My Sister's Keeper: A Novel

by Jodi Picoult

  “Dr. Neaux,” the judge interrupts, “what would you recommend, in this case?”

  “Anna needs the guidance of someone with more life experience . . . someone who has her best interests in mind. I’m happy to work with the family, but the parents need to be the parents, here—because the children can’t be.”

  When Sara turns the witness over to me, I go in for the kill. “You’re asking us to believe that donating a kidney will net Anna all these fabulous psychological perks.”

  “That’s correct,” Dr. Neaux says.

  “Doesn’t it stand to reason, then, that if she donates that same kidney—and her sister dies as a result of the operation—then Anna will suffer significant psychological trauma?”

  “I believe her parents will help her reason through that.”

  “What about the fact that Anna’s saying she doesn’t want to be a donor anymore,” I point out. “Isn’t that important?”

  “Absolutely. But like I said, Anna’s current state of mind is driven by the short-term consequences. She doesn’t understand how this decision is really going to play out.”

  “Who does?” I ask. “Mrs. Fitzgerald may not be thirteen, but she lives each day waiting for the other shoe to drop in terms of Kate’s health, don’t you think?”

  Grudgingly, the psychiatrist nods.

  “You might say she defines her own ability to be a good mother by keeping Kate healthy. In fact, if her actions keep Kate alive, she herself benefits psychologically.”

  “Of course.”

  “Mrs. Fitzgerald would be much better off in a family that included Kate. Why, I’d even go as far as to say that the choices she makes in her life are not at all independent, but rather colored by issues concerning Kate’s health care.”

  “Probably.”

  “Then by your own reasoning,” I finish, “isn’t it true that Sara Fitzgerald looks, feels, and acts like a donor for Kate?”

  “Well—”

  “Except she’s not offering her own bone marrow and blood. Just Anna’s.”

  “Mr. Alexander,” the judge warns.

  “And if Sara fits the psychological profile of a closely related donor personality who can’t make independent decisions, then why is she any more capable of making this choice than Anna?”

  From the corner of my eye, I can see Sara’s stunned face. I can hear the judge banging his gavel. “You’re right, Dr. Neaux—parents need to be parents,” I say. “But sometimes that isn’t good enough.”

  JULIA

  JUDGE DESALVO CALLS for a ten-minute break. I put down my knapsack, a Guatemalan weave, and start washing my hands when the door to one of the bathroom stalls opens. Anna comes out, hesitating for just a moment. Then she turns on the tap beside me.

  “Hey,” I say.

  Anna goes to dry her hands under the blower. The air doesn’t feed out, not reading the sensor of her palm for some reason. She waves her fingers beneath the machine again, then stares at them, as if trying to make sure that she’s not invisible. She bangs on the metal.

  When I lean over and wave a hand beneath it, hot air breathes into my palm. We share this small warmth, hobos around a kettle-bellied fire. “Campbell tells me you don’t want to testify.”

  “I don’t really want to talk about it,” Anna says.

  “Well, sometimes to get what you want the most, you have to do what you want the least.”

  She leans against the bathroom wall and crosses her arms. “Who died and made you Confucius?” Anna turns away, then reaches down to pick up my knapsack for me. “I like this. All the colors.”

  I take it and slip it over my shoulder. “I saw old women weaving them, when I was in South America. It takes twenty spools of thread to make this pattern.”

  “Truth’s like that,” Anna says, or it’s what I think she says, but by then she has left the room.

  • • •

  I am watching Campbell’s hands. They move around a lot while he is talking; he almost seems to use them to punctuate whatever he’s saying. But they’re trembling a little, too, and I attribute this to the fact that he doesn’t know what I’m going to say. “As the guardian ad litem,” he asks, “what are your recommendations in this case?”

  I take a deep breath and look at Anna. “What I see here is a young woman who has spent her life feeling an enormous responsibility for her sister’s well-being. In fact, she knows she was brought into this world to carry that responsibility.” I glance at Sara, sitting at her table. “I think that this family, when they conceived Anna, had the best of intentions. They wanted to save their older daughter; they believed Anna would be a welcome addition to the family—not just because of what she would provide genetically, but also because they wanted to love her and watch her grow up well.”

