My Sister's Keeper

by Jodie Picoult

  I turn to Judge DeSalvo. "I didn't want to come to court, but I had to. The way the law works, if a petitioner takes action—even if that's your own child—you must have a reaction. And so I was forced to explain, eloquently, why I believe that I know better than Anna what is best for her. When you get down to it, though, explaining what you believe isn't all that easy. If you say that you believe something to be true, you might mean one of two things—that you're still weighing the alternatives, or that you accept it as a fact. I don't logically see how one single word can have contradictory definitions, but emotionally, I completely understand. Because there are times I think what I am doing is right, and there are other times I second-guess myself every step of the way.

  "Even if the court found in my favor today, I couldn't force Anna to donate a kidney. No one could. But would I beg her? Would I want to, even if I restrained myself? I don't know, not even after speaking to Kate, and after hearing from Anna. I am not sure what to believe; I never was. I know, indisputably, only two things: that this lawsuit was never really about donating a kidney… but about having choices. And that nobody ever really makes decisions entirely by themselves, not even if a judge gives them the right to do so."

  Finally, I face Campbell. "A long time ago I used to be a lawyer. But I'm not one anymore. I am a mother, and what I've done for the past eighteen years in that capacity is harder than anything I ever had to do in a courtroom. At the beginning of this hearing, Mr. Alexander, you said that none of us is obligated to go into a fire and save someone else from a burning building. But that all changes if you're a parent and the person in that burning building is your child. If that's the case, not only would everyone understand if you ran in to get your child—they'd practically expect it of you."

  I take a deep breath. "In my life, though, that building was on fire, one of my children was in it—and the only opportunity to save her was to send in my other child, because she was the only one who knew the way. Did I know I was taking a risk? Of course. Did I realize it meant maybe losing both of them? Yes. Did I understand that maybe it wasn't fair to ask her to do it? Absolutely. But I also knew that it was the only chance I had to keep both of them. Was it legal? Was it moral? Was it crazy or foolish or cruel? I don't know. But I do know it was right."

  Finished, I sit down at my table. The rain beats against the windows to my right. I wonder if it will ever let up.

  CAMPBELL

  I GET TO MY FEET, look at my notecards, and—like Sara—toss them into the trash. "Like Mrs. Fitzgerald just said, this case isn't about Anna donating a kidney. It isn't about her donating a skin cell, a single blood cell, a rope of DNA. It's about a girl who is on the cusp of becoming someone. A girl who is thirteen—which is hard, and painful, and beautiful, and difficult, and exhilarating. A girl who may not know what she wants right now, and she may not know who she is right now, but who deserves the chance to find out. And ten years from now, in my opinion, I think she's going to be pretty amazing."

  I walk toward the bench. "We know that the Fitzgeralds were asked to do the impossible—make informed health-care decisions for two of their children, who had opposing medical interests. And if we—like the Fitzgeralds—don't know what the right decision is, then the person who has to have the final say is the person whose body it is… even if that's a thirteen-year-old. And ultimately, that too is what this case is about: the moment when perhaps a child knows better than her parents.

  "I know that when Anna made the choice to file this lawsuit, she did not do it for all the self-centered reasons you might expect of a thirteen-year-old. She didn't make this decision because she wanted to be like other kids her age. She didn't make this decision because she was tired of being poked and prodded. She didn't make this decision because she was afraid of the pain."

  I turn around, and smile at her. "You know what? I wouldn't be surprised if Anna gives her sister that kidney after all. But what I think doesn't matter. Judge DeSalvo, with all due respect, what you think doesn't matter. What Sara and Brian and Kate Fitzgerald think doesn't matter. What Anna thinks does." I walk back toward my chair. "And that's the only voice we ought to be listening to."

  Judge DeSalvo calls for a fifteen-minute recess to render his decision, and I use it to walk the dog. We circle the little square of green behind to the Garrahy building, with Vern keeping an eye on the reporters who are waiting for a verdict. "Come on already," I say, as Judge makes his fourth loop around, in search of the ultimate spot. "No one's watching."

