Prior to reading this book, I had heard it repeatedly described as a “health care” novel. The message, it was said, predominates. I began the book with some trepidation. Over four hundred pages of a fiction author’s message about health care is not my idea of a good time. My doubts evaporated quickly.
But not before Chapter One starts off with this:
Shepherd Armstrong Knacker
Merrill Lynch Account Number 934-23F917
December 01, 2004 – December 31, 2004
Net Portfolio Value: $731,778.56
Recognition that the “Net Portfolio Value” will soon start to decline takes little familiarity with the art of foreshadowing. This is a message book. And then the prose and characterization begin.
“Shep” Knacker is a professional handyman. He accumulated his nestegg by first building up and then selling a home repair company. The proceeds, after tax, were not sufficient and the timing was wrong for him to begin “The Afterlife”, his dream of ditching modern society for a tropical paradise where a person could get by on dollars a day. Instead, he has continued to save and has stayed on with the company. Shep had poor judgment and worse foresight in selling the company just before it became extremely valuable. The new owner, silverspooned Randy Pogatchnik, was a terrible employee and is a worse boss. Shep is miserable. The only thing that has been sustaining him is his belief in “The Afterlife.”
Shep is married to Glynis, an artisan metalworker who plans more than works to the family’s financial detriment. They have two kids: Amelia who is grown and Zach who is in high school. Shep is tired of the grind and shouldering the family’s financial load. The book begins as he is packing for “The Afterlife”. He has not yet told Glynis. He plans to:
He wasn’t presenting her with a total fait accompli either, a wave goodbye at the door. Officially he would confront her with a choice, on for which, in the service of credibility, he had paid through the nose. Odds were that he had purchased nothing but an illusion, but an illusion could be priceless. So he’d bought not one ticket, but three. They were nonrefundable.
His determination to go is bolstered by the fact that the bank account is his doing. He has provided Glynis with a home, food, and time to practice her art. She has frittered away that time, something over which the ever-responsible Shep manages to feel some guilt. The problem is that Glynis is a perfectionist and has not been pushed.
She could overcome her anguish about embarking on an object that, once completed, might not meet her exacting standards only if she had no choice. In this sense, his helping had hurt her. By providing the financial cushion that should have facilitated making all the metal whathaveyou she liked, he had ruined her life. Wrapped in a slackening bow, ease was a poisonous present.
Lionel Shriver has deftly sketched out the family. Shep is a reliably pragmatic man with a soft touch and one dream, the “priceless illusion” that keeps him motivated. Glynis is a hard-edged perfectionist who has let the dream slip, to the extent she ever shared it. We meet them at a crisis point. Shep is leaving with or without Glynis. He cannot stand mundane reality anymore.
I was won over by the writing quoted above and lines like this in which resentment is described as:
an emotion distinctive for being disagreeable on both its generating and receiving ends.
When Shep does tell Glynis, she indulges where he expected resistance. He sets his plight in heroic terms, pitting “The Afterlife” against endless milk runs to the A&P.
”There are worse fates.”
“No,” he said. “I’m not sure there are. I know we’ve seen plenty of poverty – raw sewage running in gutters and mothers scavenging for mango peels. But they know what’s wrong with their lives, and they have a notion that with a few shillings or pesos or rupees in their pockets things could be better. There’s something especially terrible about being told over and over that you have the most wonderful life on earth and it doesn’t get any better and it’s still shit.”
Shep’s passion for ditching the 9-to-5 world is infectious. Glynis’ reasonable response was grown-up but frustrating. Why can’t Shep have his dream?
The answer, of course, is health care. Glynis calmly informs Shep that she has cancer and she will need the health insurance he gets through his employer. He cannot leave for his paradise. The news is shattering. He must slink back to the jerk Pogatchnik and beg his job back. The situation is doubly hard because, as Shep left, he dropped a trail of colorful suggestions for what Pogatchnik could do with the job.
