''My Sister's Keeper'' (2004) is the eleventh novel by the American author
Jodi Picoult
Jodi Lynn Picoult () is an American writer. Picoult has published 28 novels, accompanying short stories, and has also written several issues of Wonder Woman. Approximately 40 million copies of her books are in print worldwide, translated into 34 ...
. It tells the story of thirteen-year-old Anna Fitzgerald, who sues her parents for
medical emancipation
The mature minor doctrine is a rule of law found in the United States and Canada accepting that an unemancipated minor patient may possess the maturity to choose or reject a particular health care treatment, sometimes without the knowledge or ...
when she is told to donate a
kidney
The kidneys are two reddish-brown bean-shaped organs found in vertebrates. They are located on the left and right in the retroperitoneal space, and in adult humans are about in length. They receive blood from the paired renal arteries; blood ...
to her elder sister Kate, who is gradually dying from
acute leukemia
Acute leukemia or acute leukaemia is a family of serious medical conditions relating to an original diagnosis of leukemia. In most cases, these can be classified according to the lineage, myeloid or lymphoid, of the malignant cells that grow uncon ...
.
Summary
The story takes place in the fictional town of Upper Darby,
Rhode Island
Rhode Island (, like ''road'') is a U.S. state, state in the New England region of the Northeastern United States. It is the List of U.S. states by area, smallest U.S. state by area and the List of states and territories of the United States ...
in 2004. Anna Fitzgerald's older sister, Kate, suffers from
acute promyelocytic leukemia
Acute promyelocytic leukemia (APML, APL) is a subtype of acute myeloid leukemia (AML), a cancer of the white blood cells. In APL, there is an abnormal accumulation of immature granulocytes called promyelocytes. The disease is characterized by a ...
, a blood and bone marrow cancer. Anna was born as a
savior sister specifically so she could save Kate's life through the donation of her umbilical cord blood. At first it is successful, but the cancer continues to relapse throughout Kate's life.
Anna is usually willing to donate whatever Kate needs, but when she turns 13, she is told that she will have to donate one of her
kidney
The kidneys are two reddish-brown bean-shaped organs found in vertebrates. They are located on the left and right in the retroperitoneal space, and in adult humans are about in length. They receive blood from the paired renal arteries; blood ...
s due to Kate's kidney failure. The surgery required for both Kate and Anna would be major; it is not guaranteed to work, as the stress of the operation may kill Kate anyway, and the loss of a kidney could have a serious impact on Anna's life. Since Anna is fond of
hockey
Hockey is a term used to denote a family of various types of both summer and winter team sports which originated on either an outdoor field, sheet of ice, or dry floor such as in a gymnasium. While these sports vary in specific rules, numbers o ...
, Anna petitions for medical emancipation with the help of lawyer Campbell Alexander, so she will be able to make her own decisions regarding her medical treatment and the donation of her kidney.
At first Sara, their mother, believes that Anna's decision is led by a simple need of attention, but Anna is serious and refuses to withdraw her complaint, so the case has to be discussed in front of a judge. Having been a civil attorney before becoming a mother, Sara decides to represent herself. The judge assigned to the case is Judge De Salvo, who the year before lost his twelve-year-old daughter because of a drunk driver.
Recognizing that it is impossible for Anna and Sara to be together during the trial, Judge De Salvo hires Julia Romano, the court-appointed
guardian ad litem
A legal guardian is a person who has been appointed by a court or otherwise has the legal authority (and the corresponding duty) to make decisions relevant to the personal and property interests of another person who is deemed incompetent, call ...
whose job it is to decide what would be best for Anna. Julia was once romantically involved with Campbell when they went to high school together, but Campbell broke her heart when he left her. Unbeknownst to Julia, Campbell left her because, after an accident that resulted in a
concussion
A concussion, also known as a mild traumatic brain injury (mTBI), is a head injury that temporarily affects brain functioning. Symptoms may include loss of consciousness (LOC); memory loss; headaches; difficulty with thinking, concentration, ...
