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A month ago, if someone had told me the next novel I'd be recommending to everyone was a 400-plus-page family drama about the American health-care system, I might have suggested they were smoking too much of Vancouver's main export crop. But So Much For That, the ninth novel by London- and Brooklyn-based Lionel Shriver, is more than its polemical-sounding plot.

Set in 2005-06 in New York City, it follows two families dealing with the hell that is the failing body in a culture bent on disavowing mortality. And, well, it's frequently hilarious.

It was easy for me to marvel at Shriver's finely wrought sentences and million-dollar vocabulary, but the main drive to continue reading was the brutal literary autopsy of two marriages struggling under the weight of terminal illness and impending financial ruin as a result. The novel asks us to consider the limits of love and loyalty in the face of almost-certain death. Despite my absolute reticence to admit it - because I consider myself somewhat above this sort of behaviour - the novel made me sob like a tiny little blanket-less baby. There. Feel free to mock.

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Mostly, however, what shines in this and in every Shriver novel I've read is her acerbic wit. She is not afraid of the rawest of thoughts, and not the salacious unbelievable stuff but the minute detailing of the shameful places humans go to when they're truly frightened or unhappy. She dares to write a book about cancer that's at times hilarious. She can throw a little tragedy around the room without sinking us intellectually in the kind of cheap sentiment that passes for true insight.

I always find it curious when reviewers complain that characters are unlikeable, as if this is a bad thing

That the U.S. health system is corrupt and people suffer enormously is no revelation, but Shriver does what she does best: She takes a timely social issue and brilliantly walks us through it via the complicated and often banal everyday relationships of her characters.

Shep Knacker is a likeable guy in his 50s who turned a handyman business into an empire worth $1-million. He's a quiet, plodding husband, loyal to everyone in his family, supporting them financially and emotionally, never quite getting credit for anything he does. His wife has grown tired of this dream, which she knows he'll never realize, and his teenaged son won't come out of his room. He is the moral centre at the heart of So Much For That and, for his whole adult life, he has been counting down the seconds until he could finally do something for himself - and that something is literally moving to a desert island in a Third World country where he can live like a king on his life's savings. After several research trips, he settles on Pemba, an African island.

Just as he's about to jump ship, his wife, Glynis, tells him she has a rare form of cancer. He stays put, working for the guy he sold his own company to. If Glynis was angry before her diagnosis, she lets the rage out in every possible direction once she's dealing with her treatments and an uncertain future.

It's refreshing to see a dying character not fall victim to demon sentimentality, with sudden rushes of grand understanding. Glynis is pissed off, unhinged and rarely grateful, never once acting the kind or brave face of cancer one associates with the grand cancer narrative. In this sense, Glynis shares traits with the heroine at the centre of Shriver's 2003 novel, We Need to Talk About Kevin: Both are independent women resentful in parts of the choices they made. Glynis "resented not being a celebrated metalsmith, and she resented that her status as professional non-entity appeared to everyone, including Glynis, to be all her fault. She resented her two children for diverting her energies when they were young; once they were no longer young she resented them for failing to divert her energies …"

Their best friends are Carol and Jackson, who have two daughters, one afflicted with a rare genetic disorder that requires around-the-clock care and a host of invasive procedures just to keep her breathing. Jackson is conspiracy-minded hothead with a penchant for gambling, always pleased to tell you why and how the United States is going to hell in a handbasket. His wife, Carol, is the consummate caretaker, holding everyone together. Both couples struggle financially, despite being employed and insured, to keep their heads above water.

Shriver is sometimes disliked for the very reason I'm drawn to her: She writes funny, honest people who have sex and hang-ups, and feel weird about their prescribed social roles. Her characters can make you feel almost sick about humankind, and a little bit malevolent for laughing. She makes readers uncomfortable.

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I always find it curious when reviewers complain that characters are unlikeable, as if this is a bad thing. I think it's only a bad thing if you're a lazy reader. Many characters in So Much For That are essentially not very likeable, but they are also very honest. They say things some of us only dare to think in our most self-interested, desperate moments. Shriver's characters are hard to love because they probably remind us of the worst parts of ourselves. They do things we don't expect: the disabled 17-year-old daughter who's always steps away from an emergency room and sure to die before she reaches adulthood, who makes suicide jokes at the table; the cancer patient who makes her mother feel bad for baking cookies and being a drama queen.

Shep eventually sheds his stoic, loyal façade and breaks under the weight of watching his wife slowly die, as one by one, everyone from the insurance companies, doctors, employers, close friends and family, let them down. The end is a twist no one is likely to predict. So Much For That is an engrossing page-turner about trading hope for hopelessness and back again, in a world that is ceaselessly unfair to just about everyone.

If I have one criticism - and I have it of her last novel as well - it's her editor's inability to catch and translate common British phrases that your average homegrown Brooklynite would never utter. For all Shriver's meticulous attention to detail, it wouldn't have been hard to note that Shep would have been "fired" instead of "sacked." There are numerous instances of this, and they distract from the otherwise authentic voice.

Zoe Whittall's sixth book, The Middle Ground, will be published this spring, as part of the Raven Reads series for reluctant readers.

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