  But this turns out to not be entirely true. A kid, no older than three or four, breaks away from his mother and comes crashing toward us. "Puppy!" he yells. He stretches out his hands in hot pursuit, and Judge steps closer to me.

  His mother catches up a moment later. "Sorry. My son's going through a canine stage. Can we pet him?"

  "No," I say automatically. "He's a service dog."

  "Oh." The woman straightens, pulls her son away. "But you aren't blind."

  I'm epileptic, and this is my seizure dog. I think about coming clean, for once, for the first time. But then again, you have to be able to laugh at yourself, don't you? "I'm a lawyer," I say, and I grin at her. "He chases ambulances for me."

  As Judge and I walk off, I'm whistling.

  When Judge DeSalvo comes back to the bench he brings a framed picture of his dead daughter, which is how I know that I've lost this case. "One thing that has struck me through the presentation of the evidence," he begins, "is that all of us in this courtroom have entered into a debate about the quality of life versus the sanctity of life. Certainly the Fitzgeralds have always believed that having Kate alive and part of the family was crucial—but at this point the sanctity of Kate's existence has become completely intertwined with the quality of Anna's life, and it's my job to see whether those two can be separated."

  He shakes his head. "I'm not sure that any of us is qualified to decide which of those two is the most important—least of all myself. I'm a father. My daughter Dena was killed when she was twelve years old by a drunk driver, and when I rushed to the hospital that night, I would have given anything for another day with her. The Fitzgeralds have had fourteen years of being in that position—of being asked to give anything to keep their daughter alive a little bit longer. I respect their decisions. I admire their courage. I envy the fact that they even had these opportunities. But as both attorneys have pointed out, this case is no longer about Anna and a kidney, it's about how these decisions get made and how we decide who should make them."

  He clears his throat. "The answer is that there is no good answer. So as parents, as doctors, as judges, and as a society, we fumble through and make decisions that allow us to sleep at night—because morals are more important than ethics, and love is more important than law."

  Judge DeSalvo turns his attention to Anna, who shifts uncomfortably. "Kate doesn't want to die," he says gently, "but she doesn't want to live like this, either. And knowing that, and knowing the law, there's really only one decision I can make. The sole person who should be allowed to make that choice is the very one who lies at the heart of the issue."

  I exhale heavily.

  "And by that, I don't mean Kate, but Anna."

  Beside me, she sucks in her breath. "One of the issues brought up during these past few days has involved whether or not a thirteen-year-old is capable of making choices as weighty as these. I'd argue, though, that age is the least likely variable here for basic understanding. In fact, some of the adults here seem to have forgotten the simplest childhood rule: You don't take something away from someone without asking permission. Anna," he asks, "will you please stand up?"

  She looks at me, and I nod, standing up with her. "At this time," Judge DeSalvo says, "I'm going to declare you medically emancipated from your parents. What that means is that even though you will continue to live with them, and even though they can tell you when to go to bed and what TV shows you can't watch and whether you have to finish your broccoli, with regards to
any medical treatment, you have the last word." He turns toward Sara. "Mrs. Fitzgerald, Mr. Fitzgerald—I'm going to order you to meet with Anna and her pediatrician and discuss the terms of this verdict so that the doctor understands he needs to deal directly with Anna. And just so that she has additional guidance, should she need it, I'm going to ask Mr. Alexander to assume medical power of attorney for her until age eighteen, so that he may assist her in making some of the more difficult decisions. I'm not in any way suggesting that these decisions should not be made in conjunction with her parents—but I am finding that the final decision will rest with Anna alone." The judge pins his gaze on me. "Mr. Alexander, will you accept this responsibility?"

  With the exception of Judge, I have never had to take care of anyone or anything before. And now I will have Julia, and I will have Anna. "I'd be honored," I say, and I smile at her.

