Lionel Shriver talks about her new novel, So Much for That, exploring the way we respond to terminal illness in others.
A 50-year-old woman is sprawled on a bed with the teenage daughter of her good friends. They prattle about mobile phones, Star Trek and boys, but it is an unbearably poignant conversation. Glynis has mesothelioma, a terminal form of cancer; the teenager, Flicka, suffers from familial dysautonomia, an incurable disorder of the nervous system. Each knows her time on earth is limited, but they tease each other, they laugh, they get angry. Most of all, they understand one another's suffering as nobody else can. I tell Lionel Shriver it's my favourite scene in her new novel, So Much For That, a fiery but quietly devastating exploration of the effects of illness on two New York families.
"Well, I'm very sympathetic with readers that don't just want to be depressed," she deadpans in her deep American drawl. "And also I didn't want to write a book that would depress me, right? I can't be serious all the time. There's something about dark subject matter that brings out humour; I do it myself as a writer, I know people do that in real life, and so my characters do as well. But I admit, it was very tricky to deal with this material and still produce something that people would want to read."
Arguably, the 53-year-old Shriver made her name creating thrilling fiction from difficult subject matter. Her breakthrough book remains her most popular, 2003's global bestseller We Need to Talk About Kevin, which explores the dark background to a high-school massacre. So Much For That could almost be called "We Need to Talk About Death". An unflinchingly honest appraisal of our inability not just to deal with the inevitable but to grapple with how much a life is worth, it gets right to the heart of what shattering terminal illness means to families, friends and relationships, all against the perceived injustices of the American health care system.
"I think we've lost touch with what a good death is," Shriver says. "We consider death as wholly terrible. I like the idea that you can, as Glynis's husband Shep says, 'end well', and that's a lot of what the book is about." The process of writing her ninth novel has made Shriver more comfortable with her own mortality, she says, which is particularly interesting since the genesis of So Much For That lay in the agonies she experienced watching a friend crumple under mesothelioma. After the news of the illness and an initial period of care and concern, their friendship diminished as Shriver felt more and more awkward about what they would talk about.
She still visited and still rang up, but she says seeing her friend dying brought about an "instinctive avoidance" she couldn't understand. It was trying to make sense of these feelings that sparked the book, rather than the specific tribulations of her friend - or indeed the sudden death of her brother last year. "There are no rules dictating how to behave around someone who is this sick - for the person who is dying, for the carer, for their friends and family. We're so bad about dealing with illness; there's no cultural protocol. I think we'd just prefer it all to happen offstage, so to speak. But yes, one of my close friends died prematurely in western terms, and that hit me quite hard, so it seemed like the time to deal with that material. But all of this was also intersecting with what had become a long, simmering exasperation about American health care."
Such fury drives the angry, political subplot of So Much For That. Flicka's father, Jackson, is Shriver's mouthpiece: an armchair politician who rails against a system in which people rot in dead-end jobs just to ensure they have medical insurance. "I'm not taking responsibility for everything that comes out of his mouth," she laughs, but throughout the book there is a sense of real grievance that the American health system is fundamentally unfair. Less unfair now that Obama has got through some of his reforms? "I'm not sure we've changed very much," she says, ever the intelligent cynic. "I supported that bill with a great deal of reluctance."
Shriver likes this kind of dinner party conversation (as do her fictional characters) as much as she likes talking about her own books - perhaps even more so. She is ebullient and strikingly effusive and our time together is constantly punctuated by digressions about the issues of the day. When I tell her I've just returned from the state in which she was born - North Carolina - she immediately asks me what people were saying about Obama's health care bill there.
"I bet they said you have to pay much higher taxes for free health care," she groans. When I answer in the affirmative, Shriver, not for the first time, launches a trademark tirade. "You know that tax stuff, it's just not true," she spits. "The taxes in the United States are through the roof! Where do people get this idea - I mean, if you add up the federal, the state, the local and social security, it's a massive tax system. And by the way, all of this does relate to the book - I hope it is a novel which takes on much bigger ideas than merely the way health care is organised in the United States. The existential element and the underlying political issue come together in one question: how much money can we keep spending on people who are going to die anyway?"
And if Shriver sounds brutal about that, she's unapologetic. In her novel, Shep - even though he clearly loves Glynis - realises that $2 million (Dh7.4m) to extend the life expectancy by two months of a wife battered into submission by chemotherapy is not a practical deal. Still, it's all very well to discuss these things dispassionately around the dinner table, but when it's your husband, your wife or your children, the decisions become much less clear.
"Obviously, and that's what makes the whole situation complicated and provides food for thought in the book," she defers. "Writing the book certainly hardened my resolve that if I were diagnosed with mesothelioma - a terrible, brutal cancer - I would not pay for or get treatment." Seriously? "I would definitely not get treatment. But that's because I know what this particular disease is about. By the time it's diagnosed it's basically over. But if I got breast cancer, that's another issue of course, because there are a lot of people who survive breast cancer, aren't there? So I have the feeling I'd be suckered into it? with a great sense of dread."
At least she might not have to pay for it - "I get travel insurance so I can be flown back to the UK," she laughs (she has lived in Britain for more than 20 years). But Shep does have to bear the financial as well as the emotional brunt. The nest egg that he had protected as a ticket to a comfortable retirement (the very beginning of the book has him preparing, mid-life-crisis-style, to emigrate to an African island, with or without his wife and children) is quickly spent. He is forced to hatch a plan - unfair to give away here - to stave off bankruptcy.
But as he realises the extent to which friends and family have deserted them as his wife's illness becomes, to put it bluntly, boring, is Shriver saying that money is not the be all and end all; that life is about friendship and love? "Funnily enough, I think So Much For That argues for the importance of money," she says. "It's a book that takes money very seriously. And I don't think that most novels do. Most novels have characters in them whose economic circumstances don't stand up to scrutiny.
"You read a book about a schoolteacher who lives in a nice house in London, and you think 'no they don't'! How did they get that? This is absolutely not a novel that argues that money doesn't matter. The only circumstance in which money doesn't matter is when you've got lots of it." She adds that Shep's vision of life in Africa is a simpler, less money-obsessed world. "I agree with that. But even that's idealistic: if you have enough of it, of course you can stop thinking about it. He can buy generosity, which is one of the things money is really good for. Not only is he able to take care of himself, he's able to take care of the people that he loves. By the end of the book he has given everyone what they need."
Which, for a Shriver book, is quite a departure. She tells me that tying the novel up in this neat fashion was a great satisfaction for her. In fact, only her second book, 1987's Checker and the Derailleurs, ends so cleanly. "People will complain that it's too neat, but I'm proud of it," she says. "I'm glad to give my readers a sense of satisfaction or even glee. Given how I've made them struggle in this book with some pretty difficult material, I think they've earned it?"
So Much For That is published by HarperCollins (Dh98, Magrudy's).