My Sister's Keeper: A Novel

by Jodi Picoult

  • • •

  Campbell is the one who actually answers the doctor. “I have power of attorney for Anna,” he explains, “not her parents.” He looks from me, to Sara. “And there is a girl upstairs who needs that kidney.”

  SARA

  IN THE ENGLISH LANGUAGE there are orphans and widows, but there is no word for the parent who loses a child.

  They bring her back down to us after the donated organs are removed. I am the last to go in. In the hallway, already, are Jesse and Zanne and Campbell and some of the nurses we’ve grown close to, and even Julia Romano—the people who needed to say goodbye.

  Brian and I walk inside, where Anna lies tiny and still on the hospital bed. A tube feeds down her throat, a machine breathes for her. It is up to us to turn it off. I sit down on the edge of the bed and pick up Anna’s hand, still warm to the touch, still soft inside mine. It turns out that after all these years I have spent anticipating a moment like this, I am completely at a loss. Like coloring the sky in with a crayon; there is no language for grief this big. “I can’t do this,” I whisper.

  Brian comes up behind me. “Sweetheart, she’s not here. It’s the machine keeping her body alive. What makes Anna Anna is already gone.”

  I turn, bury my face against his chest. “But she wasn’t supposed to,” I sob.

  We hold each other, then, and when I feel brave enough I look back down at the husk that once held my youngest. He is right, after all. This is nothing but a shell. There is no energy to the lines of her face; there is a slack absence to her muscles. Under this skin they have stripped her of organs that will go to Kate and to other, nameless, second-chance people.

  “Okay.” I take a deep breath. I put my hand on Anna’s chest as Brian, trembling, flips off the respirator. I rub her skin in small circles, as if this might make it easier. When the monitors flatline, I wait to see some change in her. And then I feel it, as her heart stops beating beneath my palm—that tiny loss of rhythm, that hollow calm, that utter loss.

  EPILOGUE

  When along the pavement,

  Palpitating flames of life,

  People flicker round me,

  I forget my bereavement,

  The gap in the great constellation,

  The place where a star used to be.

  —D. H. LAWRENCE,

  “Submergence”

  Kate

  2010

  THERE SHOULD BE A STATUTE of limitation on grief. A rule book that says it is all right to wake up crying, but only for a month. That after forty-two days you will no longer turn with your heart racing, certain you have heard her call out your name. That there will be no fine imposed if you feel the need to clean out her desk; take down her artwork from the refrigerator; turn over a school portrait as you pass—if only because it cuts you fresh again to see it. That it is okay to measure the time she has been gone, the way we once measured her birthdays.

  For a long time, afterward, my father claimed to see Anna in the night sky. Sometimes it was the wink of her eye, sometimes the shape of her profile. He insisted that stars were people who were so well loved they were traced in constellations, to live forever. My mother believed, for a long time, that Anna would come back to her. She began to look for signs—plants that bloomed too early, eggs with double yolks, salt spilled in the shape of letters.

  And me, well, I began to hate myself. It was, of course, all my fault. If Anna had never filed that lawsuit, if she hadn’t been at the courthouse signing papers with her attorney, she never would have been at that particular intersection at that particular moment. She would be here, and I would be the one coming back to haunt her.

  • • •

  For a long time, I was sick. The transplant nearly failed, and then, inexplicably, I began the long steep climb upward. It has been eight years since my last relapse, something not even Dr. Chance can understand. He thinks it is a combination of the ATRA and the arsenic therapy—some contributing delayed effect—but I know better. It is that someone had to go, and Anna took my place.

  Grief is a curious thing, when it happens unexpectedly. It is a Band-Aid being ripped away, taking the top layer off a family. And the underbelly of a household is never pretty, ours no exception. There were times I stayed in my room for days on end with headphones on, if only so that I would not have to listen to my mother cry. There were the weeks that my father worked round-the-clock shifts, so that he wouldn’t have to come home to a house that felt too big for us.

