Some people insist on making life difficult for themselves. If a novelist hopes to sell more than five or six copies, surely the last subject matter on earth she should tackle is death and disease. What a turn-off! Who wants to read about that?
Yet sooner or later, many of us may well wish to read about this stuff, if only because we're desperate for fiction that speaks to our experience. For, my ninth novel is not so much about being ill as it is about having someone you love fall ill, which most of us will endure, perhaps more than once, before we're ever stricken ourselves. My mother's deepest fear for years has been not her own death but my father's, as I likewise expend more anguish on the prospect of my husband's demise than my own. Though obviously being sick engenders countless trials, living alongside a loved one who's ailing involves its own stresses, including a terrible sense of helplessness no matter how many cups of tea you bring. Thus So Much for That is primarily about a marriage, and the way the sudden intrusion of grave illness not only strains the couple's tie but brings them closer.
Thus far, I've been relieved that readers describe the novel as a "page-turner," however improbably a book of this nature would make you want to keep reading it. In fact, I've puzzled over why a novel with such a dark focus would still be able to captivate readers once they get stuck in, and I've come up with a few theories.
First off, just like my cooking ? which depends on the intermingling of contrasting flavors ? many of my novels seem to spark from the intersection of two elements. (For example, We Need to Talk about Kevin might be described as "school-shooting meets maternal ambivalence.") Thus, the novel begins with the protagonist Shep Knacker, packing ? for the rest of his life. For years he's saved his pennies in order to start a whole second life somewhere in the Third World, where his money would last forever, and he might escape the hassle and exhaustion of urban America for a simpler, more contemplative, and more restful existence. He'd thought his wife, Glynis, was also keen to pursue what they call "The Afterlife," but she's kept procrastinating; clearly, she's merely been humoring him. Convinced that loyalty to The Afterlife constitutes loyalty to his very self, Shep presents her with an ultimatum: either she and their teenage son accompany him to an obscure island off the coast of Tanzania, or he goes by himself.
Yet Shep is a good man ? one of my rare creations endowed with a profound sense of right and wrong ? so Glynis's counter announcement is perfectly designed to shoot down her husband's would-be airplane: she has just been diagnosed with a rare and deadly disease. A good man does not leave his wife in such wretched circumstances; besides requiring his emotional support, she needs his health insurance. So, thereafter, all the money that Shep had saved for The Afterlife is frittered away on the many medical expenses that insurance fails to cover.
I don't think this book would work without The Afterlife, which provides the novel the classic structure of a frustrated quest. This intersection of elements also authentically duplicates the real experience of illness ? which like life itself is "what happens when you're making other plans."
Second, Shep's best friend, Jackson Burdina, from whose point of view a goodly portion of the novel is told, helps to leaven the tone of the novel, as well as to provide it energy. Jackson is a working-class autodidact whose political rage powers much of the text and numerous scenes between the two men. He's a man of many contradictions ? a free thinker, an iconoclast, but also a deeply insecure man whose education is full of holes, and he's one of my favorite characters in this book.
Third, the novel's focus on Glynis and her illness is not unrelenting. It's somewhat more palatable to identify with her husband, who will surely survive her and thus has a future, than with the terminally ill, who face only the most truncated of futures. (Only one chapter is told from Glynis's point of view; because it is a one-off, the glimpse into her head is a relief, and this may be one of the best chapters in the novel.) A handful of sideshows, all medical in nature, keep more than one ball in the air: Jackson's daughter has familial dysautonomia, an exclusively Jewish genetic disease; Shep's father falls down the stairs, and then into the exorbitant hands of long-term nursing care; Jackson splurges on plastic surgery that goes catastrophically wrong. (SMT could be thumb-nailed as "a literary ER.") Fortunately ? and you'll thank me for this ? some of this stuff is funny.
Lastly, though of course I don't want to give away the plot, the ending is surprisingly upbeat ? and you'll thank me for this, too. I thought after all the Jobian travails of the rest of the book, you and I both deserved a break.