  Then I turn to Campbell. “I also understand completely how, in this family, it became critical to do anything that was humanly possible to save Kate. When you love someone, you’ll do anything you can to keep them with you.”

  As a little girl, I used to wake up in the middle of the night remembering my wildest dreams—I was flying; I was locked in a chocolate factory; I was queen of a Caribbean isle. I would wake with the smell of frangipani in my hair or clouds caught in the hem of my nightgown until I realized that I was somewhere different. And no matter how hard I tried, I might fall asleep again but I could not will myself back into the fabric of that dream I’d been having.

  Once, during the night Campbell and I spent together, I woke up in his arms to find him still sleeping. I traced the geography of his face: from the cliff of his cheekbone to the whirlpool of his ear to the laugh lines ravined beside his mouth. Then I closed my eyes and for the first time in my life fell right back into the dream, in the very spot where I’d left it.

  “Unfortunately,” I say to the Court, “there is also a point when you have to step back and say that it’s time to let go.”

  • • •

  For a month after Campbell dumped me, I did not get out of bed except when forced to go to Mass or to sit at the dinner table. I stopped washing my hair. Under my eyes were dark circles. Izzy and I, at very first glance, looked completely different.

  On the day that I mustered the courage to get out of bed of my own volition, I went to Wheeler and trolled around the boathouse, carefully staying hidden until I found a boy on the sailing team—a summer session student—who was taking out one of the school’s skiffs. He had blond hair, instead of Campbell’s black. He was stocky, not tall and lean. I pretended I needed a ride home.

  Within an hour I had fucked him in the backseat of his Honda.

  I did it because if there was someone else, then I wouldn’t smell Campbell on my skin and taste him on the inside of my lips. I did it because I had been feeling so hollow inside that I feared floating away, like a helium balloon that rose so high you couldn’t even see the faintest splash of color.

  I felt this boy whose name I couldn’t be bothered to remember grunting and heaving inside me; I was that empty and that far away. And suddenly I knew what became of all those lost balloons: they were the loves that slipped out of our fists; the blank eyes that rose in every night sky.

  • • •

  “When I first was given this assignment two weeks ago,” I tell the judge, “and I started to look at the dynamics of this family, it seemed to me that medical emancipation was in Anna’s best interests. But then I realized I was guilty of making judgments the way everyone else in this family does—based solely on physiological effects, instead of psychological ones. The easy part of this decision is to figure out what’s medically right for Anna. Bottom line: it is not in her best interests to donate organs and blood that has no medical benefit for Anna herself but prolongs her sister’s life.”

  I see Campbell’s eyes spark; this endorsement has surprised him. “It’s harder to come up with a solution, though—because although it may not be in Anna’s best interests to be a donor for her sister, her own family is incapable of making
informed decisions about that. If Kate’s illness is a runaway train, then everyone reacts from crisis to crisis without figuring out the best way to bring this into the station. And using the same analogy, her parents’ pressure is a switch on the track—Anna isn’t mentally or physically strong enough to guide her own decisions, knowing what their wishes are.”

  Campbell’s dog gets up and begins to whine. Distracted, I turn to the noise. Campbell pushes away Judge’s snout, never taking his eyes off me.

  “I see no one in the Fitzgerald family who can make unbiased decisions about Anna’s health care,” I admit. “Not her parents, and not Anna herself.”

  Judge DeSalvo frowns down at me. “Then Ms. Romano,” he asks, “what’s your recommendation to the court?”

  CAMPBELL

  SHE’S NOT GOING TO VETO the petition.

  That’s my first incredible thought—that my case isn’t going down in flames yet, even after Julia’s testimony. My second thought is that Julia is as ripped up about this case and what it’s done to Anna as I am, except she’s put it out there on display for everyone to see.

