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Friday, March 22, 2013

Brutal Honesty

(If you must have politics, please scroll down)

From the author of We Need to Talk About Kevin (2003) comes So Much for That, a 2010 novel about the effects of devastating illnesses upon two middle-class families: the Knackers and the Burdinas.  Both families, the married couples longtime best friends, are struggling with the emotional and financial burdens of combating life-and-death illnesses.

Shep Knacker, entrepreneur of Knack of All Trades, has worked for decades with a particular goal in mind — a goal that he calls "The Afterlife":
Savings may have gone out of fashion, but surely a middle-class American income still allowed for salting something away. Thus with the application of industry, thrift, and self-denial — once the country's moral mainstays — it should be possible to inflate a robin-sized nest eff to the dimensions of an ostrich ovum merely by hopping a plane. The Third World was running a sale: two lives for the price of one. Ever since coming of age, Shep had dedicated himself to the realization of the second. He was not even sure you called it industry, when you were working so hard only that you might stop working (page 8).
Just as Shep is ready to embark upon his dream, his wife Glynis receives a diagnosis of peritoneal mesothelioma, he has to reconsider his dream of "The Afterlife" for which he has so carefully planned and dutifully labored.  Other characters in the book also face devastating diagnoses, and the reader realizes that situations such as that of the Knackers occur more often that we often realize.  The struggles go on behind closed doors and, often, closed lips.

Despite the grim topics, the novel is also filled with moments of humor (turns of phrase such as "Tylenol was making as much difference as a handful of peppermint Altoids" and "He was no more pleased that his own wife had picked up the term [inappropriate] than he would have been had she returned from a public pool with communicable plantar warts") and insights about the meaning of love.  So Much for That also poses a question: How much is one life worth?  Particularly if that life is agonizing, demeaning, and very expensive.

Video book review:


As long-time readers of this blog already know, because of Mr. AOW's stroke at the age of fifty-nine, I found the subject matter of this book of personal interest. Indeed, I wish that I had read this book before now!

Political conservatives may not agree with some of the author's political statements.  Despite the book's liberal overtones, So Much for That also includes one character's frequent rants about statism.  Conservatives will love those rants, laugh-out-loud moments which lighten the grim topics. 

Lionel Shriver does elucidate what deserves consideration, regardless of political leanings: (1) many Americans are trapped in a life-and-death struggle exacerbated by various factors, and (2) everyone with health insurance should scrutinize their own policies.

At one point, the author writes of something that those struggling with a serious family illness rarely put into words:
terribleness, which for outsiders is mere misfortune. This mere-ness that [Shep] sometimes sensed in others had grown intolerable, which was why until today he'd avoided any discussion of Glynis's condition at work (page 129).
We never know when our lifelong dreams, "The Afterlife," will be interrupted, curtailed, or, of necessity, discarded. How the families in So Much for That deal with the terribleness that befalls them makes for poignant and uplifting reading.  I found this novel important reading because those upon whom terribleness does not fall might otherwise never remotely understand that which so many hesitate to speak of.  This book does much to help readers realize what others are enduring — stoically or not.

I recommend this book (with a strong-language caveat).

26 comments:

  1. Most people live through their share of trials and tribulations as they pass through this veil of tears we call life. Whenever I get to feeling sorry for myself (rarely), I only have to think about my sister (74). She cared for my mother for the last years of her life, she cared fro two husbands for their last years, and the same for three of her four children and again for one grandson. And yet, my sister is has the most positive outlook on life of anyone I know. She is a marvel!

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  2. I think this item dovetails brilliantly with Robert Frost's poem Provide, Provide which I posted yesterday. The poem advises us to set aside a goodly store of these world's goods (MONEY!) as we go along, because the beauty we may have had in youth, and whatever glory we enjoyed for past achievements will not be there to help sustain in old age.

    HOWEVER, there is no doubt that no matter how carefully and intelligently one tries to chart his course, sooner or later unforeseen -- usually UNWANTED -- surprises will trip us up, SO it might be best to live in and for the moment "gathering rosebuds" while we still can.

    In other words, "you're damned if you do and damned if you don't," so you might as well enjoy the ride for what it's worth and take the slings and arrows as they come with as much grace and good humor as you can muster.

    We really have NO OTHER CHOICE, do we?

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  3. Money doesn't help (for long). The system is designed to take from those who have it, and "serve for free" those who don't.

    Take college educations for your kids. You can save for it, and pay the "sticker price" ($50k/year), or not, and only pay the EFC (expected family contribution) based upon what you can "afford to pay." Regardless of which path you choose, your bank account will be empty at the end of the experience.

    ps - By the time you die, your bank account will have been emptied by the health care industry...

