celebrating

medicine in literature BOOK CLUB

SO MUCH FOR THAT
by Lionel Shriver
HARPERCOLLINS

Summary
In So Much for That, Lionel Shriver asks how much health is worth, and
answers: everything. Shep Knacker, the decent, loving former owner of a
handyman business, gives up his secret dream of escaping to a tropical
island when he discovers his wife Glynis, a sculptor, has been diagnosed
with an aggressive form of cancer. His health insurance proves to be a
chimera as, chapter by chapter, the stash of money he has painstakingly built up is drained by
paying for treatments that achieve little, and by financing the care of his aged father. Meanwhile,
Shep’s best friend, Jackson Burdina, rants against American capitalism while struggling to look
after his severely disabled, but feisty and amusing, daughter Flicka. And then he takes a step that
means his health too can’t be taken for granted.
It sounds grim, but actually this novel is very funny and utterly absorbing, as it mercilessly examines
the emptiness of most of our ambitions in the face of death and implicitly asks its readers how well
we ourselves manage to support and listen to our friends, family and loved ones when they are ill.
Shriver even manages to end the book without leaving the reader miserable.

About the author

Lionel Shriver was born Margaret Ann Shriver in North Carolina in 1957, to a deeply religious family (her father
is a Presbyterian minister). At age 15, she changed her name to Lionel because she didn’t like her given
name. Considering herself a tomboy, she felt that a conventionally male name fit her personality better. She
was educated at Barnard College, Columbia University (BA, MFA). She has lived in Nairobi, Bangkok and
Belfast, and currently lives in London.
Lionel won the 2005 Orange Prize for her eighth published novel, We Need to Talk About Kevin. A thriller and
close study of maternal ambivalence, it explores aspects influencing the title character’s decision to murder nine
people at his high school. The book created a lot of controversy, and achieved success through word of mouth.
Her journalistic experience included a spell working for the Economist. In July 2005, Lionel began writing
a column for the Guardian, in which she has shared her opinions on maternal disposition within Western
society, the pettiness of British government authorities and the importance of libraries.

www.wellcomebookprize.org
 Questions
• Lionel Shriver covers a lot of ground in this book, from the American healthcare system through disability
to penis enlargement. How successful do you think she has been in tackling these knotty issues?
• What do you think of Lionel’s underlying premise that, like Shepherd Knacker, we spend our lives on plans
and dreams and forget that death or ill-health may make them useless? Do we take health for granted?
• What did you make of Shep and Glynis’s friend Jackson Burdina? How much is he a device for
expressing criticism of the American dream?
• How is the medical profession characterised? How much of it do you recognise from your experience
of doctors?
• What did you learn about the way family, friends, all of us let down people who are seriously ill and
dying? How could we do better?
• What did you feel about the ending? Why did the author choose that ending?

Passage
Jackson Burdino ‘ranting’:
Thing is, these gonzo evangelicals, who are so fired up to save Schiavo – who’s reverted, at best, to a
hundred-and-seventy-pound baby? They’re the same folks who support capital punishment. They’re
gung ho on any military adventure abroad. If they had their say, they’d roll back the clock and you couldn’t
get birth control out of wedlock. They oppose stem-cell research because it uses a few microscopic
specks from an embryo that’s otherwise going to be tossed into medical waste. They may back national
health insurance for children, but couldn’t care less about health insurance for the kids’ parents. They get
hysterical about pedophiles like Michael Jackson, but they don’t get excited about women being raped,
who are supposed to bear the babies of their attackers. Add it all up? This type? They don’t give a shit
about grown ups.

Further reading
All the King’s Men by Robert Penn Warren (1946).
The Jungle by Upton Sinclair (1906).

www.wellcomebookprize.org
The Wellcome Trust is a global charitable foundation dedicated to achieving extraordinary improvements in health by supporting the brightest minds.
The Wellcome Trust is a charity registered in England and Wales, no. 210183. Its sole trustee is The Wellcome Trust Limited, a company registered in England
and Wales, no. 2711000 (whose registered office is at 215 Euston Road, London NW1 2BE, UK).