, he developed
epilepsy
Epilepsy is a group of non-communicable neurological disorders characterized by recurrent epileptic seizures. Epileptic seizures can vary from brief and nearly undetectable periods to long periods of vigorous shaking due to abnormal electrical ...
and thought she deserved better.
Meanwhile, Anna's older brother, Jesse, who has spent most of his life being ignored in favor of ill Kate or donor Anna, spends most of his time setting fire to abandoned buildings with homemade explosives and using illegal drugs. He is a self-confessed
juvenile delinquent
Juvenile delinquency, also known as juvenile offending, is the act of participating in unlawful behavior as a minor or individual younger than the statutory age of majority. In the United States of America, a juvenile delinquent is a person ...
, which leads to their father Brian eventually confronting Jesse for his behavior.
During the trial, it is revealed that Anna is acting under her sister's wishes: Kate is tired of living; she's prepared to die and doesn't want to force Anna to donate a kidney that will likely not be adequate to save her life, so she encouraged Anna to gain the independence that has always been denied to her. As Anna stands up to testify, Campbell Alexander has an epileptic seizure and, thanks to this, Julia discovers the reason of their breakup, leading her to swear to Campbell that he doesn't need to hide his illness from her, and that they can be together. The judge rules in Anna's favor, and grants Campbell a medical
power of attorney
A power of attorney (POA) or letter of attorney is a written authorization to represent or act on another's behalf in private affairs (which may be financial or regarding health and welfare), business, or some other legal matter. The person auth ...
. After gaining medical emancipation, Anna hints that she plans to donate her kidney to Kate, wanting her sister to live. However, as Campbell drives her home after the trial, their car is t-boned by a truck. The on-call
firefighter
A firefighter is a first responder and rescuer extensively trained in firefighting, primarily to extinguish hazardous fires that threaten life, property, and the environment as well as to rescue people and in some cases or jurisdictions also ...
, who happens to be Brian, arrives at the scene, retrieving an unconscious and severely injured Anna from the wreckage of the crushed car.
At the hospital, the doctor informs Sara and Brian that Anna is
brain-dead
Brain death is the permanent, irreversible, and complete loss of brain activity, brain function which may include cessation of involuntary activity necessary to sustain life. It differs from persistent vegetative state, in which the person is al ...
and says that they will need to act quickly if they wish to donate her organs. An injured Campbell approves the procedure and Kate's life is saved. Sara and Brian are devastated and struggle to cope for the next eight years after Anna's life support machines are shut off. During this time, Jesse becomes a police officer and Kate becomes a ballet teacher. Kate ends the story by reflecting on the tragedy and explaining that she feels deep guilt but also a bond with the part of Anna inside of her.
Characters
*Kate Fitzgerald - A frail teenage girl who was diagnosed with
promyelocytic leukemia at a young age. She is the older sister of Anna, and the
middle child
"Middle Child" (stylized in all caps) is a song by American rapper J. Cole. The song was released on January 23, 2019, through Dreamville Records, Roc Nation and Interscope Records, as the first single from Dreamville's 2019 compilation album, '' ...
out of all three Fitzgerald siblings. She sometimes finds all the attention on her stifling. One of the few times that Kate experiences being a typical teenaged girl is when she dates, and has her first kiss with a boy named Taylor. Kate supports the feelings of her younger sister, Anna, and is thankful for the bodily donations Anna has been made to give her throughout her lifetime. At the end of the novel, Kate is revealed to be the one who asked Anna to sue for medical emancipation, because, fed up with the awareness of how much she took from her and the rest of their family, she wanted, for once, to be the sister who protected the other one.
