My Sister's Keeper is perhaps the most widely read of Jodi Picoult's books: ask anyone in a book club, and they will probably tell you they have read it. Most will also tell you it is a heart breaker.
In short, this is the story of Kate, diagnosed with leukemia at age 2, and her younger sister Anna who was conceived to be a genetic match so she could give Kate the cord blood to help combat the disease. Of course, that is not enough, and Anna is asked to donate more and more: platelets, granulocytes, bone marrow, and finally a kidney. It is at this point that Anna finds a lawyer and sues for medical emancipation from her parents.
The book follows the entire family, letting each major character present part of the story in first person: the mother, Sara; the father Brian; the oldest child Jesse; Anna; her attorney Campbell; and her guardian ad litem Julia. Only at the very end of the book does Kate speak.
Sara is a former attorney who invests herself heavily in Kate's medical care. Through her tough and relentless crusading, Kate has lived to be 16, kissed a boy, gone to her first prom; all things that were first thought to be impossible. Her initial diagnosis predicted she would not live past 7. Sara will not give up, and in her single minded search for the next therapy, she has become absent from the rest of the family.
Brian is a firefighter, who watches fires and sees the way they burn as a metaphor for the way his family has reacted to the overwhelming nature of Kate's illness. Jesse is 18, and a stereotypical juvenile delinquent--drinking, drugging, stealing, setting fire to buildings. He is way too obvious a cliche, really--the child who is ignored entirely because he has nothing to give Kate. There are some hints that Jesse does these things hoping to get caught, and to assuage his guilt at not being able to save Kate, although that isn't really persuasive.
Kate is a cipher, more a list of medical emergencies than a character. Anna is the one who should stand out--she is very brave to take this step to refuse her sister a kidney, and she has the most chapters in her own voice. However, Anna is carefully keeping secrets, and so her personality doesn't really ever come out. In addition, her "voice" is too literary, too adult, to pass convincingly for a 13 year old faced with the kind of pressure she is under.
Campbell and Julia have a shared past that ended badly, and neither has gotten over the other, despite the 15 years since they graduated and broke up. Campbell is a smart ass and abrasive, so he doesn't have to admit to his disability, although he does have a service dog. When asked "Why? You aren't blind?" he has a snarky answer. "I'm red-green color blind. The dog lets me know when the light changes." "I'm a lawyer. He chases ambulances for me."
The Campbell and Julia subplot is pretty superfluous. Even I figured out that the dog was there to sense the onset of epilepsy well before the time it was revealed. That also is the "reason" Campbell broke up with Julia and the "reason" he never contacted her. But she learns of his condition, and so now they are back together again. More interesting is that these two lawyers have interviews with the other characters, which gives them the chance to shed some light on things that wouldn't otherwise come out in first person narration by the characters themselves.
Julia is supposed to interview the family, doctors, etc., and give the judge a recommendation about how to dispose of Anna's petition for medical emancipation. Sara is acting as opposing counsel, which leads to some family tension as well. But none of it rings tremendously true--all the emotions of the family are tamped down, are very politely outlined but nobody ever acts without that kind of "calm cool consideration" that takes the heart out of the story.
Now, I have warned you that I will post spoilers, so if you want to keep the book fresh, do not read on. Because I have to discuss the ending. Which comes in several stages. First, during the hearing, Sara finally hears what the rest of her family have been saying for years: we love Kate too, but you have to pay attention to the rest of us. While cross-examining her husband, they engage in some pretty unbelievable nostalgia and Sara cracks and admits her mistakes. Which was really the only tension in the book--Sara was such a one-dimensional character. All she did was worry about Kate and yell at anyone who complained about anything, because they had it easier than Kate did, so they had no right to complain.
I expected to have great sympathy for Sara--I cannot imagine how hard it is to watch your child die over a decade, but her complete failure to do anything else makes her unsympathetic, and frankly a boring character. We know she is always going to side with Kate on anything, that she will always disappoint the other members of her family. The only character who really needs to grow in any appreciable way is Sara. Her redemption in the courtroom smacks of manipulation and was unbelievable to boot. This is climax #1.
