My Sister's Keeper: A Novel

by Jodi Picoult

  The thing is, I do have a choice. Which is exactly why I have to be the one to do this.

  My mother stands over me. “You went to a lawyer and made him think this is all about you—and it’s not. It’s about us. All of us—”

  My father’s hands curl around her shoulders and squeeze. As he crouches down in front of me, I smell smoke. He’s come from someone else’s fire right into the middle of this one, and for this and nothing else, I’m embarrassed. “Anna, honey, we know you think you were doing something you needed to do—”

  “I don’t think that,” my mother interrupts.

  My father closes his eyes. “Sara. Dammit, shut up.” Then he looks at me again. “Can we talk, just us three, without a lawyer having to do it for us?”

  What he says makes my eyes fill up. But I knew this was coming. So I lift my chin and let the tears go at the same time. “Daddy, I can’t.”

  “For God’s sake, Anna,” my mother says. “Do you even realize what the consequences would be?”

  My throat closes like the shutter of a camera, so that any air or excuses must move through a tunnel as thin as a pin. I’m invisible, I think, and realize too late I have spoken out loud.

  My mother moves so fast I do not even see it coming. But she slaps my face hard enough to make my head snap backward. She leaves a print that stains me long after it’s faded. Just so you know: shame is five-fingered.

  • • •

  Once, when Kate was eight and I was five, we had a fight and decided we no longer wanted to share a room. Given the size of our house, though, and the fact that Jesse lived in the other spare bedroom, we didn’t have anywhere else to go. So Kate, being older and wiser, decided to split our space in half. “Which side do you want?” she asked diplomatically. “I’ll even let you pick.”

  Well, I wanted the part with my bed in it. Besides, if you divided the room in two, the half with my bed would also, by default, have the box that held all our Barbie dolls and the shelves where we kept our arts and crafts supplies. Kate went to reach for a marker there, but I stopped her. “That’s on my side,” I pointed out.

  “Then give me one,” she demanded, so I handed her the red. She climbed up onto the desk, reaching as high as she could toward the ceiling. “Once we do this,” she said, “you stay on your side, and I stay on my side, right?” I nodded, just as committed to keeping up this bargain as she was. After all, I had all the good toys. Kate would be begging me for a visit long before I’d be begging her.

  “Swear it?” she asked, and we made a pinky promise.

  She drew a jagged line from the ceiling, over the desk, across the tan carpet, and back up over the nightstand up the opposite wall. Then she handed me the marker. “Don’t forget,” she said. “Only cheats go back on a promise.”

  I sat on the floor on my side of the room, removing every single Barbie we owned, dressing and undressing them, making a big fuss out of the fact that I had them and Kate didn’t. She perched on her bed with her knees drawn up, watching me. She didn’t react at all. Until, that is, my mother called us down for lunch.

  Then Kate smiled at me, and walked out the door of the bedroom—which was on her side.

  I went up to the line she had drawn on the carpet, kicking at it with my toes. I didn’t want to be a cheat. But I didn’t want to spend the rest of my life in my room, either.

  I do not know how long it took my mother to wonder why I wasn’t coming to the kitchen for lunch, but when you are five, even a second can last forever. She stood in the doorway, staring at the line of marker on the walls and carpet, and closed her eyes for patience. She walked into our room and picked me up, which was when I started fighting her. “Don’t,” I cried. “I won’t ever get back in!”

  A minute later she left, and returned with pot holders, dishtowels, and throw pillows. She placed these at odd distances, all along Kate’s side of the room. “Come on,” she urged, but I did not move. So she came and sat down beside me on my bed. “It may be Kate’s pond,” she said, “but these are my lily pads.” Standing, she jumped onto a dishtowel, and from there, onto a pillow. She glanced over her shoulder, until I climbed onto the dishtowel. From the dishtowel, to the pillow, to a pot holder Jesse had made in first grade, all the way across Kate’s side of the room. Following my mother’s footsteps was the surest way out.