*Andromeda "Anna" Fitzgerald - A girl who was biologically engineered in order to be a "
savior sibling
A savior baby or savior sibling is a child who is conceived in order to provide a stem cell transplant to a sibling that is affected with a fatal disease, such as cancer or Fanconi anemia, that can best be treated by hematopoietic stem cell transp ...
" to her elder sister, Kate. At first Anna was only meant to donate her umbilical cord, but in response to Kate's relapses, Anna repeatedly donates blood, marrow, and eventually, an organ to her. She is thirteen years old at the time the novel takes place, and seeks to be
medically emancipated from her parents. She believes that this legal support is necessary to help her resist the growing pressure on her to donate a kidney. She is the main protagonist of the novel.
*Jesse Fitzgerald - The oldest Fitzgerald child. Throughout most of the novel, he is a delinquent teenager, but eventually reforms after a confrontation with his father.
*Sara Fitzgerald - The controlling mother of Kate, Anna, and Jesse. She tries her hardest to keep her oldest, ill, daughter alive and well. Sara refuses to accept the idea that Kate is likely to die, and in doing so she neglects the needs of her two other children, whom she keeps seeing in relation to Kate. Before the novel's end, Sara finally listens to Anna about Kate and comes to terms with her choice to die, expressing remorse for her behavior.
*Brian Fitzgerald - Sara's husband, who understands Anna's decision to not donate her kidney, but also feels compassion for his wife. He is fond of astronomy and becomes torn between his daughters, and his wife, during Anna's emancipation trial. Ultimately, Brian sides with his wife during his testimony in court, regardless of his conflicting feelings. He also shows concern for his son, and is the one to confront him about his troubling behavior. After Anna's death, he too needs a lot of time to cope with it.
*Julia Romano - The court-appointed,
guardian ad litem
A legal guardian is a person who has been appointed by a court or otherwise has the legal authority (and the corresponding duty) to make decisions relevant to the personal and property interests of another person who is deemed incompetent, call ...
, whose job it is to decide what is best for Anna. She also often advises Anna regarding medical emancipation. She and Anna's lawyer, Campbell Alexander, dated in young adulthood, before he left her without explaining why.
*Campbell Alexander - The lawyer who defends Anna as she tries to become medically emancipated from her parents. He believes that she should have control over her own body, and eventually obtains medical
power of attorney
A power of attorney (POA) or letter of attorney is a written authorization to represent or act on another's behalf in private affairs (which may be financial or regarding health and welfare), business, or some other legal matter. The person auth ...
over her, when the case is successful. He personally uses a service dog, which others find mysterious, because he does not tell anyone why. It is later uncovered that Campbell suffers from
epilepsy
Epilepsy is a group of non-communicable neurological disorders characterized by recurrent epileptic seizures. Epileptic seizures can vary from brief and nearly undetectable periods to long periods of vigorous shaking due to abnormal electrical ...
, and that this diagnosis is the reason he broke up with Julia, as he did not believe she "deserved" an unwell mate, that she'd have to look after.
*Suzanne - Jesse, Kate and Anna's wealthy aunt, Brian's sister-in-law and Sara's older sister of 10 years. Their relationship is strained due to her overzealousness in keeping Kate alive. Unlike Brian, Suzanne shows more support for Anna, even explaining how disappointed she is in Sara for how she treated both her daughters.
*Dr. Harrison Chance - Kate's oncologist.
*Judge DeSalvo - The presiding judge over Anna's medical emancipation case.
*Isobel "Izzy" Romano - Julia's twin sister and roommate. She is a jewelry designer and she is fresh from a relationship with another woman named Janet. She is very close to her sister and as such despises Campbell for having left Julia.
*Taylor Ambrose - Kate's boyfriend. He is diagnosed with
myeloid leukemia
Myeloid leukemia is a type of leukemia affecting myeloid tissue.
