My Sister's Keeper: A Novel

by Jodi Picoult

  “I know where you’re going with this, Mr. Alexander,” the psychiatrist says coldly. “The problem is that this kind of medical situation hasn’t existed before. There is no precedent. We’re trying to feel our way as best we can.”

  “Isn’t your job as an ethics committee to look at situations that haven’t existed before?”

  “Well. Yes.”

  “Dr. Bergen, in your expert opinion, is it ethically right for Anna Fitzgerald to have been asked to donate parts of her own body repeatedly for thirteen years?”

  “Objection!” my mother calls out.

  The judge strokes his chin. “I want to hear this.”

  Dr. Bergen glances at me again. “Quite frankly, even before I knew that Anna didn’t want to be a participant, I voted against her donating a kidney to her sister. I don’t believe Kate would live through the transplant, and therefore Anna would undergo a serious operation for no reason at all. Up until this point, however, I think that the risk of the procedures was small, compared to the benefit the family as a whole received, and I support the choices the Fitzgeralds made for Anna.”

  Campbell pretends to consider this. “Dr. Bergen, what kind of car do you drive?”

  “A Porsche.”

  “Bet you like it.”

  “I do,” he says guardedly.

  “What if I told you that you have to give up your Porsche before you leave this courtroom, because that action will save Judge DeSalvo’s life?”

  “That’s ridiculous. You—”

  Campbell leans in. “What if you had no choice? What if, today, psychiatrists simply have to do whatever lawyers decide is in the best interests of others?”

  He rolls his eyes. “In spite of the high drama you’re alluding to, Mr. Alexander, there are basic donor rights, safeguards put into place in medicine, so that the greater good doesn’t steamroll the pioneers who help create it. The United States has a long and nasty history of the abuse of informed consent, which is what led to laws relating to Human Subjects Research. It keeps people from being used as experimental lab rats.”

  “Then tell us,” Campbell says, “how the hell did Anna Fitzgerald slip through the cracks?”

  • • •

  When I was only seven months old, there was a block party in our neighborhood. It’s just as bad as you’re thinking: Jell-O molds and towers of cheese cubes and dancing in the street to music piped out of someone’s living room stereo. I, of course, have no personal recollection of any of this—I was plopped down in one of those walkers they made for babies before babies started overturning them and cracking their heads open.

  At any rate, I was in my walker, tooling around between the tables and watching the other kids, so the story goes, when I sort of lost my footing. Our block is canted at an angle, and suddenly the wheels were moving faster than I could make them stop. I whizzed past adults, under the barricade the cops had put up at the end of the road to shut it off to traffic, and I was heading right for a main drag full of cars.

  But Kate came out of nowhere and ran after me. She somehow managed to grab me by the back of my shirt moments before I got hit by a passing Toyota.

  Every now and then, someone on the block brings this up. Me, I remember it as the time she saved me, instead of the other way around.

  • • •

  My mother gets her first chance to play lawyer. “Dr. Bergen,” she says, “how long have you known of my family?”

  “I’ve been at Providence Hospital for ten years now.”

  “In those ten years, when some aspect of Kate’s treatment was presented to you, what did you do?”

  “Come up with a plan of action that was recommended,” he says. “Or an alternate, if possible.”

  “When you did, at any point in your report did you mention that Anna shouldn’t be a part of it?”

  “No.”

  “Did you ever say this would hurt Anna considerably?”

  “No.”

  “Or put her in grave medical danger herself?”

  “No.”

  Maybe it’s not Campbell, after all, who will turn out to be my white knight. Maybe it’s my mother.

  “Dr. Bergen,” she asks, “do you have kids?”

  The doctor looks up. “I have a son. He’s thirteen.”

  “Have you ever looked at these cases that come to the medical ethics committee and put yourself in a patient’s shoes? Or better yet, a parent’s shoes?”

  “I have,” he admits.

  “If you were me,” my mother says, “and the medical ethics committee handed you back a piece of paper with a suggested course of action that would save your son’s life, would you question them further . . . or would you just jump at the chance?”