    There NO escape. The pursuit of a "nest egg" is a mirage.

    Carpe diem.

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  4. I beg to differ, FJ. At age 72 (n less than three weeks!) I am living proof that things do not have to work out that way. I'm a devote of the Give Me Neither Poverty nor Riches School of Survival with Style -- certainly one of the Lucky Ones, but there are many more of us than you might think.

    Only a fool allows himself to feel angry and embittered at not winning every hand of poker. The wise man simply enjoys the game -- whatever it may bring.

    ~ Ebshebeda

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  5. Those things that matter most to us matters least to the legions of bureaucrats who make a pretty good living by screwing the average American. The sooner we re-discover this truth, the better off we will be.

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  6. AOW, this sounds like a great book and I can see why it touched your personal experiences. And with this being the third anniversary of Obamacare (can it be that long?), insurance, costs of health care and our own personal situations is on everyone's mind.

    I just read where 6 out of every 10 doctors plan on retiring early because of Obamacare and changes in the system and how those doctors can practice.

    http://www.everydayhealth.com/senior-health/more-docs-plan-to-retire-early.aspx

    You can count my hubby in that group. Changes in how doctors are allowed to treat their patients and how they are reimbursed for that treatment have been in the works for years (probably 20), but with Obamacare the changes will be like a sledgehammer. Good health care will will go down the tubes, with unqualified nurse-practitioners stepping into the place of doctors, mis-diagnoses, mis-treatment, ..

    Debbie
    Right Truth
    http://www.righttruth.typepad.com

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  7. I LOVE Doris's video-review. Now THERE is a lady who knows how to talk PROPERLY.

    She doesn't shout. She doesn't pout.
    She doesn't whine. She doesn't pine.
    She doesn't simper. She doesn't whimper.
    She doesn't accuse. She doesn't excuse.
    She doesn't seem to have an axe to grind.
    In short she's really a great find.

    How could we not love her and all her fast-diminishing kind? ;-)


    She doesn't carry on like a second-grader who's furious that someone called her a "name" at recess.
    In short she's a LADY, God bless her!

    Is "Lionel Shriver," possibly, a nom de plume?

    I know there are men named Shirley, Leslie, Dana and Marion in Britain -- and the USA --, but a woman named LIONEL does seem a bit much even in this day and age.

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  8. Well don't worry, Debbie. I'm sure you and your husband have heard of the AMA.

    As older doctors retire, the AMA will open admissions to med school to control the number of doctors as they have for decades. We'll still have a shortage of GP's.

    But there will be no shortage of applicants since the law is such a dismal profession at the moment.

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  9. But there will be no shortage of applicants since the law is such a dismal profession at the moment.

    Not nearly as "dismal" as Obamacare will soon make the medical profession. Doctors will no longer own their own small practice's... they'll all be "on salary" at a megaclinic in the mall earning the bureaucrat maximum hourly wage.

    Think Cuba... where everyone has medical care, but there's not a single skilled surgeon worth employing (just ask Hugo Chavez).

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  10. Debbie (and others too),
    The book makes the valid point that one can still go medically bankrupt even with health insurance -- and without being confined in a nursing home (Only one character entered a nursing home).

    I shared with a good friend this information about the dangers of looming medical bankruptcy in certain situations, and her jaw hit the ground. She never realized that such a thing could happen! But it DOES happen, and more often than we typically think about.

    As one who had to step outside of the health-insurance network on rare occasions, I know how expensive doing so can be. But sometimes stepping outside the network is essential for proper treatment.

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  11. The novel provides an honest look inside the kind of health insurance that many small business owners have or provide to their employees.

    These policies have pitfalls too often ignored: co-pays galore, high deductibles, co-insurance on top of the co-pays, reduced benefits for out-of-network treatment, and the maze of reasonable and customary fees, as well as the dangers of no cap on out-of-pocket expenses and the lifetime limitation on benefits paid.

    I have to wonder if ObamaCare will contain the same pitfalls.

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  12. An unforeseen event can destroy all planning.

    And this is exactly what supporter of the social welfare state through programs like Medicare wish to ameliorate.

    It makes such obvious sense to me I don't understand why the right tolerates waste like for profit insurers and useless military spending.
    Most understand the problem but fight the solution.

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  13. At first, life is hard. Then we die.

    Not so very long ago, our average lifespan was 40 years.

    During the First World War, from 1916 thru 1918 I think it was, millions of people died from the flu, for which there was no cure. Before that, millions died of smallpox and typhoid. There was no cure for tuberculosis and many other diseases and no such thing as vaccinations or penicillin.

    My point is that no matter how good things are for us, we still take them for granted and want more. We don't get to live forever, though most of us want to, and we don't all get to enjoy good health all our lives. Few of us do, in fact.