Types include:
* Acute myeloid leukemia
* Chronic myelogenous leukemia
* Acute megakaryoblastic leukemia
* Blastic plasmacytoid dendritic cell neoplasm
See also
* Hematological m ...
and meets her at the hospital while undergoing
chemotherapy
Chemotherapy (often abbreviated to chemo and sometimes CTX or CTx) is a type of cancer treatment that uses one or more anti-cancer drugs (chemotherapeutic agents or alkylating agents) as part of a standardized chemotherapy regimen. Chemotherap ...
. Kate has some of her happiest times with him, as he's one of the only people with whom she's been able to fully relate. After they go to a prom, Kate comes to believe that Taylor has ceased contact with her. She becomes estranged from her mother after learning the truth, which is that Sara learned about Taylor's death and concealed it from Kate, fearing that the grief would rob Kate of the will to live.
Development history
Publication history
Picoult, Jodi. ''My Sister's Keeper.'' Atria Books: New York, 2004; /.
Critical reception
In review for ''
The Washington Post
''The Washington Post'' (also known as the ''Post'' and, informally, ''WaPo'') is an American daily newspaper published in Washington, D.C. It is the most widely circulated newspaper within the Washington metropolitan area and has a large nati ...
'', Katherine Arie described some of the characters as unconvincing, such as Brian, who is "too good to be true", Jesse, "a poster child for self-destructive behavior", and Kate, who is "as weak and wispy on the page as she's supposed to be in life", but ultimately called the book "a thrill to read".
In 2009 the
American Library Association
The American Library Association (ALA) is a nonprofit organization based in the United States that promotes libraries and library education internationally. It is the oldest and largest library association in the world, with 49,727 members a ...
(ALA) and the office for Intellectual Freedom named ''My Sister's Keeper'' the seventh out of ten most frequently challenged books in the US. Schools and libraries attempted to
ban the book due to its mature themes.
Adaptations
New Line Cinema
New Line Cinema is an American film production studio owned by Warner Bros. Discovery and is a film label of Warner Bros. It was founded in 1967 by Robert Shaye as an independent film distribution company; later becoming a film studio after acq ...
adapted
''My Sister's Keeper'' into a feature film, which was directed by
Nick Cassavetes
Nicholas David Rowland Cassavetes (born May 21, 1959) is an American actor, director, and writer. He has directed such films as ''She's So Lovely'' (1997), ''John Q.'' (2002), ''The Notebook'' (2004), '' Alpha Dog'' (2006), and '' My Sister's Kee ...
and released on June 26, 2009.
It starred
Cameron Diaz
Cameron Michelle Diaz (born August 30, 1972) is an American actress. With a variety of works in film, she is widely recognised for her work in romantic comedies and animation. Diaz has received various accolades, including nominations for ...
as Sara and
Alec Baldwin
Alexander Rae Baldwin III (born April 3, 1958) is an American actor, comedian, and producer. In his early career, Baldwin played both leading and supporting roles in a variety of films such as Tim Burton's ''Beetlejuice'' (1988), Mike Nichol ...
as Campbell. Kate and Anna were played respectively by
Sofia Vassilieva
Sofia Vladimirovna Vassilieva (born October 22, 1992) is an American actress. Notable roles include portraying the children's book character Eloise in ''Eloise at the Plaza'' and ''Eloise at Christmastime'', Ariel DuBois in the Emmy-winning TV ...
and
Abigail Breslin
Abigail Kathleen Breslin (born April 14, 1996) is an American actress. She rose to prominence with the comedy-drama film '' Little Miss Sunshine'' (2006), for which she received a nomination for the Academy Award for Best Supporting Actress at ...
.
[
The film features an alternate ending and more emphasis on certain subplots while entirely eliminating others. This was against the wishes of Picoult.
]
References
External links
''My Sister's Keeper'' at the author's site
{{Organ transplantation in fiction
2004 American novels
American novels adapted into films
Medical ethics in fiction
Novels about cancer
Novels about siblings
Novels by Jodi Picoult
Novels set in Rhode Island
Atria Publishing Group books