  He doesn’t answer. He doesn’t have to.

  • • •

  Judge DeSalvo calls a second recess after that. Campbell says something about getting up and stretching my legs. So I start to follow him out, walking right past my mother. As I pass by, I feel her hand on my waist, tugging down my T-shirt, which is riding up in the back. She hates the spaghetti-strap girls, the ones who come to school in halters and low-riders, like they’re trying out as dancers in a Britney Spears video instead of going to math class. I can almost hear her voice: Please tell me that shrank in the wash.

  She seems to realize mid-tug that maybe she shouldn’t have done this. I stop, and Campbell stops, too, and her face goes bright red. “Sorry,” she says.

  I put my hand over hers and tuck my shirt into the back of my jeans where it should be. I look at Campbell. “Meet you outside?”

  He’s giving me a look that has Bad Idea written all over it, but he nods and heads down the aisle. Then my mother and I are nearly alone in the courtroom. I lean forward and kiss her on the cheek. “You did really great up there,” I tell her, because I don’t know how to say what I really want to: that the people you love can surprise you every day. That maybe who we are isn’t so much about what we do, but rather what we’re capable of when we least expect it.

  SARA

  2002

  KATE MEETS TAYLOR AMBROSE when they are sitting side by side, hooked up to IVs. “What are you here for?” she asks, and I immediately look up from my book, because in all the years that Kate has been receiving outpatient treatment I cannot remember her initiating a conversation.

  The boy she is talking to is not much older than she is, maybe sixteen to her fourteen. He has brown eyes that dance, and is wearing a Bruins cap over his bald head. “The free cocktails,” he answers, and the dimples in his cheeks deepen.

  Kate grins. “Happy hour,” she says, and she looks up at the bag of platelets being infused into her.

  “I’m Taylor.” He holds out his hand. “AML.”

  “Kate. APL.”

  He whistles, and raises his brows. “Ooh,” he says. “A rarity.”

  Kate tosses her cropped hair. “Aren’t we all?”

  I watch this, amazed. Who is this flirt, and what has she done with my little girl?

  “Platelets,” he says, scrutinizing the label on her IV bag. “You’re in remission?”

  “Today, anyway.” Kate glances at his pole, the telltale black bag that covers the Cytoxan. “Chemo?”

  “Yeah. Today, anyway. So, Kate,” Taylor says. He has that rangy puppy look of a sixteen-year-old, one with knobby knees and thick fingers and cheekbones he hasn’t yet grown into. When he crosses his arms, the muscles swell. I realize he’s doing this on purpose, and I duck my head to hide a smile. “What do you do when you’re not at Providence Hospital?”

  She thinks, and then a slow smile lights her up from the inside out. “Wait for something that makes me come back.”

  This makes Taylor laugh out loud. “Maybe sometime we can wait together,” he says, and he passes her a wrapper from a gauze pad. “Can I have your phone number?”

  Kate scribbles it down as Taylor’s IV begins to beep. The nurse comes in and unhooks his line. “You’re outta here, Taylor,” she says. �
��Where’s your ride?”

  “Waiting downstairs. I’m all set.” He gets out of the padded chair slowly, almost weakly, the first reminder that this is not some casual conversation. He slips the piece of paper with our phone number into his pocket. “Well, I’ll call you, Kate.”

  When he leaves Kate lets all her breath out in a dramatic finish. She rolls her head after him. “Oh my God,” she gasps. “He is gorgeous.”

  The nurse, checking her flow, grins. “Tell me about it, honey. If only I were thirty years younger.”

  Kate turns to me, blooming. “You think he’ll call?”

  “Maybe,” I say.

  “Where do you think we’ll go out?”

  I think of Brian, who has always said that Kate can date . . . when she’s forty. “Let’s take one step at a time,” I suggest. But inside, I am singing.

