This challenging novel is unforgiving in its account of America’s failing health care system, where lives are crippled with financial uncertainty. Glynis Knacker and Shep, her handyman husband, are faced with a terrible crisis after Glynis’s unexpected diagnosis of a rare form of cancer. Now in their forties, Glynis and Shep have enjoyed a close marriage, a partnership that Shep guilelessly hopes will weather them through Glynis’s initial prognosis.

But the revelation leaves Shep and Glynis remarkably unprepared. This particular type of cancer - mesothelioma - is enormously difficult to treat. Glynis’s oncologist warns the couple: “I won’t mislead you. It’s also very serious.” From the initial fever, tenderness and abdominal swelling to the monthly CAT scans, X-rays and injections, not to mention the painful side effects of the chemotherapy, Shep finds that he must set aside his commitments and his dream of retiring to Pemba, an exotic island off the coast of Tanzania.

A man brought up with the “application of industry,” of "thrift and self-denial," Shep knows the ineffable value of money. A few years earlier, he sold his company to an employee so that he could hang on for a month or two while his family sold off all of their motley possessions. In the interim, however, every party seems to be taking Shep for granted. He spends most of his waking hours subsidizing his daughter, Amelia; paying for private school for his son, Zach; and making several “loans” to his sister, Beryl, which he knows she will never pay back.

Shep’s mutual funds are his capital, but when he discovers the medical insurer won’t pick up much of Glynis’s bill, the psychological and physical demands of her illness pale in comparison to the sudden shrinkage of his once-untouchable investment account. Shep’s best friend, Jackson, and his wife, Carol, shocked at Glynis’s deteriorating condition, have their own struggles: Flicka, their teenage daughter, a “high-functioning smart cookie,” has a rare genetic disorder and needs expensive care on a daily basis.

What ensues is a warmhearted and often funny quartet of kindness that accelerates in the face of adversity. Shep embarks on a yearlong commitment to help Glynis endure the drugs and treatments as she becomes evermore weak, exhausted and scared. Ultimately forced to shoulder the burdens of family and work, Shep tries to ignore the cancer that storms his beautiful and fragile wife.

Shep blithely accepts his fate, while Jackson, filled with rage, rails against a system of "taxes and spongers, mugs and mooches." Jackson also tries not to think about the abnormal swelling around his groin and the truth that both he and Shep are gradually being pillaged by the terrible state of modern American health care. Given Shep’s natural pragmatism, it’s heartrending to see him battle to remain serene in the face of a selfish sister and the compulsive, uncomfortable mushiness of his in-laws, who try to circumvent Glynis’s rising anger and exasperation.

A though-provoking meditation on terminal illness, the author doesn’t sugarcoat or sentimentalize Glynis's deteriorating condition as Shep is forced to accept the inevitable. Plunged into desperate measures as time passes, Shep knows he's being blindsided by a futile system while his wife bleeds from within, consumed by sickness, death, and a profound, almost transcendent sorrow.