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on 10 February 2012
I began this book with some trepidation having lost my Mum to an aggressive cancer 18 months ago. I'm young and none of my friends have experienced anything similar and I wanted to read something I could identify with. This book had me captivated. All the emotions, grief and heart-breaking decisions are realisticly conveyed. At the same time the book captures the resilience of the human spirit, and the joy and dignity that people can find together, even in such bleak circumstances. Surprisingly, many parts of the book made me laugh out loud. The sharp wit questioning the conventional wisdom was refreshing. I enjoyed the ending, it had the same strength, optimism, love and hope that my Mum showed at the end of her life.
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Shep Knacker has a dream of leaving New York and setting up home in some distant place. He plans to lead a simple life with the help of his substantial nest-egg acquired from the sale of his business. However his dream is his alone and not shared by his wife and children. His research tells him that an ideal place to spend his "Afterlife" would be an island paradise off the Tanzanian coast. But his determination to set off on this adventure is shattered by the news of his wife's cancer.

From this point disastrous events occur. All Shep's former financial decisions have been wrong and he is now caught up in battles with a third-rate health insurance company that will only pay a portion of the astronomonical fees. His wife Glynis is put on a range of experimental (and expensive) drugs and month by month Shep sees his nest-egg diminishing. He seems to love Glynis rather than like her and an inner resentment builds up. Shep is a decent character but is generally considered a "soft touch" by his whole family. As well as supporting an ailing wife he has a son at an expensive school, a daughter being subsidised through university, a sister who is too creative to actually earn money and a father who despises the monetary system but expects to be assisted by his son.

His long term friend Jackson has a disabled daughter suffering from a horrific genetic syndrome. Jackson is often filled with rage and has frequent rants about how the government is ripping everyone off. He is convinced that people who works hard and pay their taxes are made fools of by both the federal government and by idle scroungers.

Sounds awful, doesn't it? But actually this is a really compelling read. I was enthralled, horrified and angry in turn. Sometimes I wanted to scream: "Shep - get a grip!" By halfway through this book I expected the ending to be really depressing. But amazingly it is not. Lionel Shriver actually gives us a redemptive and (dare I say) uplifting conclusion.

(This book should be compulsory reading for anyone who thinks more privatisation in our Health Service would be a good thing!)
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on 26 August 2012
An interesting book on many levels. As a novel, it is flawed - over-long, laboured in places, lots of telling of irrelevant back-story and a laughably implausible finale. Some of the diatribes I sense belong more to the author than her characters. But it is a page-turner -after the first few chapters where I struggled to get a handle on the characters, especially Flicka, I couldn't put it down.

It's essentially a critique of the consequences of applying market principles to health care. Capitalism relies on creating needs where none previously existed and health care is no exception. The NHS isn't immune - as new drugs and treatments are developed, of course people will want them but at least, so far, the NHS hasn't gone into partnership with the ultimate capitalist racket of insurance, which makes money out of fear.

Few reviewers have mentioned the parallel story to the escalatingly expensive and futile cancer treatment, that of botched penis enlargement surgery - a parallel being the real-life breast enhancement scandal. Plastic surgery in all but the most extreme cases seems to me to be an indicator of decadence ... but then the arguments get more subtle. What about cosmetic dentistry? Botox? In the States I once sat in a restaurant where the lighting revealed everyone had whitened teeth (gleaming an odd shade of blue) and most women had identically perky breasts - it was horrifying and yet if people have the money, who is to say it can't be spent on 'enhancement'.

Other 'health' threads in the novel concern a life-limiting illness and the case of the protagonist's father who can no longer live independently. Throughout, the moral and emotional impacts are explicitly set against the financial cost - chapter headings show Shep's declining bank balance. At the end we learn that prolonging life for a few months through the misery of chemo, cost in the region of 2 million dollars. One of the cruellest and most recognisable elements is the doctor's refusal to be honest about the prognosis and the fake need for 'hope'.

I found the novel disturbing - but was glad to have read it. Like 'Kevin', it holds a mirror to our sick society with its dread of death and aging and refusal to be adult. The portrayal of the African paradise was an idea too far that didn't ring true and glided over the health concerns of those at the other end of the material spectrum. Issues of entitlement, hope, marital and parental obligation are all elements that could keep The Moral Maze going for several weeks. A good one I would imagine for book clubs.
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on 30 January 2012
A thinly-disguised work of fiction, this novel tips the American Dream on its head - about seven times. It feels like a literary fist-shaking at the way things are.

From Flicka (the girl whose survival seems to flicker like a weak light bulb throughout the novel) to Jackson, the cynical worker whose rage at the status quo is at the heart of many of us, her characters in this seem to represent our anxieties and doubts about our working life, the powers that be.

