Review: So Much For That

Fury: Lionel Shriver flays the American healthcare system. Photo / Supplied

Readers will need both stamina and stomach to get through Lionel Shriver's 480-page So Much for That. Be prepared for a gruesome parade of ailments depicted in queasy detail. Medical conditions such as peritoneal mesothelioma, an uncommon form of cancer: "They will slice her like a vegetable. And then pick, bit by bit, the tiny shreds of that onion skin that look peculiar - too stiff or too slimy or the wrong colour."

Or familial dysautonomia, a rare congenital condition that causes seizures and requires eating via a tube and regular airway clearance. "The pump's sickening gurgle and slurp, the grotesque accumulation of mucus in the waste container." Not to mention scatological details of geriatric care and chemotherapy. Plus a botched enhancement surgery.

The characters are pretty awful too. Glynis, who is diagnosed with mesothelioma, is not a good patient. Uncompromising, angry and bitter, she gets satisfaction when she has made others feel uncomfortable also. "Umbrage was her drug of choice."

Her husband, Shep, seems saint-like tending to his wife's needs, all the while seething - "the underground mumble of self-pity" - as he watches his hard-earned nest egg and retirement plan dwindle to nothing. In the face of others' hardship, Shep's sister Beryl remains obliviously self-centred. His best friend, Jackson, rails and rants about everything - from restricted parking zones to where his taxes are spent.

Shep's teenage son is so aloof he's described as hikikomori - Japanese for reclusive people who withdraw from social life so much they never leave their rooms. And Shep's boss is a monstrous caricature of the obnoxious, uncaring manager. Even the characters' names jar. Shep is Shepherd Knacker - perhaps an unsubtle reference to his destiny. And Jackson's suffering teenage daughter is Flicka - an odd label for life with familial dysautonomia.

None of this is surprising from the author of the Orange prize-winning We Need to Talk About Kevin. Shriver's hallmark is unapproachable subjects - in that instance a high school shooting massacre and ambivalence about motherhood. She relishes the unsayable, mercilessly flailing readers' sensibilities with characters' lives so depressing and of such unrelenting ghastliness that sometimes you have to look away.

Shriver's saving grace, despite her prickly protagonists and nauseating content, is an ability to deliver such a knockout climax that wading through the quagmire is worthwhile. We Need to Talk About Kevin brilliantly achieved such a result. True to form, So Much for That provides a climactic resolution with a scene that gives new meaning to splatter horror. But while you have to admire Shriver's tactical skill, the crescendo lacks the cathartic impact of Kevin.

It's not hard to also see the novel as a flaying of the American healthcare system. Cue diatribe and detail about the machinations of medical insurance - "this cathedral of healthcare" - that aims to avoid paying out. But there's also much more - the awkwardness of talking about death, the culture of cheerfulness around cancer treatment and black comedy about whether, in the face of mounting debt, existence is cost effective. "Terminal illness was insolvency of the body."

Shriver fan Ruth Franklin, in The New Republic, sees So Much for That as not actually about health insurance. "It is, instead, a novel of fury only barely contained, fury at an American way of life that is so broken and dysfunctional that it has become impossible for people to conduct their lives in a decent, humane way."

Unfortunately Shriver seems to lose her nerve and provides a cop-out ending, worthy of Hollywood - a realisation of an "afterlife" that says as long as you have money, you can still fulfil the American dream, only not in America.

* So Much For That, by Lionel Shriver, HarperCollins $29.99.