  • • •

  I am taking a shower when Kate jimmies the lock and comes into the bathroom. “I want to talk to you,” she says.

  I poke my head out from the side of the plastic curtain. “When I’m finished,” I say, trying to buy time for the conversation I don’t really want to have.

  “No, now.” She sits down on the lid of the toilet and sighs. “Anna . . . what you’re doing—”

  “It’s already done,” I say.

  “You can undo it, you know, if you want.”

  I am grateful for all the steam between us, because I couldn’t bear the thought of her being able to see my face right now. “I know,” I whisper.

  For a long time, Kate is silent. Her mind is running in circles, like a gerbil on a wheel, the same way mine is. Chase every rung of possibility, and you still get absolutely nowhere.

  After a while, I peek my head out again. Kate wipes her eyes and looks up at me. “You do realize,” she says, “that you’re the only friend I’ve got?”

  “That’s not true,” I immediately reply, but we both know I’m lying. Kate has spent too much time out of organized school to find a group she fits into. Most of the friends she has made during her long stretch of remission have disappeared—a mutual thing. It turned out to be too hard for an average kid to know how to act around someone on the verge of dying; and it was equally as difficult for Kate to get honestly excited about things like homecoming and SATs, when there was no guarantee she’d be around to experience them. She’s got a few acquaintances, sure, but mostly when they come over they look like they’re serving out a sentence, and sit on the edge of Kate’s bed counting down the minutes until they can leave and thank God this didn’t happen to them.

  A real friend isn’t capable of feeling sorry for you.

  “I’m not your friend,” I say, yanking the curtain back into place. “I’m your sister.” And doing a damn lousy job at that, I think. I push my face into the shower spray, so that she cannot tell I’m crying, too.

  Suddenly, the curtain whips aside, leaving me totally bare. “That’s what I wanted to talk about,” Kate says. “If you don’t want to be my sister anymore, that’s one thing. But I don’t think I could stand to lose you as a friend.”

  She pulls the curtain back into place, and the steam rises around me. A moment later I hear the door open and close, and the knife-slice of cold air that comes on its heels.

  I can’t stand the thought of losing her, either.

  • • •

  That night, once Kate falls asleep, I crawl out of my bed and stand beside hers. When I hold my palm up under her nose to see if she’s breathing, a mouthful of air presses against my hand. I could push down, now, over that nose and mouth, hold her when she fights. How would that really be any different than what I am already doing?

  The sound of footsteps in the hallway has me diving underneath the cave of my covers. I turn onto my side, away from the door, just in case my eyelids are still flickering by the time my parents enter the room. “I can’t believe this,” my mother whispers. “I just can’t believe she’s done this.”

  My father is so quiet that I wonder if maybe I have been mistaken, if maybe he isn’t here at all.

  “This is Jesse, all over again,” my mother adds. “She’s doing it for the attention.” I can feel her looking down at me, like I’m some kind of creature she’s never seen before. “Maybe we need to take her somewhere, alone. Go to a movie, or shopping, so she doesn’t feel left out. Make her see that she doesn’t have to do something crazy to get us to notice her. What do you think?”

  My father takes his time answering. “Well,” he say
s quietly, “maybe this isn’t crazy.”

  You know how silence can push in at your eardrums in the dark, make you deaf? That’s what happens, so that I almost miss my mother’s answer. “For God’s sake, Brian . . . whose side are you on?”

  And my father: “Who said there were sides?”

  But even I could answer that for him. There are always sides. There is always a winner, and a loser. For every person who gets, there’s someone who must give.

  A few seconds later, the door closes, and the hall light that has been dancing on the ceiling disappears. Blinking, I roll onto my back—and find my mother still standing beside my bed. “I thought you were gone,” I whisper.

  She sits down on the foot of my bed and I inch away. But she puts her hand on my calf before I move too far. “What else do you think, Anna?”

  My stomach squeezes tight. “I think . . . I think you must hate me.”

  Even in the dark, I can see the shine of her eyes. “Oh, Anna,” my mother sighs, “how can you not know how much I love you?”

