breaks the news to Glynis that the plane leaves tomorrow, and that he is getting on the plane with or without her or their son, Glynis breaks the news to Shep that she has mesothelioma, a form of cancer brought on by exposure to asbestos. Shep in turn slowly unpacks his bags.
Glynis is a fascinating character, one that is difficult to love. She does not take her illness gracefully and unleashes her spite and bile on family members and friends. Glynis is a sympathetic and refreshing character though, one that is more real than the fairy Florence Nightingale good patient found in most novels. Glynis hangs on to every morsel of hope her doctors dispense to her, and in these exchanges Shriver examines the American attitude towards sickness and finds that it involves denial, deceit, guilt and vested interest. First there is denial that the illness is fatal. Followed by deceit from medical professionals and good-intentioned family members that the disease can be beaten, but only one tries hard enough. Then comes guilt; if a treatment is not successful, perhaps it is because the patient is not enough of a fighter, and has not battled hard enough. And for the family members, if one treatment is not successful, there is always a second, more experimental treatment available. It of course costs more, but in dealing with the health of a loved one, should one even consider prosaic financial concerns? Of course not! We need to spend every single dime we have to ensure the best care is provided. And finally the vested interest. The institution foisting this belief onto consumers is the medical profession, who have a vested interest in maximizing the amount of medical care one consumes.
As the treatments wear on, Shep's bank account is slowly depleted and the AfterLife slowly recedes. The Knacker's best friends, Jackson and Carol Burdina, have their own set of challenges: their child Flicka is afflicted with a rare fatal disease, their second child is obese, and their marriage is deteriorating. Carol is a martyr, sacrificing herself as an IBM drone in order to secure health insurance. Jackson initially leavens the story with his Tea-Party like rants, but midway through the rants turn from funny to angry, the change attributable to his lack of sex life with Carol. Carol wants nothing to do with him after a botched-penile enlargement surgery. His need for sex drives him to the arms of a prostitute, who, after viewing his damaged goods, also rejects him. Despondent, Jackson returns home to first castrate himself and then kill himself with a bullet to the head.
Jackson's suicide is a call-to-arms for Shep. Initially defined by Jackson as a 'Mug' (aka a sucker), Shep now switches sides to become a 'Mooch'. Glynis is suing the manufacturer of the metal-working supplies she used thirty years ago that contained the asbestos that caused the cancer. That she stole the supplies from a secure area after it was known they were harmful becomes a detail that Shep believes can be overlooked in her deposition. The company, shocked by Glynis' condition, promptly offer a hefty settlement that replenishes the coffers for the AfterLife.
Some of the most moving writing in the novel describes the slow deterioration of Glynis. Her dying initially is a 'rage against the dying of the light'. She is bitter and angry, and rails against the hypocrites who visit her to make themselves feel better by assuaging some form of guilt. Shriver examines how modern medicine utilizes the words of war like fight and battle to describe modern medicine's approach to disease. Some diseases though are fatal and the novel makes a forceful case that we would be better served by accepting the inevitability of certain diseases and ultimately our own mortality.
The novel concludes with the escape to the AfterLife by Shep and Glynis and their son. Shep also dadnaps his father from a nursing home, where he has been placed after breaking a bone in a fall. Also along for the ride are Carol and her two children. On the island of Pemba, Glynis, Flicka and Shep's Dad all pass over with some of their dignity restored.
The novel confronts the reader with the issue of mortality and money. Dying is something we want to avoid at all costs and this attitude has created a sick society. Sick in the sense that we cannot discuss money and mortality in the same sentence without some nut screaming about 'death squads' or how crass we are to put a price tag on a life. Should we though spend every last dime to continue life? And is there a quality or quantity factor? Should we spend $100,000 to continue a life for one more day? And suppose that day is a day spent hooked up to a ventilator? In the background of the novel the Karen Schiavo case plays out and surfaces these questions nicely. The novel provides no easy answer, though in the AfterLife Glynis is more accepting of her death. That the AfterLife in the novel is a physical location rather than a spiritual belief is ironic.
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