  Judge has chosen this moment to become a colossal pain in the ass. He sinks his teeth into my coat and starts tugging, but I’ll be damned if I’m going to break before I hear Julia finish.

  “Ms. Romano,” DeSalvo asks, “what’s your recommendation to the court?”

  “I don’t know,” she says softly. “I’m sorry. This is the first time I’ve ever served as a guardian ad litem and been unable to reach a recommendation, and I know that’s not acceptable. But on one hand I have Brian and Sara Fitzgerald, who have done nothing but make choices throughout the course of both their daughters’ lives out of love. Put that way, they certainly don’t seem like the wrong decisions—even if they aren’t the right decisions for both of those daughters anymore.”

  She turns to Anna, and beside me I can feel her sit a little straighter, prouder. “On the other hand, I have Anna, who after thirteen years is standing up for herself—even though it may mean losing the sister she loves.” Julia shakes her head. “It’s a Solomon’s choice, Your Honor. But you’re not asking me to split a baby in half. You’re asking me to split a family.”

  When I feel a tug on my other arm I start to slap the dog away again, but then realize that this time, it’s Anna. “Okay,” she whispers.

  Judge DeSalvo excuses Julia from the stand. “Okay what?” I whisper back.

  “Okay I’ll talk,” Anna says.

  I stare at her in disbelief. Judge is whining now, and batting his nose against my thigh, but I can’t risk a recess. All it will take for Anna to change her mind is a split second. “You sure?”

  But she doesn’t answer me. She stands up, drawing all attention in the courtroom to herself. “Judge DeSalvo?” Anna takes a deep breath. “I have something to say.”

  ANNA

  LET ME TELL YOU ABOUT the first time I had to give an oral report in class: it was third grade, and I was in charge of talking about the kangaroo. They’re pretty interesting, you know. I mean, not only are they found on Australia alone, like some kind of mutant evolutionary strain—they have the eyes of deer and the useless paws of a T. Rex. But the most fascinating thing about them is the pouch, of course. This baby, when it gets born, is like the size of a germ and manages to crawl under the flap and tuck itself inside, all while its clueless mother is bouncing around the Outback. And that pouch isn’t like they make it out on Saturday morning cartoons—it’s pink and wrinkled like inside your lip, and full of important motherish plumbing. I’ll bet you didn’t know kangaroos don’t just carry one joey at a time. Every now and then there will be a miniature sibling, tiny and jellied and stuck in the bottom while her older sister scrapes around with enormous feet and makes herself comfortable.

  As you can see, I clearly knew my stuff. But when it was nearly my turn, just as Stephen Scarpinio was holding up a papier-mâché model of a lemur, I knew that I was going to be sick. I went up to Mrs. Cuthbert, and told her if I stayed to do this assignment, no one was going to be happy.

  “Anna,” she said, “if you tell yourself you feel fine, you will.”

  So when Stephen finished, I got up. I took a deep breath. “Kangaroos,” I said, “are marsupials that live only in Australia.”

  Then I projectile vomited over four kids who had the bad luck to be sitting in the front row.

  For the whole rest of the year, I was called KangaRalph. Every now and then some kid would go on a plane on vacation, and I’d go to my cubby to find a barf bag pinned to the front of my fleece pullover, a makeshift marsupial pouch. I was the school’s greatest embarrassment until Darren Hong went to capture the flag in gym and accidentally pulled down Oriana Bertheim’s skirt.

  I’m telling you this to explain my general aversion to public speaking.

  But now, on the witness stand, there’s even more to be worried about. It’s not that I’m nervous, like Campbell thinks. I am not afraid of clamming up, either. I’m afraid of saying too much.

  I look out at the courtroom and see my mother, sitting at her lawyer table, and at my father, who smiles at me just the tiniest bit. And suddenly I can’t believe I ever thought I might be able to go through with this. I get to the edge of my seat, ready to apologize for wasting everyone’s time and bolt—only to realize that Campbell looks positively awful. He’s sweating, and his pupils are so big they look like quarters set deep in his face. “Anna,” Campbell asks, “do you want a glass of water?”