  She holds out her arms and I crawl into them, as if I’m small again and I fit there. I press my face hard into her shoulder. What I want, more than anything, is to turn back time a little. To become the kid I used to be, who believed whatever my mother said was one hundred percent true and right without looking hard enough to see the hairline cracks.

  My mother holds me tighter. “We’ll talk to the judge and explain it. We can fix this,” she says. “We can fix everything.” And because those words are really all I’ve ever wanted to hear, I nod.

  SARA

  1990

  THERE IS AN UNEXPECTED COMFORT to being at the oncology wing of the hospital, a sense that I am a member of the club. From the kindhearted parking attendant who asks us if it’s our first time, to the legions of children with pink emesis basins tucked beneath their arms like teddy bears—these people have all been here before us, and there’s safety in numbers.

  We take the elevator to the third floor, to the office of Dr. Harrison Chance. His name alone has put me off. Why not Dr. Victor? “He’s late,” I say to Brian, as I check my watch for the twentieth time. A spider plant languishes, brown, on a windowsill. I hope he is better with people.

  To amuse Kate, who is starting to lose it, I inflate a rubber glove and knot it into a coxcomb balloon. On the glove dispenser near the sink is a prominent sign, warning parents not to do this very thing. We bat it back and forth, playing volleyball, until Dr. Chance himself comes in without a single apology for his delay.

  “Mr. and Mrs. Fitzgerald.” He is tall and rail-thin, with snapping blue eyes magnified by thick glasses, and a tightly set mouth. He catches Kate’s makeshift balloon in one hand and frowns at it. “Well, I can see there’s already a problem.”

  Brian and I exchange a glance. Is this coldhearted man the one who will lead us through this war, our general, our white knight? Before we can even backpedal with explanations, Dr. Chance takes a Sharpie marker and draws a face on the latex, complete with a set of wire-rimmed glasses to match his own. “There,” he says, and with a smile that changes him, he hands it back to Kate.

  • • •

  I only see my sister Suzanne once or twice a year. She lives less than an hour and several thousand philosophical convictions away.

  As far as I can tell, Suzanne gets paid a lot of money to boss people around. Which means, theoretically, that she did her career training with me. Our father died while mowing the lawn on his forty-ninth birthday; our mother never quite sewed herself together in the aftermath. Suzanne, ten years my senior, took up the slack. She made sure I did my homework and filled out law school applications and dreamed big. She was smart and beautiful and always knew what to say at any given moment. She could take any catastrophe and find the logical antidote to cure it, which is what made her such a success at her job. She was just as comfortable in a boardroom as she was jogging along the Charles. She made it all look easy. Who wouldn’t want a role model like that?

  My first strike was marrying a guy without a college degree. My second and third were getting pregnant. I suppose that when I didn’t go on to become the next Gloria Allred, she was justified in counting me a failure. And I suppose that until now, I was justified in thinking that I wasn’t one.

  Don’t get me wrong, she loves her niece and nephew. She sends them carvings from Africa, shells from Bali, chocolates from Switzerland. Jesse wants a glass office like hers when he grows up. “We can’t all be Aunt Zanne,” I tell him, when what I mean is that I can’t be her.

  I don’t remember which of us stopped returning phone calls first, but it was easier that way. There’s nothing worse than silence, strung like heavy beads on too delicate a conversation. So it takes me a full week before I pick up the phone. I dial direct. “Suzanne Crofton’s line,” a man says.

  “Yes.” I hesitate. “Is she available?”

  “She’s in a meeting.”

  “Please . . .” I take a deep breath. “Please tell her it’s her sister calling.”

  A moment later that smooth, cool voice falls into my ear. “Sara. It’s been a while.”

  She is the person I ran to when I got my period; the one who helped me knit back together my first broken heart; the hand I would reach for in the middle of the night when I could no longer remember which side our father parted his hair on, or what it sounded like when our mother laughed. No matter what she is now, before all that, she was my built-in best friend. “Zanne?” I say. “How are you?”

