MY SISTER'S KEEPER
By Jodi Picoult
Atria. 423 pp. $25
A few years ago the BBC reported that a British couple wanted to create the United Kingdom's first "designer baby," one whose umbilical-cord stem cells could be used to treat an older brother with a life-threatening blood disorder. The news reopened controversy on both sides of the Atlantic and raised a series of sobering questions. Is the deliberate selection of an embryo as a tissue match for a terminally ill child ethical? How would a child feel, knowing he was conceived for the sole purpose of saving his sibling's life? What would happen if the ailing sibling required future medical treatments or transplants? Where would a donor's own rights begin and his responsibility end?
Leave it to Jodi Picoult to jump into the fray. Picoult is known for writing fictional page-turners that address controversial issues, and her latest novel is no exception. My Sister's Keeper tells the story of a feisty 13-year-old, Anna Fitzgerald, who was conceived to save her sister Kate's life. Over the years, Anna dutifully serves as her sister's donor, providing Kate, who has leukemia, with stem cells, blood and bone marrow. But when Kate's organs begin to fail and Anna's parents expect her to donate a kidney, she balks. Fed up with spending time in the hospital for medical procedures that are not in her best interest or for her benefit, and tired of living in her sister's shadow, Anna decides to sue her parents for "medical emancipation," or the right to make decisions about her own body.
Denying Kate a kidney, Anna knows, will lead to her death. But why should she submit to major abdominal surgery and have to make do with only one kidney? On the other hand, what kind of monster would let her sister die? Picoult explores the emotional, legal and moral dimensions of Anna's dilemma from alternating perspectives -- Anna's, her parents', her brother's, her lawyer's, her guardian's -- giving considered balance to both sides of the lawsuit. The novel's shifting points of view also help to add depth to a cast of characters who would otherwise seem rather thinly drawn. Without this device, Anna's mother could become a one-sided study in shrill desperation, and Anna's lawyer, Campbell, could be mistaken for a base egomaniac.
In fact, Campbell emerges as the most appealing of the lot. A good old boy who never grew up, he is a scene stealer and a sarcastic wit. He's also a tough nut to crack. Campbell is a closet epileptic, and he steers conversation partners away from registering his condition by deflecting questions about his seizure-alert dog with tall tales: "I have an iron lung . . . and the dog keeps me from getting too close to magnets;" "I have Ebola . . . he's tallying the people I infect;" "I have an irregular heartbeat and he's CPR certified;" "He translates for my Spanish-speaking clients;" "He chases ambulances for me."
Campbell also figures in an entertaining subplot, a romance with Anna's court-appointed guardian, Julia, Campbell's high-school sweetheart. Julia, a persuasive do-gooder, is as serious as Campbell is frivolous. She's useful, too -- from her position as a children's advocate, she can isolate the crux of the case in a way the others, too close to the action, cannot: "Traditionally, parents make decisions for a child, because presumably they are looking out for his or her best interests. But if they are blinded, instead, by the best interests of another one of their children, the system breaks down. And somewhere, underneath all the rubble, are casualties like Anna." Picoult's other characters are less convincing. Anna's gentle father, Brian, a fire-fighting hero and armchair astronomer, is almost too good to be true, and Picoult stretches noticeably to make both his job and his hobby symbolically relevant to the story. Anna's brother, Jesse, is a poster child for self-destructive behavior. Kate, finally, is as weak and wispy on the page as she's supposed to be in life.
Picoult is at her best, and most moving, when writing from the perspective of Anna's mother, Sara. Exhausted by Kate's recurrent illness, Sara is often on edge and overwhelmed. But she is also focused: Her tenacity, her vigilance and her support during Kate's aggressive cancer treatments all give Kate a reason to live. Mothering takes on new meaning, and the mundane becomes surreal: Kate's goldfish, according to the oceanologist Sara consults in a desperate effort to save the pet's life, requires bottled water, and the mere thought of buying Jesse a new pair of soccer cleats after Kate relapses seems "downright obscene."
Picoult uses the present tense throughout the novel, which lends an appropriate breathlessness to the narrative -- after all, Kate doesn't have long to live -- and encourages the reader to charge eagerly through the story. Unfortunately, the characters themselves are overwhelmed by the galloping pace. Indeed, it is not Anna, her parents, or even Campbell, but a bittersweet turn of events -- one last plot twist, a surprise ending -- that solves the dilemma at hand.
Nevertheless, My Sister's Keeper is a thrill to read, and it winds up asking a final, important question: Can a child born to save another ever really be free? Babies selected for certain characteristics, like Anna, are predestined to be tied indefinitely to the circumstances of their birth, and to their parents and their siblings in need. Aren't they? •
Katherine Arie, a former staff editor of the Atlantic Monthly and fiction editor of Atlantic Unbound, is a writer based in London.