  I look at him and think, Do you?

  What I want is to go home. I want to run away to a place where no one knows my name and pretend to be a millionaire’s adopted daughter, the heir to a toothpaste manufacturing kingdom, a Japanese pop star.

  Campbell turns to the judge. “May I confer for a moment with my client?”

  “Be my guest,” Judge DeSalvo says.

  So Campbell walks up to the witness stand and leans so close that only I can hear him. “When I was a kid I had a friend named Joseph Balz,” he whispers. “Imagine if Dr. Neaux had married him.”

  He backs away while I am still smiling, and thinking that maybe, just maybe, I can last for another two or three minutes up here.

  Campbell’s dog is going crazy—he’s the one who needs water or something, from the looks of it. And I’m not the only one to notice. “Mr. Alexander,” Judge DeSalvo says, “please control your animal.”

  “No, Judge.”

  “Excuse me?!”

  Campbell goes tomato red. “I was speaking to the dog, Your Honor, like you asked.” Then he turns to me. “Anna, why did you want to file this petition?”

  A lie, as you probably know, has a taste all its own. Blocky and bitter and never quite right, like when you pop a piece of fancy chocolate into your mouth expecting toffee filling and you get lemon zest instead. “She asked,” I say, the first two words that will become an avalanche.

  “Who asked what?”

  “My mom,” I say, staring at Campbell’s shoes. “For a kidney.” I look down at my skirt, pick at a thread. Just maybe I will unravel the whole thing.

  • • •

  About two months ago, Kate was diagnosed with kidney failure. She got tired easily, and lost weight, and retained water, and threw up a lot. The blame was pinned to a bunch of different things: genetic abnormalities, granulocyte-macrophage colony-stimulating factor—growth hormone shots Kate had once taken to boost marrow production, stress from other treatments. She was put on dialysis to get rid of the toxins zipping around her bloodstream. And then, the dialysis stopped working.

  One night, my mother came into our room when Kate and I were just hanging out. She had my father with her, which meant we were in for a more heavy discussion than who-left-the-sink-running-by-accident. “I’ve been doing some reading on the internet,” my mother said. “Transplants of typical organs aren’t nearly as difficult to recover from as bone marrow transplants.”

  Kate looked at me and popped in a new CD. We both kn
ew where this was headed. “You can’t exactly pick up a kidney at Kmart.”

  “I know. It turns out that you only need to match a couple of HLA proteins to be a kidney donor—not all six. I called Dr. Chance to ask if I might be a match for you, and he said in normal cases, I probably would.”

  Kate hears the right word. “Normal cases?”

  “Which you’re not. Dr. Chance thinks you’d reject an organ from the general donor pool, just because your body has already been through so much.” My mother looked down at the carpet. “He won’t recommend the procedure unless the kidney comes from Anna.”

  My father shook his head. “That’s invasive surgery,” he said quietly. “For both of them.”

  I started thinking about this. Would I have to be in the hospital? Would it hurt? Could people live with just one kidney?

  What if I wound up with kidney failure when I was, like, seventy? Where would I get my spare?

  Before I could ask any of this, Kate spoke. “I’m not doing it again, all right? I’m sick of it. The hospitals and the chemo and the radiation and the whole freaking thing. Just leave me alone, will you?”

  My mother’s face went white. “Fine, Kate. Go ahead and commit suicide!”

  She put her headphones on again, turned the music up so loud that I could hear it. “It’s not suicide,” she said, “if you’re already dying.”

  • • •

  “Did you ever tell anyone that you didn’t want to be a donor?” Campbell asks me, as his dog starts doing helicopters in the front of the courtroom.

  “Mr. Alexander,” Judge DeSalvo says, “I’m going to call a bailiff to remove your . . . pet.”

  It’s true, the dog is totally out of control. He’s barking and leaping up with his front paws on Campbell and running in those tight circles. Campbell ignores both Judges. “Anna, did you decide to file this lawsuit all by yourself?”