Anna is not sick, but she might as well be. By age thirteen,she has undergone countless surgeries, transfusions, and shots so that her older sister, Kate, can somehow fight the leukemia that has plagued her since childhood. The product of preimplantation genetic diagnosis, Anna was conceived as a bone marrow match for Kate -- a life and a role that she has never challenged...until now. Like most teenagers, Anna is beginning to question who she truly is. But unlike most teenagers, she has always been defined in terms of her sister -- and so Anna makes a decision that for most would be unthinkable, a decision that will tear her family apart and have perhaps fatal consequences for the sister she loves.
Told from multiple points of view, My Sister's Keeper examines what it means to be a good parent, a good sister, a good person. Is it morally correct to do whatever it takes to save a child's life, even if that means infringing upon the rights of another? Is it worth trying to discover who you really are, if that quest makes you like yourself less? Should you follow your own heart, or let others lead you? What happens when emotion catches up to scientific advances?
I've read a few places that when Jodi Picoult is thinking about what to write next she likes to ask the question "What if?". On her website, she talked about the inspiration for this story, and part of it was about a family who did have a child so that they could harvest the cord blood for their sick child. Her question then was "What if the elder child ever goes out of remission?" Another what if question could be "What if a family becomes so focused on one child that they lose sight of the others?".
The use of Anna as a place to harvest required components to help fight her older sister Kate's cancer started from before she was even born. Anna's embryo was chosen because she was an exact match for Kate, and when she was born, the cord blood from the umbilical cord was used straight away as a treatment for Kate, who then went into remission. However each time that Kate went out of remission, there were more medical procedures for Anna, painful bone marrow extractions, blood donations. Anna could not go to hockey camps, for example, in case she was too far away when Kate needed her. The year that Anna turns 13, Kate's kidneys give out after years of treatments, chemotherapy, arsenic injections, and the only way that she will survive this last health crisis is if she gets a kidney transplant. Yes, she could go on the transplant list, however, why wait when you have a perfect kidney just waiting to be harvested from your bred for the purpose sibling. It is just expected that Anna will go along with the plan, so when she hires a lawyer in order to lodge a suit so that she can be medically emancipated from her parents everyone is shocked. In other words they do not have the last say in what medical procedures are performed on her - Anna wants a chance to choose what happens to her.
Told from a variety of viewpoints, and including flashbacks to key events during Kate's illness, this is not only a book about the medical history and procedures, or the legal and ethical questions such a situation raises (interesting as those questions are), it is also a book about what happens to a family that is always under extreme pressure, always focused mainly on one member.
Kate and Anna are not the only children of Brian and Sara Fitzgerald. There is also Jesse, elder brother to the girls, and quite frankly, juvenile delinquent. Jesse is on drugs, an arsonist who is setting fires in mostly abandoned buildings, yet it is not difficult to understand why Jesse is the way he is. From the time he was a young child, he has practically become invisible to his family as they lurch from one medical emergency to the next. Whilst Anna feels invisible as far as what she wants is concerned, Jesse is it seems completely dissociated with the things going on, not because he doesn't love his sister, but because he is not personally required to be involved in the same way that Kate and Anna are. It really is no wonder that he will go to such extremes to get attention, and yet that still isn't enough because more often than not people make allowances for him because he is from the family with that sick girl.
Brian works for the Fire Brigade, saving people from burning buildings, attending accidents, cutting people from car wrecks. Whilst Brian is trying to deal with the illness of his elder daughter and the lawsuit, he also trying to figure out who the arsonist is that knows so much about setting fires to cause maximum damage. I liked Brian. He seems to be a man who is trying his best to keep his family together, I think knowing full well that in order for them to move forward they may need to give up the fight for at least one of them. Sara, his wife, used to be a lawyer before she became a mother, and for me, seems to have if not forgotten that her other children have needs, at least chooses to ignore that fact a lot of the time. Sara makes a lot of mistakes and yet as a mother I don't see that there is a lot of room for her to do otherwise. Yes she makes bad choices, but she really wanted to have her daughter Kate around - well and happy, and THEN she would have time for her other daughter (she appears to have completely given up on Jesse). With the events at the end of the book, it is clear that this is something that she will have to regret for the rest of her life.
One interesting thing about the varying viewpoints is that we never actually hear anything from one of the central characters in the book, that being Kate. The whole story revolves around her illness and her treatment, and yet it is like she is the centre of a tropical storm, the maelstrom goes on around her, caused by her, but without her participation.
If it sounds as though this book is a heavy read, it is, and yet Picoult manages moments of levity, particularly through the character of the lawyer Campbell, and less directly through Julia, the court appointed guardian ad litem. Her role is to take note of all the circumstances in the case and then to ensure that Anna gets what is best for her as far as the case is concerned, which if you are only taken Anna's situation into consideration would seem to be that she keeps both kidneys, yet it isn't straight forward because Anna and Kate have an incredibly strong bond. It is also difficult to measure because Anna still lives at home with her parents who could be putting pressure on her in relation to the lawsuit, yet it would not be the right thing to remove her from her home either. Julia and Campbell have a past, one that didn't end well, and they are carrying a LOT of emotional baggage around with them, but things have changed over the years for both of them as well. For one, Campbell has a service dog, but no one seems to know exactly what it is for, and if you were to ask him what it is for, you could get any number of different answers.
And how do we get closure in a story like this? Well, I can't help but think that it wasn't easy. It wasn't easy to read. I lay in bed reading the last couple of chapters crying my eyes out, sobbing so hard that my chest hurt. Was I emotionally involved with this story. You bet I was!
Before finishing this review, I want to say something about oncology nurses. My sister is an oncology nurse, and I have met a few others through her. I do not know how they do this job and stay sane. I could not ever be any kind of nurse. I have the weakest stomach of anyone I know (won't even have a dog because the thought of cleaning up after them makes me want to throw up) and yet they go to work and deal with the aftermath of the chemo treatments, vomiting, diarrhea, warring families and the like. We don't often talk about the messy aspects of her work although sometimes we do talk about the patients that have affected her, partially because it gives a chance for her to have a break, and because she knows how weak I really am, but when I found this quote in the book I really wanted to spotlight it in honour of my sister and her colleagues, and all the other nurses out there who often don't seem to be rewarded or recognised enough for what they do:
An oncology ward is a battlefield, and there are definite hierachies of command. The patients, they're the ones doing the tour of duty. The doctors breeze in and out like conquering heroes, but they need to read your child's chart to remember where they've left off from the previous visit. It is the nurses who are the seasoned sergeants - the ones who are there when your baby is shaking with such a high fever she needs to be bathed in ice, the ones who can teach you how to flush a central venous catheter, or suggest which patient floor kitchens might still have Popsicles left to be stolen, or tell you which dry cleaners know how to remove the stains of blood and chemotherapy from clothing. The nurses know the name of your daughter's stuffed walrus and show her how to make tissue paper flowers to twist around her IV stand. The doctors may be mapping out the war games but it is the nurses who make the conflict bearable.
To the nurses out there. Thanks for everything you do.
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The Inside Cover