  • • •

  The arsenic, which ultimately put Kate into remission, worked its magic by wearing her down. Taylor Ambrose, a drug of an entirely different sort, works his magic by building her up. It becomes a habit: when the phone rings at seven P.M., Kate flies from the dinner table and hides in a closet with the portable receiver. The rest of us clear the dinner plates and spend time in the living room and get ready for bed, hearing little more than giggles and whispers, and then Kate emerges from her cocoon, flushed and glowing, first love beating like a hummingbird at the pulse in her throat. Every time it happens, I can’t stop staring. It is not that Kate is so beautiful, although she is; it’s that I never really let myself believe that I would see her all grown up.

  I follow her into the bathroom one night, after one of her marathon phone sessions. Kate stares at herself in the mirror, pursing her lips and raising her brows in a come-hither pose. Her hand comes up to her cropped hair—after the chemo, it never grew back in waves, just thick straight tufts that she usually cultivates with mousse to look like bedhead. She holds her palm out, as if she still expects to see hair shedding.

  “What do you think he sees when he looks at me?” Kate asks.

  I come to stand behind her. She is not the child that mirrors me—that would be Jesse—and yet when you put us side by side, there are definite similarities. It’s not in the shape of the mouth but the set of it, the sheer determination that silvers our eyes.

  “I think he sees a girl who knows what he’s been through,” I tell her honestly.

  “I got on the internet and read up on AML,” she says. “His leukemia’s got a pretty high cure rate.” She turns to me. “When you care more if someone else lives than you do about yourself . . . is that what love’s like?”

  It is hard, all of a sudden, to pull an answer through the tunnel of my throat. “Exactly.”

  Kate runs the tap and washes her face with a foam of soap. I hand her a towel, and as she rises from the cloud of it, she says, “Something bad’s going to happen.”

  On alert, I search her out for clues. “What’s the matter?”

  “Nothing. But that’s the way it works. If there’s something as good as Taylor in my life, I’m going to pay for it.”

  “That’s the stupidest thing I’ve ever heard,” I say out of habit, yet there is a truth to this. Anyone who believes that people have ultimate control of what life hands to them needs only to spend a day in the shoes of a child with leukemia. Or her mother. “Maybe you’re finally getting a break,” I say.

  Three days later, during a routine CBC, the hematologist tells us that Kate is once again throwing promyelocytes, the first slide down a steep slope of relapse.

  • • •

  I have never eavesdropped, at least not intentionally, until the night that Kate comes back from her first date with Taylor, to see a movie. She tiptoes into her room and sits down on Anna’s bed. “You awake?” she asks.

  Anna rolls over, groans. “I am now.” Sleep slips away from her, like a shawl falling to the floor. “How was it?”

  “Wow,” Kate says, and she laughs. “Wow.”

  “How wow? Like, tonsil hockey wow?”

  “You are so disgusting,” Kate whispers, although there’s a smile behind it. “But he is a really good kisser.” She dangles this like a fisherman.

  “Get out!” Anna’s voice shines. “So what was it like?”

  “Flying,” Kate answers. “I bet it feels just the same way.”

  “I don’t get what that has in common with someone slobbering all over you.”

  “God, Anna, it’s not like he spits on you.”

  “What does Taylor taste like?”

  “Popcorn.” She laughs. “And guy.”

  “How did you know what to do?”

  “I didn’t. It just kind of happened. Like the way you play hockey.”

  This, finally, makes sense to Anna. “Well,” she says, “I do feel pretty good when I’m doing that.”

  “You have no idea,” Kate sighs. There is some movement; I imagine her stripping off her clothes. I wonder if Taylor is imagining the same, somewhere.

  Pillow is punched, cover yanked back, sheets rustle as Kate gets into bed and rolls onto her side. “Anna?”

  “Hmm?”

  “He has scars on his palms, from graft-versus-host,” Kate murmurs. “I could feel them when we were holding hands.”

  “Was it gross?”

  “No,” she says. “It was like we matched.”

  • • •

  At first, I can’t get Kate to agree to undergo the peripheral blood stem cell transplant. She refuses because she doesn’t want to be hospitalized for chemo, doesn’t want to have to sit in reverse isolation for the next six weeks when she could be going out with Taylor Ambrose. “It’s your life,” I point out to her, and she looks at me as if I’m crazy.

