My Sister's Keeper

A thirteen-year-old girl walks into a pawn shop. She's small for her age, with money she's saved for weeks—roughly one hundred and thirty-seven dollars. In her hand, she holds a gold locket. Her father gave it to her after a bone marrow donation when she was five years old. The pawnbroker offers twenty dollars. The locket is worth more, but the girl doesn't argue. She needs the money for something more important.

Her name is Anna Fitzgerald. And she's about to hire a lawyer to sue her parents.

This is where Jodi Picoult's novel My Sister's Keeper begins—not with a courtroom speech or a dramatic hospital scene, but with a child selling a gift from her father in a desperate attempt to take control of her own body.

Anna was born for a specific purpose. When her older sister Kate was diagnosed with acute promyelocytic leukemia at age two, Anna's parents made a decision that would shape their family forever. They consulted a geneticist and conceived a child who would be a perfect genetic match for Kate. That child was Anna. From the moment of her birth, Anna's umbilical cord blood was used to give Kate a transplant that put her into remission for five years.

But remission isn't a cure. When Kate's cancer returned at age eight, Anna became a living donor bank—leukocytes, growth factor shots, bone marrow aspirations, all performed without her consent. She was a child, and children don't get to choose.

Now, at thirteen, Kate is in kidney failure. Her parents want Anna to donate one of her kidneys.

The problem with donating a kidney is that it's not like donating blood. You can live with one kidney, but the surgery carries risks. You have to give up contact sports. You have to live knowing that if something happens to your remaining kidney, you'll be the one waiting for a transplant. For Anna, who loves hockey, this isn't a small sacrifice.

But the real issue isn't hockey. It's choice.

Anna has never been asked. Not once. Her parents have simply assumed that her body belongs to Kate, that her purpose is to keep her sister alive. And for thirteen years, Anna has gone along with it. She's endured needles and surgeries and recovery rooms, all while watching her mother's attention follow Kate from hospital bed to hospital bed.

The novel begins with Anna taking a step that no thirteen-year-old should have to take. She walks into a lawyer's office—Campbell Alexander, a man she's chosen from the phone book—and tells him she wants to sue her parents for the rights to her own body. Campbell dismisses her at first, assuming she's a typical teenager with a typical complaint. But Anna doesn't back down. She explains the situation clearly, without self-pity. She's been donating her body to her sister since birth. Now she wants the legal right to say no.

Campbell agrees to take her case. He refuses her money.

The petition for medical emancipation lands on Sara Fitzgerald like a bomb. Sara is Anna and Kate's mother, a former lawyer who gave up her career to raise her children. She's also a woman who made a promise the night Kate was diagnosed: she would not let her daughter die. That promise has driven every decision she's made for fourteen years. It's why she conceived Anna. It's why she pushed for every treatment, every procedure, every experimental therapy. It's why she can't understand how Anna could possibly refuse to donate a kidney.

To Sara, the math is simple. Kate will die without a transplant. Anna can save her. There is no other option.

But the novel asks a harder question: does Anna have to be the one to save her?

This is the central dilemma of My Sister's Keeper. It's a story about a family pushed to its breaking point by a child's illness. It's about a mother's fierce, almost desperate love for a dying daughter. It's about a father caught between his wife and his children. It's about a brother who feels invisible, acting out in dangerous ways to get attention. And it's about two sisters—one who wants to live, one who wants to give her sister the choice to die.

The novel unfolds over a single week, from the day Anna files her petition to the day Judge DeSalvo delivers his verdict. But within that week, Picoult weaves flashbacks that span thirteen years, showing us how this family arrived at this impossible moment. We see Kate's diagnosis, the brutal rounds of chemotherapy, the bone marrow transplant that gave her five more years. We see Anna's first donation at age five, the growth factor shots that made her bones ache, the pain of recovery while her mother stayed by Kate's side. We see Jesse, the oldest child, slowly disappearing into the background until his only way of being seen is to set fires.

The novel doesn't take sides. It doesn't tell us what's right or wrong. Instead, it gives us the perspectives of every character—Anna, Sara, Brian, Jesse, Campbell, and even Kate herself—and lets us sit with the impossible choices they all face.

Anna's lawsuit fractures her family. Her mother fights her in court. Her father initially supports her, then changes his mind on the witness stand. Her brother watches from the sidelines, carrying his own guilt about not being able to save Kate. The only person who seems to understand Anna's fight is Campbell, a lawyer with a secret of his own—a service dog named Judge who follows him everywhere, and a medical condition that he's spent years hiding.

As the trial unfolds, the question becomes more complicated than whether Anna should donate a kidney. It becomes about who has the right to decide. Is it Anna, who has spent her entire life giving? Is it Sara, who has spent every waking hour fighting for Kate's survival? Or is there no right answer at all—only a series of impossible choices between two children who both deserve to live?

The novel forces us to confront a question that has no easy answer: When one child's life depends on another child's body, where do we draw the line?