Though in the main So Much for That is a work of imagination, it was initially inspired by the death of one of my closest friends in 2006. Like Glynis, my friend Terri was a metalsmith (though Terri was more accomplished than my character), and we met at Buck's Rock Creative Work Camp in Connecticut, where we both taught in the metal shop. (I'm a bit of an amateur metalsmith myself.) When Terri was diagnosed with mesothelioma in 2005, she was, like Glynis, only 50 years old, roughly my contemporary; we'd known each other for 25 years.
Since mesothelioma is almost always caused by asbestos exposure, it's virtually certain that Terri was contaminated by then legal products she worked with as an art student and early in her career in the 1970s.
(I've tried not to dwell on the fact that I was taking metalsmithing courses in the same era and would have worked with the same products that killed my friend.) Typically for her disease, Terri lived about a year and three months beyond her diagnosis.
In SMT, I faithfully replicated the expense of Terri's surgery and chemo ? a staggering two million dollars for treatments that may have extended her life not much more than three months. As much as I loved my friend, I've had to wonder in retrospect whether those miserable three extra months were worth the price ? both in dollars and suffering.
I realize that close family will nearly always opt for pulling out all the medical stops in order to eke out a little more time with a loved one, but I worry that on a macro-economic level we can't continue to lavish such large amounts of money on small extensions of life.
Obviously this novel is trying to highlight systemic inadequacies in American healthcare, which, when I began the book, was not slated for any sort of Congressional reform. At that time, Obama was an absurd long shot for the Democratic presidential nomination, and I'd no way of knowing that as this novel approached its release Barack Obama would be president and "healthcare" would be the biggest buzzword in American news.
I do have strong convictions about the waste and injustice of medical practice in the U.S., and I'm unapologetic about the political fury that teems through my text. I've lived for many years in the United Kingdom, and, contrary to what the scaremongers tell you, Britain's National Health Service is miles ahead of the chaotic, overpriced jangle of healthcare in the U.S. I've always received good quality care from the NHS, and fervently wish Obama had not taken the only real answer to my own country's healthcare problems off the table from the start: an American NHS.
Nevertheless, I never aimed to write a fictional polemic or a thinly disguised nonfiction treatise on the evils of private insurers. Thus, the novel engages with larger issues that afflict not just America but all Western healthcare systems, like the above: how much can we and should we spend to keep a single person alive? Likewise, it takes on the subject matter addressed in Barbara Ehrenreich's Smile or Die [released in the U.S. as Bright-Sided]: cancer sufferers' poisonous cult of positive thinking, which ultimately blames a deteriorating patient for not having the right attitude. In kind, I challenge the commonplace language of "battle" against cancer, an argot that demands a depleted patient "fight for life" like a good little soldier. SMT raises other issues even more timeless ? like the challenge of confronting a terminal diagnosis, and the difficulties we create for other people, who see all too clearly that we're dying, when we refuse to face the unpleasant truth.
SMT is set firmly in 2005-2006, so whatever happens in future this story is an accurate accounting of the economic implosion that many American families have experienced due to medical bills ? the leading cause of bankruptcy in the U.S., often as not filed by people who have health insurance. Yet it's possible that legislation will get through Congress (or has already gotten through; I'm writing in early January 2010) whose provisions would make Shep's and Glynis's fiscal circumstances somewhat less dire.
A ban on denying insurance coverage for those with preexisting conditions might enable Shep to buy a supplementary policy once Glynis is diagnosed. Yet even a mandatory cap on out-of-pocket expenses would not reprieve my characters from being charged huge sums for going "out of network" for Glynis's care; a patient's percentage responsibility for out-of-network physicians would not count as "out of pocket." Shep earns too high a salary to benefit from governmental subsidies or tax breaks. His father's situation will in any case remain unchanged; Medicaid does not pick up the tab for nursing homes or assisted-living facilities until an elderly citizen has exhausted every resource and is flat broke. Since the weak, patchwork Congressional bills proposed at present would all result in health insurance companies making yet more money, the one thing I'm not worried about is that the plot of this novel will suddenly seem irrelevant because American healthcare is now working so spectacularly well.
Still, first and foremost, like all my books, So Much for That aims to tell a good story. So I'm willing to make what's a pretty safe bet: that this will prove the most entertaining novel about illness and death you read this year.