  “Exactly,” she says.

  In the end, we compromise. The oncology team agrees to let Kate begin her chemo as an outpatient, in preparation for a transplant from Anna. At home, she agrees to wear a mask. At the first indication of her counts dropping, she’ll be hospitalized. They aren’t happy; they worry it will affect the procedure, but like me they also understand that Kate has reached the age where she can bargain with her will.

  As it turns out, this separation anxiety is all for naught, since Taylor shows up for Kate’s first outpatient chemo appointment. “What are you doing here?”

  “I can’t seem to stay away,” he jokes. “Hey, Mrs. Fitzgerald.” He sits down beside Kate in the empty adjoining chair. “God, it feels good to be in one of these without an IV hookup.”

  “Rub it in,” Kate mutters.

  Taylor puts his hand on her arm. “How far into it are you?”

  “Just started.”

  He gets up and sits on the wide arm of Kate’s chair, picks the emesis basin up from Kate’s lap. “A hundred bucks says you can’t make it till three without tossing your cookies.”

  Kate glances at the clock. It is 2:50. “You’re on.”

  “What did you have for lunch?” He grins, wicked. “Or should I guess based on the colors?”

  “You’re disgusting,” Kate says, but her smile is as wide as the sea. Taylor puts his hand on her shoulder. She leans into the contact.

  The first time Brian touched me, he saved my life. There had been cataclysmic downpours in Providence, a nor’easter that swelled the tides and put the parking lot at the courthouse entirely underwater. I was clerking then, when we were evacuated. Brian’s department was in charge; I walked onto the stone steps of the building to see cars floating by, and abandoned purses, and even a terrified paddling dog. While I had been filing briefs, the world I knew had been submerged. “Need a hand?” Brian asked, dressed in his full turnout gear, and he held out his arms. As he swam me to higher ground, rain struck my face and pelted my back. I wondered how—in a deluge—I could feel like I was being burned alive.

  “What’s the longest you’ve ever gone before throwing up?” Kate asks Taylor.

  “Two days.”

  “Get out.”

  The nurse glances up from
her paperwork. “True,” she confirms. “I saw it with my own eyes.”

  Taylor grins at her. “I told you, I’m a master at this.” He looks at the clock: 2:57.

  “Don’t you have anywhere else you’d rather be?” Kate says.

  “Trying to weasel out of the bet?”

  “Trying to spare you. Although—” Before she can finish, she goes green. Both the nurse and I rise from ours seats, but Taylor reaches Kate first. He holds the vomit basin beneath her chin and when she starts retching, he rubs his hand in slow circles on her upper back.

  “It’s okay,” he soothes, close to her temple.

  The nurse and I exchange glances. “Looks like she’s in good hands,” the nurse says, and she leaves to take care of another patient.

  When Kate is finished, Taylor puts the basin aside and wipes her mouth with a tissue. She looks up at him, glow-eyed and flushed, her nose still running. “Sorry,” she mutters.

  “For what?” Taylor says. “Tomorrow, it could be me.”

  I wonder if all mothers feel like this the moment they realize their daughters are growing up—as if it is impossible to believe that the laundry I once folded for her was doll-sized; as if I can still see her dancing in lazy pirouettes along the lip of the sandbox. Wasn’t it yesterday that her hand was only as big as the sand dollar she found on the beach? That same hand, the one that’s holding a boy’s; wasn’t it just holding mine, tugging so that I might stop and see the spiderweb, the milkweed pod, any of a thousand moments she wanted me to freeze? Time is an optical illusion—never quite as solid or strong as we think it is. You would assume that, given everything, I saw this coming. But watching Kate watch this boy, I see I have a thousand things to learn.

  “I’m some fun date,” Kate murmurs.

  Taylor smiles at her. “Fries,” he says. “For lunch.”

  Kate smacks his shoulder. “You are disgusting.”

  He raises one brow. “You lost the bet, you know.”

  “I seem to have left my trust fund at home.”

  Taylor pretends to study her. “OK, I know what you can give me instead.”

  “Sexual favors?” Kate says, forgetting I am here.