  Then one morning, my mother realized that we had eaten everything in the house, down to the last shrunken raisin and graham cracker crumb, and she went to the grocery store. My father paid a bill or two. I sat down to watch TV and watched an old I Love Lucy and started to laugh.

  Immediately, I felt like I had defiled a shrine. I clapped my hand over my mouth, embarrassed. It was Jesse, sitting beside me on the couch, who said, “She would have thought it was funny, too.”

  See, as much as you want to hold on to the bitter sore memory that someone has left this world, you are still in it. And the very act of living is a tide: at first it seems to make no difference at all, and then one day you look down and see how much pain has eroded.

  • • •

  I wonder how much she keeps tabs on us. If she knows that for a long time, we were close to Campbell and Julia, even went to their wedding. If she understands that the reason we don’t see them anymore is because it just plain hurt too much, because even when we didn’t talk about Anna, she lingered in the spaces between the words, like the smell of something burning.

  I wonder if she was at Jesse’s graduation from the police academy, if she knows that he won a citation from the mayor last year for his role in a drug bust. I wonder if she knew that Daddy fell deep into a bottle after she left, and had to claw his way out. I wonder if she knows that, now, I teach children how to dance. That every time I see two little girls at the barre, sinking into pliés, I think of us.

  • • •

  She still takes me by surprise. Like nearly a year after her death, when my mother came home with a roll of film she’d just developed of my high school graduation. We sat down at the kitchen table together, shoulder to shoulder, trying not to mention as we looked at all our double-wide grins that there was someone missing from the photo.

  And then, as if we’d conjured her, the last picture was of Anna. It had been that long since we’d used the camera, plain and simple. She was on a beach towel, holding out one hand toward the photographer, trying to get whoever it was to stop taking her picture.

  My mother and I sat at the kitchen table staring at Anna until the sun set, until we had memorized everything from the color of her ponytail holder to the pattern of fringe on her bikini. Until we couldn’t be sure we were seeing her clearly anymore.

  • • •

  My mother let me have that picture of Anna. But I didn’t frame it; I put it into an envelope and sealed it and stuffed it far back into a corner drawer of a filing cabinet. It’s there, just in case one of these days I start to lose her.

  There might be a morning when I wake up and her face isn’t the first thing I see. Or a lazy August afternoon when I can’t quite recall anymore where the freckles were on her right shoulder. Maybe one of these days, I will not be able to listen to the sound of snow falling and hear her footsteps.

  When I start to feel this way I go into the bathroom and I lift up my shirt and touch the white lines of my scar. I remember how, at first, I thought the stitches seemed to spell out her name. I think about her kidney working inside me and her blood running through my veins. I take her with me, wherever I go.

  MY

  SISTER’S

  KEEPER

  JODI PICOULT

  A READERS CLUB GUIDE

  ABOUT THIS GUIDE

  The suggested questions are intended to help your reading group find new and interesting angles and topics for discussion for Jodi Picoult’s My Sister’s Keeper. We hope that these ideas will enrich your c
onversation and increase your enjoyment of the book.

  Many fine books from Washington Square Press feature Readers Club Guides. For a complete listing, or to read the Guides online, visit http://www.BookClubReader.com.

  A CONVERSATION WITH JODI PICOULT

  Q: Your novels are incredibly relevant because they deal with topics that are a part of the national dialogue. Stem cell research and “designer babies” are issues that the medical community (and the political community) seems to be torn about. Why did you choose this subject for My Sister’s Keeper? Did writing this novel change any of your views in this area?