  • • •

  Thirty-six hours after Kate is officially diagnosed with APL, Brian and I are given an opportunity to ask questions. Kate messes with glitter glue with a child-life specialist while we meet with a team of doctors, nurses, and psychiatrists. The nurses, I have already learned, are the ones who give us the answers we’re desperate for. Unlike the doctors, who fidget like they need to be somewhere else, the nurses patiently answer us as if we are the first set of parents to ever have this kind of meeting with them, instead of the thousandth. “The thing about leukemia,” one nurse explains, “is that we haven’t even inserted a needle for the first treatment when we’re already thinking three treatments down the line. This particular illness carries a pretty poor prognosis, so we need to be thinking ahead to what happens next. What makes APL a little trickier is that it’s a chemoresistant disease.”

  “What’s that?” Brian asks.

  “Normally, with myelogenous leukemias, as long as the organs hold up, you can potentially reinduce the patient into remission every time there’s a relapse. You’re exhausting their body, but you know it will respond to treatment over and over. However, with APL, once you’ve offered a given therapy, you usually can’t rely upon it again. And to date, there’s only so much we can do.”

  “Are you saying,” Brian swallows. “Are you saying she’s going to die?”

  “I’m saying there are no guarantees.”

  “So what do you do?”

  A different nurse answers. “Kate will start a week of chemotherapy, in the hopes that we can kill off the diseased cells and put her into remission. She’ll most likely have nausea and vomiting, which we’ll try to keep to a minimum with antiemetics. She’ll lose her hair.”

  At this, a tiny cry escapes from me. This is such a small thing, and yet it’s the banner that will let others know what’s wrong with Kate. Only six months ago, she had her first haircut; the gold ringlets curled like coins on the floor of the SuperCuts.

  “She may develop diarrhea. There’s a very good chance that, with her own immune system laid low, she will get an infection that will require hospitalization. Chemo may cause developmental delays, as well. She’ll have a course of consolidation chemotherapy about two weeks after that, and then a few courses of maintenance therapy. The exact number will depend on the results we get from periodic bone marrow aspirations.”

  “Then what?” Brian asks.

  “Then we watch her,” Dr. Chance replies. “With APL, y
ou’ll want to be vigilant for signs of relapse. She’ll have to come into the ER if she has any hemorrhaging, fever, cough, or infection. And as far as further treatment, she’ll have some options. The idea is to get Kate’s body producing healthy bone marrow. In the unlikely event that we achieve molecular remission with chemo, we can retrieve Kate’s own cells and reinstill them—an autologous harvest. If she relapses, we may try to transplant someone else’s marrow into Kate to produce blood cells. Does Kate have any siblings?”

  “A brother,” I say. A thought dawns, a horrible one. “Could he have this, too?”

  “It’s very unlikely. But he may wind up being a match for an allogeneic transplant. If not, we’ll put Kate on the national registry for MUD—a matched, unrelated donor. However, getting a transplant from a stranger who’s a match is much more dangerous than getting one from a relative—the risk of mortality greatly increases.”

  The information is endless, a series of darts thrown so fast I cannot feel them sting anymore. We are told: Do not think; just give your child up to us, because otherwise she’s going to die. For every answer they give us, we have another question.

  Will her hair grow back?

  Will she ever go to school?

  Can she play with friends?

  Did this happen because of where we live?

  Did this happen because of who we are?

  “What will it be like,” I hear myself ask, “if she dies?”

  Dr. Chance looks at me. “It depends on what she succumbs to,” he explains. “If it’s infection, she’ll be in respiratory distress and on a ventilator. If it’s hemorrhage, she’ll bleed out after losing consciousness. If it’s organ failure, the characteristics will vary depending on the system in distress. Often there’s a combination of all of these.”

  “Will she know what’s happening,” I ask, when what I really mean is, How will I survive this?

  “Mrs. Fitzgerald,” he says, as if he has heard my unspoken question, “of the twenty children here today, ten will be dead in a few years. I don’t know which group Kate will be in.”