I would seem to be the perfect audience for this novel. Like the main characters, my husband and I are in the trades and the arts, respectively, and one of us has a typically terminal cancer. Yet reading the book took what felt like forever -- and not because it was too painful or too close to home. In fact, when it is close to home, the book is at its best, conveying the deeply complex and sometimes contradictory emotions, as well as the endless practical and often petty concerns that arise with grievous illness; there's life and death, and what about the children, and, oh yes, the matter of money.

In "So Much for That," Lionel Shriver gives us Shep Knacker (a shepherd and a knacker), who works for the handyman business he started (and sold) and is on the verge of taking off on the getaway he's always planned, a retreat to a distant and simpler world (in this case Pemba, an island off the coast of Africa), which he calls the Afterlife. Just when he's ready to go -- is, literally, packed -- his wife, a metalworking artist, informs him that he can't, because she needs his health insurance. She has mesothelioma, the cancer associated with asbestos.

Shortly we meet Shep's best friend and co-worker, Jackson, who has his own continuing medical nightmare in the form of a daughter with a rare degenerative disease called familial dysautonomia, and who complicates his own marriage with an incomprehensible and severely botched penal enlargement operation.

The novel then becomes two books: one that is issue-oriented, with the autodidact anarchist Jackson as a convenient and garrulous commentator on everything from tax policy to health care inequities to venal business practices; the other a more novelistic and experiential story of reevaluating love and marriage and life in the face of impending death -- all while having to deal with the practical details of chemo and diet and insurance and the demands of friends and family members.

This, I can tell you firsthand, is very real and moving in a well earned way: Glynis, who's dying, is a bit delusional, quite difficult and contrary, and recognizably human; Shep, for all his longing and whimsy (he constructs idiosyncratic fountains) is reasonable and responsible to a fault, caring for his ailing father, his feckless sister, and finally Glynis, as he feels he must, though we are party to his near-crippling sense of loss, frustration and failure.

Which may explain why, though I struggled, irritated, through the endless passages of exposition as Jackson explained pretty much everything, I nonetheless could not wait to get back to this book night after night -- to find out how Shep and Glynis did, in the end. Finally, I can't help but admire a book that is at once so worldly and all-embracing, nearly newsy in its perspective on issues ranging from the current health care debate to the business of law, and so intimate and moving on matters of the heart, body and soul.

Ellen Akins is the author of "World Like a Knife" and "Hometown Brew." She lives in Cornucopia, Wis.