My Sister's Keeper

by Jodie Picoult

  Dr. Chance is no exception to the rule. From the onset he's anxious to leave. He checks his watch so often you'd think he was about to miss a train. The difference this time around is that Sara Fitzgerald is just as anxious to get him out of the courtroom. Because the patient who is waiting, the person who is dying, is Kate.

  But beside me, Anna's body throws heat. I get up, continue my questioning. Slowly. "Dr. Chance, were any of the treatments that involved donations from Anna's body sure things'?"

  "Nothing in cancer is a sure thing, Mr. Alexander."

  "Was that explained to the Fitzgeralds?"

  "We carefully explain the risks of every procedure, because once you begin treatments, you compromise other bodily systems. What we wind up doing for one treatment successfully may come back to haunt you the next time around." He smiles at Sara. "That said, Kate's an incredible young woman. She wasn't expected to live past age five, and here she is at sixteen."

  "Thanks to her sister," I point out.

  Dr. Chance nods. "Not many patients have both the strength of body and the good fortune to have a perfectly matched donor available to them."

  I stand up, my hands in my pockets. "Can you tell the Court how the Fitzgeralds came to consult Providence Hospital's preimplantation genetic diagnosis team to conceive Anna?"

  "After their son was tested and found to be an unsuitable donor for Kate, I told the Fitzgeralds about another family I'd worked with. They'd tested all the patient's siblings, and none qualified, but then the mother got pregnant during the course of treatment and that child happened to be a perfect match."

  "Did you tell the Fitzgeralds to conceive a genetically programmed child to serve as a donor for Kate?"

  "Absolutely not," Chance says, affronted. "I just explained that even if none of the existing children was a match, that didn't mean that a future child might not be."

  "Did you explain to the Fitzgeralds that this child, as a perfectly genetically programmed match, would have to be available for all these treatments for Kate throughout her life?"

  "We were talking about a single cord blood treatment at the time," Dr. Chance says. "Subsequent donations came about because Kate didn't respond to the first one. And because they offered more promising results."

  "So if tomorrow scientists were to come up with a procedure that would cure Kate's cancer if Anna only cut off her head and gave it to her sister, would you recommend that?"

  "Obviously not. I would never recommend a treatment that risked another child's life."

  "Isn't that what you've done for the past thirteen years?"

  His face tightens. "None of the treatments have caused significant long-term harm to Anna."

  I take a piece of paper out of my briefcase and hand it to the judge, and then to Dr. Chance. "Can you read the part that's marked?"

  He puts on a pair of glasses and clears his throat. "I understand that anesthesia involves potential risks. These risks may include, but are not limited to: adverse drug reactions, sore throat, injury to teeth and dental work, damage to vocal cords, respiratory problems, minor pain and discomfort, loss of sensation, headaches, infection, allergic reaction, awareness during general anesthesia, jaundice, bleeding, nerve injury, blood clot, heart attack, brain damage, and even loss of bodily function or of life."

  "Are you familiar with this form, Doctor?"

  "Yes. It's a standard consent form for a surgical procedure."

  "Can you tell us who the patient receiving it was?"

  "Anna Fitzgerald."

  "And who signed the consent form?"

  "Sara Fitzgerald."

  I rock back on my heels. "Dr. Chance, anesthesia carries a risk of life impairment or death. Those are pretty strong long-term effects."

  "That's exactly why we have a consent form. It's to protect us from people like you," he says. "But realistically, the risk is extremely small. And the procedure of donating marrow is fairly simple."

  "Why was Anna being anesthetized for such a simple procedure?"

  "It's less traumatic for a child, and they're less likely to squirm around."

  "And after the procedure, did Anna experience any pain?"

  "Maybe a little," Dr. Chance says.

  "You don't remember?"

  "It's been a long time. I'm sure even Anna's forgotten about it by now."

  "You think?" I turn to Anna. "Should we ask her?"

  Judge DeSalvo crosses his arms.