My God, the author faces everything from terminal illness to men's emasculation from work and retirement to the alternative dream of retirement. And much more besides.

I urge you read every one of her novels. This lives up to the high expectations we expect from her. She's fearless and her characters are more real than some real people I know!

I envy her talent and can't wait to get a Lionel Shriver in my hands again.
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on 2 May 2010
I absolutely loved this novel. Dealing with real life and death issues...amazingly sensitive and well observed.
As a UK resident i am so glad i live in a country with a National Health Service. May this book be a warning to anyone to any one who takes it for granted.
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on 15 July 2011
Another Brit who wasn't interested in the minutiae of US health policies and felt that it dragged in the middle. How many obscure diseases and iatrogenic illnesses can you fit in a book and still make it believable? Fewer than this book has. The way people with cancer are too ready to swallow oncologists' offers of ever more expensive and unlikely to work chemotherapy agents for a few months more life (of feeling sick and tired) is well portrayed.
I felt that this could have been a good book if she'd stuck to just 1 illness and more on the effect the illness can have on a relationship without the US insurance/ financial stuff.
The way people planning to leave their partner before finding they are ill can resent that partner and not want to nurse someone they no longer really wish to be with was also skirted round. You aren't allowed to decide you still don't want to live with your partner and are bored with them once they become ill. Shep became too saintly.
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on 25 October 2010
Shep Knacker's dreams of 'The Afterlife' may at first seem idealised, but if we're honest we've all had them: the escape from the routine of work-sleep-work. What few of us have had or will, thankfully, never have is to face a situation of a partner with a terminal illness. How would we react? Hopefully like Shep Knacker.

Positive: Lionel Shriver makes us think about what money value we should put on life. The book will make you feel sad, angry, and unsure, but at the same time you'll laugh along with the characters as they find ways to cope with adversity.

Negative: Perhaps too much emphasis on the shortfalls of the USA healthcare system.
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on 22 November 2014
This book really is a diatribe on the state of health service provision in America. as such, it is pretty hard work especially since none of the characters are particularly attractive so it is a bit hard to feel too much empathy with any of them (even the very few who are well).

It is all very unrelenting and there are very few moments of light relief.

The ending is very slightly more upbeat but wasn't quite to lift the prevailing gloomy moo.

There are the occasional funny episodes of ver black humour and Flicka is a sparky teenager who emerges as possibly the strongest and most likeable character especiaaly given the withering assessments she makes of others and the contingency plans he makes to ensure an easeful death if need be.

There is a note about her -real) condition in the notes at the back but i would have found this more use at the beginning to put me on notice.

overall, this is worth sticking with as it provides a terrible lesson for the Uk health service which could easily go the same way unless we are all vigilant
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on 12 July 2011
This is a very good depiction of what happens to a person and their family when cancer strikes; well I presume it is anyway, luckily I have not been directly or closely affected. It is also a first rate arguement for keeping the NHS. For both of those points I award a star. However the charecters are very simplistic. Shep, the "hero" is a veritable put upon angel. Just about everyone else is either a freeloading parasite, a downright "baddie" or a bit of a fool. There are a few exceptions to that rule. Another rule:If something can go wrong, it will. And of course we have a very happy ending where everyone lives happily ever after, except those that die peacefully and happy. It is quite a long book, so it does represent value for money but I think this was written by a computer.
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on 15 March 2014
Shep Knacker is our main character along with his wife Glynis and his best friend Jackson. Shep has sold up his family business in the hopes of going to "the Afterlife" traveling to and living in his one chosen place on earth with his loved ones. Years on and he has decided this is the day he is leaving whether his family join him or not, he is going. Sadly his wife has some life changing news and Shep will be staying to help her face her diagnosis and pay for the health care she requires.

The book gives a bleak look at how much health care in the US can cost both between Glynis and his friends little girls care, she has FD, Familial dysautonomia. The book has a lot of medical information both on Glynis's condition and Jackson's daughter. I found this really interesting but have to say the book isn't purely about cost or the medical system however it is a large theme throughout the story.

Shep is a fairly simple chap, has done well financially and wants to move to a more civilized country. His nature and duties keep him home to look after his wife. He is a doormat, used by just about everyone in his life and it isn't long in the story before we find out and see how little he is respected. The characters are not very nice people at all, I actually hated his sister who is one of the most vilest creatures I have ever read about.

I am never sure how I feel about this writer, I read we need to talk about Kevin, started off not impressed then couldn't put it down. This one captured my interest, however had the medical side not been in it I am not sure I would have found it as engaging as I did. It is a book that certainly makes you think and I wanted to see it out to the end. 3/5 for me this time, I would read this author again but won't be rushing out to buy all her work.
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