Blurring Fiction and Non-fiction in Medical Care.

Today WaPo's Ron Charles reviews Lionel Shriver's latest drag-you-through-the-truth novel, So Much For That.

The first part of the novel plays out while Terri Schiavo hovers on TV, with Republicans vowing to spare no expense to maintain her brain-dead body even as millions of conscious Americans are denied health coverage. Meanwhile, Glynis's treatment produces a double helix of hospital bills and insurance statements as bewildering as the cancer treatment itself. Shep is willing to spend whatever it takes to heal his wife -- every chapter begins with an updated statement from his dwindling Merrill Lynch account -- but what is the monetary value of a single life? What are another three months of pain worth?

And setting aside the novel's politics and economics, I've never read anything that made me so cringingly self-conscious about the way we respond to friends who are seriously ill. Granted, Glynis is a particularly unpleasant patient, angry and bitter about her feeble artistic career, but that only makes her more real. "Umbrage was her drug of choice," and she delivers a scathing diatribe on the culture of cheer that's built up around cancer treatment. She rages against "these nauseating speeches . . . the upchucking reminiscences . . . All this -- sentimentality!" Echoing Barbara Ehrenreich's similar complaints last year in "Bright-Sided," Shriver rips into the guilt-inducing support-group lingo: "hanging tough. Refusing to let go. Not giving up. Going the last mile. You'd think they were organizing a grammar-school sports day. . . . After all this military talk she now equates -- dying -- with dishonor. With failure. With personal failure."

Shep, meanwhile, notices "with an acrid taste in his mouth" that the initial pledges "to help in any way possible" are never followed by any actual assistance. "Their friends and family alike had poor emotional endurance," he realizes. "No parent had ever sat them down to explain that this is what you do and say when someone you at least claim to care about is deathly ill. It wasn't in the curriculum." If you've gone through this shocking evaporation of human contact, you know how true it is. When my daughter was born with severe brain damage 20 years ago, we were effectively ostracized by our community. My wife worried that we'd be overwhelmed by offers of assistance from fellow church members. None. Zip. One of our best friends told us later, "I sensed something was wrong, so I didn't call." But then as a friend of mine died last year across the street, I was too embarrassed to do anything besides send a brief note of encouragement. This is a novel that irradiates such sins of omission with shame.

As our chronic debate on health care reform drags on -- that hacking political cough that gets no better -- here is a novel that dramatizes what middle-class families are really suffering. "So Much for That" is a furious objection to watching the dream of health, financial security and old-age companionship wither and die. It's a bitter pill, indeed, but take it if you can.