  "Speaking of risk," I continue smoothly. "Can you tell us about the research that's been done on the long-term effects of the growth factor shots she's taken twice now, prior to harvest for transplant?"

  "Theoretically, there shouldn't be any long-term sequelae."

  "Theoretically," I repeat. "Why theoretically?"

  "Because the research has been done on lab animals," Dr. Chance admits. "Effects on humans are still being tracked."

  "How comforting."

  He shrugs. "Physicians don't tend to prescribe drugs that have the potential to wreak havoc."

  "Have you ever heard of thalidomide, Doctor?" I ask.

  "Of course. In fact, recently, it's been resurrected for cancer research."

  "And it was a milestone drug once before," I point out. "With catastrophic effects. Speaking of which . . . this kidney donation—are there risks associated with the procedure?"

  "No more than for most surgeries," Dr. Chance says.

  "Could Anna die from complications of this surgery?"

  "It's highly unlikely, Mr. Alexander."

  "Well, then, let's assume Anna comes through the procedure with flying colors. How will having a single kidney affect her for the rest of her life?"

  "It won't, really," the doctor says. "That's the beauty of it."

  I hand him a flyer that has come from the nephrology department of his own hospital. "Can you read the highlighted section?"

  He slips on his glasses again. "Increased chance of hypertension. Possible complications during pregnancy." Dr. Chance glances up. "Donors are advised to refrain from contact sports to eliminate the risk of harming their remaining kidney."

  I clasp my hands behind my back. "Did you know that Anna plays hockey in her free time?"

  He turns toward her. "No. I didn't."

  "She's a goalie. Has been for years now." I let this sink in. "But since this donation is hypothetical, let's concentrate on the ones that have already happened. The growth factor shots, the DLI, the stem cells, the lymphocyte donations, the bone marrow—all of these myriad treatments Anna endured—in your expert opinion, Doctor, are you saying that Anna has not undergone any significant medical harm from these procedures?"

  "Significant?" He hesitates. "No, she has not."

  "Has she received any significant benefit from them?" Dr. Chance looks at me for a long moment. "Sure," he says. "She's saving her sister."

  Anna and I are eating lunch upstairs at the courthouse when Julia walks in. "Is this a private party?"

  Anna waves her inside, and Julia sits down without so much as a glance toward me. "How are you doing?" she asks.

  "Okay," Anna replies. "I just want it to be over."

  Julia opens up a packet of salad dressing and pours it over the lunch she's brought. "It will be, before you know it."

  She looks at me when she says this, briefly.

  That's all it takes for me to remember the smell of her skin, and the spot below her breast where she has a beauty mark in the shape of a crescent moon.

  Suddenly Anna gets up. "I'm going to take Judge for a walk." she announces.

  "Like hell you are. There are reporters out there, still."

  "I'll walk him in the hallway, then."

  "You can't. He has to be walked by me; it's part of his training."

  "Then I'm going to pee," Anna says. "That's something I'm still allowed to do by myself, right?"

  She walks out of the conference room, leaving Julia and me and everything that shouldn't have happened but did.

  "She left us
alone on purpose," I realize.

  Julia nods. "She's a smart kid. She can read people very well." Then she sets down her plastic fork. "Your car is full of dog hair."

  "I know. I keep asking Judge to pull it back in a ponytail but he never listens."

  "Why didn't you just get me up?"

  I grin. "Because we were anchored in a no-wake zone."

  Julia, however, doesn't even crack a smile. "Was last night a joke to you, Campbell?"

  That old adage pops into my head: If you want to see God laugh, make apian. And because I am a coward, I grab the dog by his collar. "I need to walk him before we're called back into court."

  Julia's voice follows me to the door. "You didn't answer me."

  "You don't want me to," I say. I don't turn around. That way I don't have to see her face.

  When Judge DeSalvo adjourns us for the day at three because of a weekly chiropractic appointment, I walk Anna out to the lobby to find her father—but Brian's gone. Sara looks around, surprised. "Maybe he got a fire call," she says. "Anna, I'll—"

  But I put my hand on Anna's shoulder. "I'll take you to the fire station."