  A: I came across the idea for this novel through the back door of a previous one, Second Glance. While researching eugenics for that book, I learned that the American Eugenics Society—the one whose funding dried up in the 1930s when the Nazis began to explore racial hygiene too—used to be housed in Cold Spring Harbor, New York. Guess who occupies the same space today? The Human Genome Project . . . which many consider “today’s eugenics.” This was just too much of a coincidence for me, and I started to consider the way this massive, cutting-edge science we’re on the brink of exploding into was similar to—and different from—the eugenics programs and sterilization laws in America in the 1930s. Once again, you’ve got science that is only as ethical as the people who are researching and implementing it—and once again, in the wake of such intense scientific advancement, what’s falling by the wayside are the emotions involved in the case-by-case scenarios. I heard about a couple in America that successfully conceived a sibling that was a bone-marrow match for his older sister, a girl suffering from a rare form of leukemia. His cord blood cells were given to the sister, who is still (several years later) in remission. But I started to wonder . . . what if she ever, sadly, goes out of remission? Will the boy feel responsible? Will he wonder if the only reason he was born was because his sister was sick? When I started to look more deeply at the family dynamics and how stem cell research might cause an impact, I came up with the story of the Fitzgeralds. I personally am pro stem cell research—there’s too much good it can to do simply dismiss it. However, clearly, it’s a slippery slope, and sometimes researchers and political candidates get so bogged down in the ethics behind it and the details of the science that they forget completely we’re talking about humans with feelings and emotions and hopes and fears . . . like Anna and her family. I believe that we’re all going to be forced to think about these issues within a few years, so why not first in fiction?

  Q: In Jesse, you’ve done an amazing job of bringing the voice of the “angry young man” alive with irreverent originality. Your ability to transcend gender lines in your writing is seemingly effortless. Is this actually the case, or is writing from a male perspective a difficult thing for you to do?

  A: I have to tell you—writing Jesse is the most fun I’ve had in a long time. Maybe at heart I’ve always wanted to be a seventeen-year-old juvenile delinquent, but for whatever reason, it was just an absolute lark to take someone with so much anger and hurt inside him and give him voice. It’s always more fun to pretend to be someone you aren’t, for whatever reason—whether that means male, or thirteen, or neurotic, or suicidal, or any of a dozen other first-person narrators I’ve created. Whenever I try on a male voice—like Jesse’s or Campbell’s or Brian’s—it feels like slipping into a big overcoat. It’s comfortable there, and easy to get accustomed to wearing . . . but if I’m not careful, I’ll slip and show what I’ve got on underneath.

  Q: On page 190, Jesse observes, while reminiscing on his planned attempt to dig to China, that “Darkness, you know, is relative.” What does this sentiment mean and why did you choose to express it through Jesse, who in some ways is one of the least reflective characters in the novel?

  A: Well, that’s exactly why it has to be Jesse who says it. To Jesse, whatever injustices he thinks he’s suffered growing up will always pale to the Great Injustice of his sister being sick. He can’t win, plain and simple, so he doesn’t bother to try. When you read Jesse, you think you see exactly what you’re getting: a kid who’s gone rotten to the core. But I’d argue that in his case, you’re dealing with an onion . . . someone whose reality is several layers away from what’s on the surface. The question isn’t whether Jesse’s bad, it’s what made him that way in the first place and whether that’s really who he is, or just a facade he uses to protect a softer self from greater disappointment.

  Q: How did you choose which quotes would go at the beginning of each section? Milton, Shakespeare, D. H. Lawrence—are these some of your favorite authors, or did you have other reasons for choosing them?

  A: I suppose I could say that all I ever read are the Masters, and that these quotes just popped out of my memory—but I’d be lying! The bits I used at the beginning of the sections are ones that I searched for, diligently. I was looking for allusions to fire, flashes, stars—all imagery that might connect a family that is figuratively burning itself out.

  Q: Sisterhood—and siblinghood, for that matter—is a central concept in this work. Why did you make Isobel and Julia twins? Does this plot point somehow correspond with the codependence between Kate and Anna? What did you hope to reveal about sisterhood through this story?

