Only the bravest writer would consider America’s broken health care system fodder for fiction. Lionel Shriver brings us Shep Knacker, a generous, middle-aged everyman who has sacrificed and invested, planning an early retirement in Africa. Plane tickets in hand, he is confronted with news of his wife’s terminal illness. Shep’s relationships with family and friends are tested in the ordeal of his wife’s battle with cancer. His health insurance is inadequate, his job is demoralizing and the caregiving is exhausting. The characters are real; the dialogue, intelligent, cynical and witty; the issue, so relevant but uncomfortable. Chronicled at the start of each chapter is Shep’s rapidly dwindling Merrill Lynch account, begging you to consider: just how much is one life worth? This fictional account that feels all too real shows how the burden of health care is borne by the survivors.