  In the car, she is quiet. I pull into the station parking lot and leave the engine running. "Listen," I tell her, "you may not have realized it, but we had a great first day."

  "Whatever."

  She gets out of my car without another word and Judge hops up into the vacated front seat. Anna walks toward the station, but then veers left. I start to pull back out, and then against my better judgment turn off the engine. Leaving Judge in the car, I follow her around the back of the building.

  She stands like a statue, her face turned up to the sky. What am I supposed to do, say? I have never been a parent; I can barely take care of myself.

  As it turns out, Anna starts speaking first. "Did you ever do something you knew was wrong, even though it felt right?"

  I think of Julia. "Yeah."

  "Sometimes I hate myself," Anna murmurs.

  "Sometimes," I tell her, "I hate myself, too."

  This surprises her. She looks at me, and then at the sky again. "They're up there. The stars. Even when you can't see them."

  I put my hands into my pockets. "I used to wish on a star every night."

  "For what?"

  "Rare baseball cards for my collection. A golden retriever. Young, hot female teachers."

  "My dad told me that a bunch of astronomers found a new place where stars are being born. Only it's taken us 2,500 years to see them." She turns to me. "Do you get along with your parents?"

  I think about lying to her, but then I shake my head. "I used to think I'd be just like them when I grew up, but I'm not. And the thing is, somewhere along the way, I stopped wanting to be like them, anyway."

  The sun washes over her milky skin, lights the line of her throat. "I get it," Anna says. "You were invisible, too."

  TUESDAY

  A little fire is quickly trodden out;

  Which, being suffered, rivers can not quench.

  —WILLIAM SHAKESPEARE, King Henry VI

  CAMPBELL

  BRIAN FITZGERALD IS MY LOCK. Once the judge realizes that at least one of Anna's parents agrees with her decision to stop being a donor for her sister, granting her emancipation won't be quite as great a leap. If Brian does what I need him to—namely, tell Judge DeSalvo that he knows Anna has rights, too, and that he's prepared to support her—then whatever Julia says in her report will be a moot point. And better still, Anna's testimony would only be a formality.

  Brian shows up with Anna early the next morning, wearing his captain's uniform. I paste a smile on my face and get up, walking toward them with Judge. "Morning," I say. "Everyone ready?"

  Brian looks at Anna. Then he looks at me. There is a question right there on the verge of his lips, but he seems to be doing everything he can not to ask it.

  "Hey," I say to Anna, brainstorming. "Want to do me a favor? Judge could use a couple of quick runs up and down the stairs, or he's going to get restless in court."

  "Yesterday you told me I couldn't walk him."

  "Well, today you can."

  Anna shakes her head. "I'm not going anywhere. The minute I leave you're just going to talk about me."

  So I turn to Brian again. "Is everything all right?"

  At that moment, Sara Fitzgerald comes into the building. She hurries toward the courtroom, and seeing Brian with me, pauses. Then she turns slowly away from her husband and continues inside. Brian Fitzgerald's eyes follow his wife, even after the doors close behind her. "We're fine," he says, an answer not meant for me.

  "Mr. Fitzgerald, were there times that you disagreed with your wife about having Anna participate in medical treatments for Kate's benefit?"

  "Yes. The doctors said that it was only cord blood we needed for Kate. They'd be taking part of the umbilicus that usually gets thrown out after giving birth—it wasn't anything that the baby was ever going to miss, and it certainly wasn't going to hurt her." He meets Anna's eye, gives her a smile. "And it worked for a little while, too. Kate went into remission. But in 1996, she relapsed again. The doctors wanted Anna to donate some lymphocytes. It wasn't going to be a cure, but it would hold Kate over for a while." I try to draw him along. "You and your wife didn't see eye to eye over this treatment?"

  "I didn't know if it was such a great idea. This time Anna was going to know what was happening, and she wasn't going to like it."

  "What did your wife say to make you change your mind?"

  "That if we didn't draw blood from Anna this time, we'd need marrow soon anyway."