  A: I think there is a relationship between sisters that is unlike other sibling bonds. It’s a combination of competition and fierce loyalty, which is certainly evident in both sets of sisters in this book. The reason Izzy and Julia are twins is because they started out as one embryo, before splitting in utero, and as they grew, their differences became more pronounced. Kate and Anna, too, have genetic connections, but unlike Izzy and Julia, they aren’t able to separate from each other to grow into distinct individuals. I wanted to hold up both examples to the reader, so that they could see the difference between two sisters who started out as one and diverged, and two sisters who started out distinct from each other and somehow became inextricably tangled.

  Q: Anyone who has watched a loved one die (and anyone with a heart in their chest) would be moved by the heartfelt, realistic, and moving depiction of sickness and death that is presented in this story. Was it difficult to imagine that scenario? How did you generate the realistic details?

  A: It’s always hard to imagine a scenario where a family is dealing with intense grief, because naturally you can’t help but think of your own family going through that sort of hell. When researching the book, I spoke to children who had cancer, as well as their parents—to better capture what it felt like to live day by day and maintain a positive attitude in spite of the overwhelming specter of what might be just around the corner. To a lesser extent, I also drew on my own experience, as a parent with a child who faced a series of surgeries: when my middle son, Jake, was five, he was diagnosed with bilateral cholesteatomas in his ears—benign tumors that will eventually burrow into your brain and kill you, if you don’t manage to catch them. He had ten surgeries in three years, and he’s tumor-free now. Clearly, I wasn’t facing the same urgent fears that the mom of a cancer patient faces, but it’s not hard to remember how trying those hospitalizations were. Every single time I walked beside his gurney into the OR, where I would stay with him while he was anesthetized, I’d think, “Okay, just take my ear; if that keeps him from going through this again.” That utter desperation and desire to make him healthy again became the heart of Sara’s monologues . . . and is the reason that I cannot hate her for making the decisions she did.

  Q: Sara is a complicated character, and readers will probably both criticize her and empathize with her. How do you see her role in the story?

  A: Like Nina Frost in Perfect Match, Sara’s going to generate a bit of controversy, I think. And yet, I adore Nina . . . and I really admire Sara too. I think that she’s the easy culprit to blame in this nightmare, and yet I would caution the reader not to rush to judgment. As Sara says at the end of the book, it was never a case of choosing one child over the other—it was a case of wanting both. I don’t think she meant for Anna t
o be at the mercy of her sister, I think she was intent on doing what had to be done only to keep that family intact. Now, that said, I don’t think she’s a perfect mom. She lets Jesse down—although she certainly was focused on more pressing emergencies, it’s hard for me to imagine giving up so completely on a child, no matter what. And she’s so busy fixating on Kate’s shaky future that she loses sight of her family in the here and now—an oversight, of course, that she will wind up regretting forever at the end of the book.

  Q: The point of view of young people is integral in your novels. In fact, more wisdom, humor, and compassion often come from them than anywhere else. What do you think adults could stand to learn from children? What is it about children that allows them to get to the truth of things so easily?

  A: Kids are the consummate radar devices for screening lies. They instinctively know when someone isn’t being honest, or truthful, and one of the really hard parts about growing up is learning the value of a white lie. For them, it’s artifice that has to be acquired. Remember how upset Holden Caulfield got at all the Phonies? Anna sees things the way they are because mentally she’s still a kid—in spite of the fact that she’s pretty much lost her childhood. The remarkable thing about adolescents, though, that keeps me coming back to them in fiction is that even when they’re on the brink of realizing that growing up means compromising and letting go of those ideals, they still hold fast to hope. They may not want to admit to it (witness Jesse!), but they’ve got it tucked into their back pockets, just in case. It’s why teens make such great and complicated narrators.

  Q: The ending of My Sister’s Keeper is surprising and terribly sad. Without giving too much away, can you share why you choose to end the novel this way? Was it your plan from the beginning, or did this develop later on, as you were writing?