  "I want those forms signed before you leave the courthouse today," the judge orders. "Good luck, Anna. Stop by every now and then, and let me know how you are."

  He bangs his gavel, and we rise as he leaves the courtroom. "Anna," I say, when she remains still and shocked beside me. "You did it."

  Julia reaches us first and leans over the gallery railing to hug Anna. "You were very brave." Over Anna's shoulder she grins at me. "And so were you."

  But then Anna steps away, and finds herself facing her parents. There is a foot between them, and a universe of time and comfort. It isn't until that moment that I realize I have begun already to think of Anna as older than her biological age, yet here she is unsure and unable to make eye contact. "Hey," Brian says, bridging the gap, pulling his daughter into a rough embrace. "It's okay." And then Sara slips into this huddle, her arms coming around both of them, all their shoulders forming the wide wall of a team that has to reinvent the very game they play.

  ANNA

  VISIBILITY SUCKS. The rain, if possible, is coming down even harder. I have this brief vision of it pummeling the car so hard it crunches like an empty Coke can, and just like that it's harder for me to breathe. It takes a second for me to realize that this has nothing to do with the shitty weather or latent claustrophobia, but with the fact that my throat is only half as wide as usual/tears hardening it like an artery, so that everything I do and say involves twice as much work.

  I have been medically emancipated for a whole half hour now. Campbell says the rain is a blessing, it's kept the reporters away. Maybe they will find me at the hospital and maybe they won't, but by then I will be with my family and it won't really matter. My parents left before us; we had to fill out the stupid paperwork. Campbell offered to drop me off when we were through, which is nice considering I know he wants nothing more than to hook up with Julia, which they seem to think is some tremendous mystery, but so isn't. I wonder what Judge does, when it's the two of them. I wonder if he feels left out.

  "Campbell?" I ask, out of nowhere. "What do you think I should do?"

  He doesn't pretend to not know what I'm talking about. "I just fought very hard at a trial for your right to choose, so I'm not going to tell you what I think."

  "Great," I say, settling deep into my seat. "I don't even know who I really am."

  "I know who you are. You're the premier doorknob caddy in all of Providence Plantations. You've got a wise mouth, and you pick the crackers out of the Chex Mix, and you hate math and…"

  It's kind of cool, watching Campbell try to fill in all the blanks.

  "… you like boys?" he finishes, but that one's a question.

  "Some of them are okay," I admit, "but they probably all grow up to be like you."

  He smiles. "God forbid."

  "What are you going to do next?"

  Campbell shrugs. "I may actually have to take on a paying case."

  "So you can continue to support Julia in the style to which she's accustomed?"

  "Yeah," he laughs. "Something like that."

  It gets quiet for a moment, so all I can hear is the squelch of the windshield wipers. I slip my hands under my thighs, sit on them. "What you said at the trial… do you really think I'll be amazing in ten years?"

  "Why, Anna Fitzgerald, are you fishing for compliments?"

  "Forget I said anything."

  He glances at me. "Yes, I do. I imagine you'll be breaking guy's hearts, or painting in Montmartre, or flying fighter jets, or hiking through undiscovered countries." He pauses. "Maybe all of the above."

  There was a time when, like Kate, I'd wanted to be a ballerina. But since then I've gone through a thousand different stages: I wanted to be an astronaut. I wanted to be a paleontologist. I wanted to be a backup singer for Aretha Franklin, a member of the Cabinet, a Yellowstone National Park ranger. Now, based on the day, I sometimes want to be a microsurgeon, a poet, a ghost hunter.

  Only one thing's a constant. "Ten years from now," I say, "I'd like to be Kate's sister."

  BRIAN

  MY BEEPER GOES OFF just as Kate starts another course of dialysis. An MVA, two cars, with Pl-a motor vehicle accident with injuries. 'They need me," I tell Sara. 'You'll be okay?"