Shep’s best friend is Jackson. Jackson and his wife Carol have a daughter, Flicka, who suffers from familial dysautonomia (FD). FD is a rare genetic disorder that affects almost exclusivly Ashkenazi Jews and causes insensitivity to pain and a multitude of other problems. Flicka is sixteen years old, a daddy’s girl, and will be lucky to survive to her late twenties. Jackson and Carol also have a second daughter, Heather, who they would have aborted had the amniocentesis revealed that she too had the disorder. Heather craves the attention her suffering sister receives. To keep her from feeling “left out”, Jackson and Carol obtained a prescription of placebos. To placate themselves, they allowed Heather to eat her way into obesity as compensation for the misfortune of having an unwell sister.
My misgivings about this being a message book started creeping back on the little cat feet of foggy passages like this:
”You sound so down on Medicare and Medicaid. But you’re not saying that you wish old and poor people didn’t have access to health care.”
Jackson sighed. That line was so predictable. Shep was a class-A Mug. For the ranks of complacent dupes to which, alas, Jackson also belonged, Shep Knacker could be the mascot. “No, I’m not saying that. My point is, guys with health benefits don’t think they’re paying their own medical bills. They cling to their precious employee health insurance as if it’s this great freebie. It’s not free! They don’t understand they’d be getting, like, fifteen grand more in salary if it weren’t for the damned health benefit! It’s fucking sad, man.”
“Money’s gotta come from somewhere, Jacks. Som big national thing would send taxes through the roof. There goes your fifteen grand. Worse, if you earn a decent living.”
“It seems like it’s all the same dough, but it’s not. Think about it. Every piece of paper that just landed in your mailbox cost money. Some officious twit was paid to fill in all those codes, and tick the boxes, and fire off copies to five other places. Thirty percent of the money spent on medical care in this country goes to so-called ‘administration.’……”
Large sections of the book are filled with conversations like this one. Shep playing straight man while Jackson, who has been dealing with the health care industry for years, feeds him statistics and rants in a way familiar to anyone who has heard political talk radio (left/right, does it matter?) or someone who listens to political talk radio. Under the weight of a great bulk of this sort of dialogue, the smooth realism of the opening starts to fade. It is to Lionel Shriver’s great credit that, despite this sort of thing, her characters only occasionally feel like props for her essay on health care. Shep, Glynis, Jackson, Carol, and Flicka throb with vitality and truth. Zach spends his time holed up in his room, so is little more than a placeholder for most of the book. Amelia is window dressing and Heather is a disaster.
There is a third major health crisis that begins developing a third or so into the book. Shriver plays it a little too coy, only giving hints of the condition besides otherwise providing full access to the character’s thoughs. The strings, in other words, started to show.
This transparency is not helped by the fact that the narrative hangs on the three major health issues: FD with about 350 or so sufferers worldwide; mesothelioma with an incidence rate of less than 30 per 1,000,000; and the unidentified condition which, given the statistics I was able to find, may have an incidence rate as high as 100 per 1,000,000, but it is probably much, much lower (I added plenty of fudge factors to get to 100/Million). The third condition is asking lots of indulgence from the reader. I found it hard to indulge given the way this third afflicted character had been portrayed and all the circumstances surrounding his life. The numbers were an aggravating factor, but the plot machinations required to get there were simply too implausible.
(I am not including in the tally an elderly parent and the parent’s health issues which are plausible. Though this fourth health care crisis could feel wedged in to provide a comprehensive birth-to-death overview of the disadvantages of the American health care system.)
Still, Lionel Shriver is skilled at keeping us perched on the shoulder of these two suffering families. The frustrations of dying in slow motion are conveyed with a disquieting candor. Cancer is a bitch and Shriver holds back little of the psychological trauma. At least, she maintains the grit for the first two-thirds to three-quarters of the book.
The material is so heavy, the tragedy so black, Shriver must have felt a need to provide some light and hope. She does this through a number of very suspect plot developments. Coincidence upon coincidence would not be so bad, but the novel ultimately gives way to Hallmark(tm) moments. Closure and even hope for the future abounds, which alone is not bad, but it feels similar to what I imagine a Nicholas Sparks book feels like at the end if I was ever masochistic enough to subject myself to his dreck. Things work out too well, the characters handle life’s uppercuts too easily.
The downside of this happy-as-possible-under-the-circumstances ending is that the message is lost. Topping off the novel with syrup leaves such a sickly sweet taste that it is hard to imagine many readers are left with a hunger for action.