  "How did you feel about that?"

  Brian shakes his head, clearly uncomfortable. "You don't know what it's like," he says quietly, "until your child is dying. You find yourself saying things and doing things you don't want to do or say. And you think it's something you have a choice about, but then you get up a little closer to it, and you see you had it all wrong." He looks up at Anna, who is so still beside me I think she has forgotten to breathe. "I didn't want to do that to Anna. But I couldn't lose Kate."

  "Did you have to use Anna's bone marrow, eventually?"

  "Yes."

  "Mr. Fitzgerald, as a certified EMT, would you ever perform a procedure on a patient who didn't present with any physical problems?"

  "Of course not."

  "Then why did you, as Anna's father, think this invasive procedure, which carried risk to Anna herself and no personal physical benefit, was in her best interests?"

  "Because," Brian says, "I couldn't let Kate die."

  "Were there other points, Mr. Fitzgerald, when you and your wife disagreed over the use of Anna's body for your other daughter's treatment?"

  "A few years ago, Kate was hospitalized and… losing so much blood nobody thought she'd make it through. I thought maybe it was time to let her go. Sara didn't."

  "What happened?"

  "The doctors gave her arsenic, and it kicked in, putting Kate into remission for a year."

  "Are you saying that there was a treatment which saved Kate, that didn't involve the use of Anna's body?"

  Brian shakes his head. "I'm saying… I'm saying I was so sure Kate was going to die. But Sara, she didn't give up on Kate and she came back fighting." He looks over at his wife. "And now, Kate's kidneys are giving out. I don't want to see her suffering. But at the same time, I don't want to make the same mistake twice. I don't want to tell myself it's over, when it doesn't have to be."

  Brian has become an emotional avalanche, headed right for the glass house I have been meticulously crafting. I need to reel him in. "Mr. Fitzgerald, did you know your daughter was going to file a lawsuit against you and your wife?"

  "No."

  "When she did, did you speak to Anna about it?"

  "Yes."

  "Based on that conversation, Mr. Fitzgerald, what did you do?"

  "I moved out of the house with Anna."

  "Why?"

  "At the time I believed Anna had the righ
t to think this decision out, which wasn't something she'd be able to do living in our house."

  "After having moved out with Anna, after having spoken to her at great lengths about why she's initiated this lawsuit—do you agree with your wife's request to have Anna continue to be a donor for Kate?"

  The answer we have rehearsed is no; this is the crux of my case. Brian leans forward to reply. "Yes, I do," he says.

  "Mr. Fitzgerald, in your opinion …" I begin, and then I realize what he's just done. "Excuse me?"

  "I still wish Anna would donate a kidney," Brian admits. Staring at this witness who has just completely fucked me over, I scramble for footing. If Brian won't support Anna's decision to stop being a donor, then the judge will find it far harder to rule in favor of emancipation.

  At the same time, I'm patently aware of the smallest sound that has escaped from Anna, the quiet break of soul that comes when you realize that what looked like a rainbow was actually only a trick of the light. "Mr. Fitzgerald, you're willing to have Anna undergo major surgery and the loss of an organ to benefit Kate?"

  It is a curious thing, watching a strong man fall to pieces. "Can you tell me what the right answer is here?" Brian asks, his voice raw. "Because I don't know where to look for it. I know what's right. I know what's fair. But neither of those apply here. I can sit, and I can think about it, and I can tell you what should be and what ought to be. I can even tell you there's got to be a better solution. But it's been thirteen years, Mr. Alexander, and I still haven't found it."

  He slowly sinks forward, too big in that tiny space, until his forehead rests on the cool bar of wood that borders the witness stand.

  Judge DeSalvo calls for a ten-minute recess before Sara Fitzgerald will begin her cross-examination, so that the witness can have a few moments to himself. Anna and I go downstairs to the vending machines, where you can spend a dollar on weak tea and weaker soup. She sits with her heels caught on the rungs of a stool, and when I hand her her cup of hot chocolate she sets it down on the table without drinking.