  The ambulance is headed to the corner of Eddy and Fountain, a bad intersection to begin with, rendered worse by this weather. By the time I arrive, the cops have blocked off the area. It's a T-bone: the two vehicles rammed together by sheer force into a conglomerate of twisted steel. The truck made out better; the smaller BMW is literally bent like a smile around its front end. I get out of the car and into the pouring rain, find the first policeman I can. "Three injured," he says. "One's already en route."

  I find Red working the Jaws of Life, trying to cut through the driver's side of the second car to get to the victims. "What have you got?" I shout over the sirens.

  "First driver went through the windshield," he yells back. "Caesar took her in the ambulance. The second ambulance is on its way. There are two people in here, from what I can see, but both doors are accordions."

  "Let me see if I can crawl over the top of the truck." I start to work my way up the slick metal and shattered glass. My foot goes through a hole I couldn't see in the flatbed, and I curse and try to get myself untangled. With careful movements I pull myself into the pleated cab of the truck, maneuver myself forward. The driver must have flown out the windshield over the height of the little BMW; the entire front end of the Ford-150 has plowed through the sports car's passenger side, as if it were made of paper.

  I have to crawl out what was the window of the truck, because the engine is between me and whoever's inside the BMW. But if I twist myself a certain way, there is a tiny space where I can nearly fit myself, one that puts me up against the tempered glass, spiderweb-shattered, stained red with blood. And just as Red forces the driver's side door free with the Jaws and a dog comes whimpering out, I realize that the face pressed up against the other side of the broken window is Anna's.

  "Get them out," I yell, "get them out now!" I do not know how I force myself back out of this snarled skeleton to knock Red out of the way; how I unhook Campbell Alexander from his seat belt and drag him to lay in the street with the rain pelting around him; how I reach inside to where my daughter is still and wide-eyed, strapped into her belt the way she is supposed to be and Jesus God no.

  Paulie comes out of nowhere and lays his hands on her and before I know what I'm doing I deck him, sending him sprawling. "Fuck, Brian," he says, holding his jaw.

  "It's Anna. Paulie, it's Anna."

  When they understand, they try to hold me back and do this work for me, but it is my baby, my baby, and I am having none of it. I get her onto a backboard and strap her down, let them load her onto the ambulance. I tip back the bottom of her chin, ready to intubate, but see the little scar she got from falling on Jesse's ice skate, and fall apart. Red moves me aside and does it instead, then takes her pulse. "It's weak, Cap," he says, "but it's there."

  He puts in an IV line while I pick up the radio and call in our ETA. 'Thirteen-year-old female, MVA, severe closed head injury…" When the cardiac monitor b
lanks out, I drop the receiver and start CPR. "Get the paddles," I order, and I pull open Anna's shirt, cut through the lace of the bra she wanted so badly but doesn't need. Red shocks her, and gets the pulse back, bradycardia with ventricular escape beats.

  We bag her and put in an IV. Paulie screams into the loading zone for ambulances and throws open the back doors. On the trailer, Anna is immobile. Red grabs my arm, hard. "Don't think about it," he says, and he takes the head of Anna's stretcher and rushes her into the ER.

  They will not let me into the trauma room. A flock of firefighters dribble in for support. One of them goes up to get Sara, who arrives frantic. "Where is she? What happened?"

  "A car accident," I manage. "I didn't know who it was until I got there." My eyes fill up. Do I tell her that she is not breathing independently? Do I tell her that the EKG flatlined? Do I tell her that I have spent the past few minutes questioning every single thing I did on that call, from the way I crawled over the truck to the moment I pulled her from the wreckage, certain that my emotion compromised what should have been done, what could have been done?

  At that moment I hear Campbell Alexander, and the sound of something being thrown against a wall. "Goddammit," he says. "Just tell me whether or not she was brought here!"

  He bursts out of the doorway of another trauma room, his arm in a cast, his clothes bloodied. The dog, limping, is at his side. Immediately, Campbell's eyes home in on mine. "Where's Anna?" he asks.