    I saw a guy on TV once who was horribly burned from head to toe. He had no hair, no ears, no nose and was half blind. His flesh hung in wattles of scar tissue. But he was happy because he was alive and making a contribution to society.

    We all have sob stories. You wouldn't believe the tale of my own childhood, but it's none of your damn business and that's how it ought to be.

    Take what you have and run with it. Those who wallow in their misery instead of being grateful for the gift of life have lost touch with what really matters.

    I have a little card that I've been giving out since I was in high school, and it reads: "Your story has touched my heart. Never before have I met anyone with as much troubles as you. Please accept this card as a token of my sincerest sympathy".

    We all have problems. Suck it up, shut up and move on. Don't be a whiner and don't provide a forum for whiners.

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  14. Black Sheep:
    Would that have been Dave Riever?
    I agree with you 100%
    But I also believe that this life is a prelude.

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  15. It may have been Riever, it was a long time ago. As to preludes, the only ones I'm sure of are prior to having sex, and the one Honda made.

    Good luck on any post-prelude.

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  16. Life is like Crackerjax: The more you get the more you want.

    But I agree with that fellow Richard Lamm who was governor of Colorado years ago. After things get to a certain point we all have a duty to die.

    Dick Wilde

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  17. So Much for That may sound as if it's a book filled with a litany of whining.

    But it isn't!

    One point that the book makes: read the health insurance policy that you have. Just because you have insurance doesn't mean that you are protected -- at least, you're not as protected as you might think.

    The humor in the book is wonderful. One character reminds me of bloggers in that he rails against big government (and other scams). What happens to him is humorous in the extreme. The passages about that character remind me of The World According to Garp.

    And the lessons in one's own health care management! The book reminds us that patients and their families need to ask certain questions of doctors and not just blindly agree to treatment programs because the experts have recommended those programs.

    The book also presents intricate and realistic family relationships.

    I emphasize again that the novel does have a happy ending, the crux of which is to live one's life one's own terms.

    BTW, only one of the characters in the book is elderly. All the rest are children or people in their 40s.

    So Much for That is available in most public libraries.

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  18. FT,
    there is no doubt that no matter how carefully and intelligently one tries to chart his course, sooner or later unforeseen -- usually UNWANTED -- surprises will trip us up, SO it might be best to live in and for the moment "gathering rosebuds" while we still can

    Those lessons are clearly a central theme of the novel So Much for That. Another central theme is knowing when and how to say goodbye.

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  19. Black Sheep,
    My point is that no matter how good things are for us, we still take them for granted and want more.

    Actually, Shep Knacker, the main character, doesn't want more. His "Afterlife" involves helping others as well as enjoying an escape from working for someone whose standards of carpentry are shoddy and an escape from mooching family members -- especially his sister and his daughter, who majored in media studies followed by no prospects of a financial future. Along the way in the novel, Shep becomes a better and wiser person precisely because he is his wife's caregiver.

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  20. Debbie,
    I think that your husband might also enjoy this book. The book does deal with medical ethics and asks this question: How honest should doctors be with terminally ill patients and their families?

    And another question that the book poses: Why are hospital bills and EOB's so difficult to decipher?

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  21. FJ,
    Along the lines of something you mentioned above....

    Obamacare official: “Let’s just make sure it’s not a third-world experience.

    A shortage of doctors and a substantial increase in health insurance premiums are on the horizon. See THIS and THIS.

    At the rate things are going, both healthcare and health insurance are part of the road to serfdom! Even without a catastrophic illness.

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  22. I REPEAT....PEOPLE NEED TO REALIZE THAT A FAMILY CAN GO MEDICALLY BANKRUPT EVEN WITH HEALTH INSURANCE IN PLACE.

    So Much for That is accurate in its depiction of over $725,000 being gobbled up within a little over a year if a catastrophic illness strikes -- even when no nursing home is required.

    Disbelieve the above at your own peril.

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  23. Round the clock care: $10/hour for 24/7 for 365 days a year. Do the math. $87,600 -- not including medication, health insurance premiums, and incidentals (bed pads, special food, extra home-heating, medical equipment, etc.).

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  24. Sounds like you need an "undocumented" helper. Of course, when the minimum wage reaches $10/hr, they're going to be in EXTREMELY short supply. So best import YOURS today! ;)

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  25. FJ,
    My mother-in-law in the last stages of Alzheimer's is in a place run by Mongolian immigrants. I can't imagine that these people are here legally. The "facility" costs only $1200/month.

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  26. FJ,
    Money doesn't help (for long).

    [...]

    By the time you die, your bank account will have been emptied


    For the majority of Americans, that is true for both paying for college and paying for dire-situation health situations.

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