Then Anna testifies. She was willing to donate the kidney, she hardly needed to think about it, because she loves her sister and can't imagine life without her. The big secret she has been keeping is that it was Kate who asked her to do this. Was this because Kate was tired of living this way and wanted to die? Did Kate feel guilty for taking so much away from Anna, and did this to set Anna free? So Anna could live her life without having to be physically close to Kate in case a donation need arose? Not clear. But now we all find Anna isn't selfish or a bad sister, but an Incredibly Superhumanly Wonderful Sister (TM). This is climax #2.
Then the judge rules--there is a lot of talk from the characters about the difference between "moral" and "legal" and "right." Nobody can say what is the right thing to do in this case. Even Julia starts crying and says she doesn't know what to recommend. The judge ends up granting the petition, appointing Campbell to assist Anna in making her own medical decisions. This is climax #3.
We then skip forward 6 months. Anna is signing some papers and Campbell is driving her to the hospital. Brian, Sara and Kate are waiting, Kate is nearly dead. Is this the kidney donation we were allegedly fighting over during the course of the book? It kind of looks like it, but it's not clear. Then, oh noes! Brian gets a call and has to go to an emergency! It's a car accident! It's Anna in the car with Campbell, and she's got a massive head injury!! She is declared brain dead!! Oh, the irony! We never thought we'd lose Anna while we were busy taking care of Kate!!! But now, Kate can have the kidney!! This is climax #4.
We then skip ahead another year. Kate is still alive, and Anna's kidney has not only saved her from fatal renal failure, but has also cured the leukemia. Jesse got caught by Dad as arsonist, turned his life around and now is graduating from police academy. Everybody loves each other, and Anna is their personal angel. The End. (Climax #5, for those still counting.)
And ya know what? Ann Landers wrote this ending about a thousand years ago. Happens all the time: new wife never gets to spend holidays with her family, because husband's mother is so ill and "this may be her last Christmas/Easter/Thanksgiving/Secretary's Day." Then, of course, wife's mom dies unexpectedly, while frail MIL lives to be 206.
So, of course, Kate isn't going to be the one who dies first. Given the circumstances, they all expect her to die first, so they have to be shocked into the realization that you can't ignore the rest of your family, because they aren't safe either. Good thing Sara had her epiphany before Anna kicked the bucket, huh?
Look--it's a competent read, with distinct (if not fully living) characters, an intriguing premise with a human face. It's a decent basis for discussion: what would you do? How do you decide what is in the best interest of your children when their interests are opposed? Do you understand Sara's actions? Do you approve of them? Do sick kids have to eat their vegetables like their healthy siblings?
At the same time, it fails to really breathe life into the characters, and as a result, the process feels manipulated. In the very tone of the writing, you don't fear that Kate is really going to die, or that Anna will really refuse to donate a kidney. Jesse isn't really going to do major harm to himself, his future, or anybody else. Julia and Campbell aren't really going to stay mad at each other, although their "love" is pretty unbelievable too. It's not clear how Picoult is going to land each of her balls, but you really don't feel like there is much at stake in this juggling act.
I wish Picoult had really been able to bring Anna to life: the kind of 13 year old who could begin to do what she did is truly exceptional, but we never see the spark of it in her. I would have mourned her death more if it hadn't been used as such a "shocking plot twist." Kate doesn't get much personality either--she's like a medically accurate Beth March, whose personality is limited to being the kind of person who dies in a novel.
The parents never really came to any kind of explosion between themselves either. I would think this would be the kind of situation that would drive a huge wedge between Sara and Brian, especially once Brian starts to see Anna's point. But they remain civil, and as loving as anybody else in the book, never once showing any cracks in their relationship.
So--a well crafted read, but not an emotionally engaging book. (I insert this caveat: if you have/had a terminally ill person you were close to, you experience will probably be entirely the opposite of mine. I can only say that as fiction, it doesn't show me what I couldn't already imagine about being in that situation--it doesn't reach out and grab me and thrust my face into the cold water of these people's lives. I don't dare make any claims about it for readers with this kind of history of their own.)
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