Book World Live: Bestselling Novelist Jodi Picoult
'Handle With Care'

Jodi Picoult
Friday, March 6, 2009 1:00 PM

"When I was doing my residency in pediatrics... I was awed by the parents of children with chronic diseases... Why were there not novels and movies and ballads to celebrate their love and their determination and their very particular side of the story?

"Well, here's such a novel. It's well written, it's conscientiously researched and, most important, it presents a character who is a child instead of a disability personified." -- From Dr. Perri Klass's Washington Post review of Handle with Care

Bestselling novelist Jodi Picoult is known for stories that blend the drama of relationships with that of legal and medical ethics. She was online Friday, March 6 to discuss her books, including the just-published Handle With Care, which is about a family struggling to deal with their young daughter's rare bone disease. Might it have been better if she had never been born?

A transcript follows.

Join Book World Live each week for a discussion based on a story or review in Book World or in the weekday Style Section.


Jodi Picoult: Hi there, this is Jodi Picoult. Thanks for joining me today during this chat! I am happy to be here talking about HANDLE WITH CARE - my newest novel - which centers around a wrongful birth lawsuit instigated by Charlotte O'Keefe, whose daughter Willow has osteogenesis imperfecta - brittle bone disease. Like many parents with disabled kids, Charlotte is struggling to make ends meet - and a lawsuit that will offer her a payout might be just the help she needs to make sure Willow's taken care of. Willow's OI means she'll have hundreds to thousands of breaks over her lifetime - and much physical impairment - but mentally, she's 100% normal, maybe even smarter than her peers. So when Charlotte gets up in court and says "If I'd known earlier about this condition I would have terminated the pregnancy" her daughter can hear her, and understand her -- even though Charlotte insists that she's only doing it because she loves her daughter. I'm looking forward to your questions!


Washington, D.C.: As a mom who is currently caring for a toddler with a broken leg, I can't imagine caring for a child with breaks ALL THE TIME. I noticed in your foreword you met with these families. Did you sense that they were all always on guard and traumatized? Or did they seem normal?

Jodi Picoult: The parents actually are so calm it's inspiring ! I think they get used to trauma being part of their lives every day, so they don't sweat the small stuff. Some families are more cautious than others - I met parents who wanted their kids to shuffle around on their knees so they wouldn't fall...but I also met parents who told their kids to live their lives to the fullest, and that they'd deal with breaks as they came!


Cherry Hill, N.J.: I am a big fan, Jodi! I love your books. How do you come up with your ideas? Are they from personal experiences?

Jodi Picoult: Thankfully, I don't live the lives of my very sad characters! I think I can write these kinds of stories because I have such a disgustingly happy home life :) The ideas come from What If questions I can't answer - a book is my way of thrashing through all POVs to see why my opinion is what it is.


New York, N.Y.: What do you do to master great writing ability as well as grasping medical and legal issues? I presume you either graduated with a degree in English and then completed medical and law school. Or else you are a terrific researcher. How did you develop such wide knowledge?

Jodi Picoult: I don't have a medical OR a law degree - but when I need that research, I find people who are experts and do looooong interviews, or shadow them for a few days, so that I can write about the characters and their actions with authority.


New York City, N.Y.: Hi Jodi,

I went to your book reading and signing yesterday in the Barnes and Noble Union Square and I wasn't able to ask you my question at the time. I remember you said that your books usually take you about 9 months for you to write. I wanted to know, with 9 months dedicated to writing the book, how do you manage your time, writing the book, researching about the subject and edit the book to your own liking all in enough time to be able to release a new book almost every year?

Jodi Picoult: I don't know -- but for right now, I'm able to manage my time well enough to do it all in that time span. If a book ever took longer to write, I'd let it run its course - I'd never just cram it into 9 months to stay on schedule! I am a big fan of using every minute I've got, and multitasking.


Anonymous: First, I'd like to say I am a fan of your writing and have read all of your books, I even have a small collection of signed copies!

I have often considered contacting you to see if you would write a story on this topic, so I am glad to see you have. I am nervous, though to read it, as I terminated a pregnancy once I learned that my baby girl (in utero) had many medical problems. She would have suffered physically and mentally for her entire life if she were born. Her body would have required multiple operations for years, and we just did not have the resources or a support network we would need. I think about our girl and what our family might be like if she were with us, every day. I still believe I made the right choice for her and for our family -- but it is not a decision we took lightly and it still affects my husband and me daily (and I know it will forever).

I know you work very hard to really understand and communicate what your characters are going through (I had a brother with a terminal illness when we were young children and you got everything perfectly right in "My Sister's Keeper").

THANK YOU for sharing your talent and deep understanding of people and their relationships and inner turmoils. I will read this book -- but I have to admit, I am afraid to face it. I am sure you have written it perfectly.

Jodi Picoult: Thank you so much for sharing your story with me. I think this is a topic that suggests there will be different answers for different families, based on what they feel they can handle. No decision made is ever an easy one, when it comes to a disabled child. I hope that when you read HWC, you find the emotions true to the ones you experienced.


Freising, Germany: Is the act of penitence a common theme amongst your novels? I'm thinking primarily of the opening pages to "Salem Falls" and the quote from "The Crucible": "Is there no good penitence but it be public?". Was "Crime and Punishment" by Dostoevsky ever an influence in your writing?

Jodi Picoult: It's so funny you asked me this question - my son is taking Russian Lit right now in high school and I tell him my brain is a Russian-Lit-Free zone! I don't think I write the same sort of nihilism in Russian Lit - there's more hope in my stories. I wouldn't say it's penitence, necessarily, but redemption that's key: every main character has to wake up to his/her flaws and at least understand that they exist before they can move to the conclusion of the story.


Reston, Va.: A friend of mine's first child had a mild case of OI, and I have no idea how she managed to be as wonderful a mother as she was! Always positive and loving in a situation where I'm pretty sure I'd be bald from pulling my hair out. Her daughter managed to live to about 12.

I look forward to reading your book. I've read several of yours, and appreciate your choice of topicsi and writing skill. It's hard to "love" a book about teen suicide, but I really appreciate your books after reading them. They make me think.

Jodi Picoult: Thanks so much. I know my topics are tough ones, and I really do appreciate the fact that you're all willing to come along for the ride, no matter where I choose to take you!


Boston, Mass.: What made you decide to write a book about this topic?

Jodi Picoult: First off: Go Red Sox :)

I started this topic with a story I read about a woman who had sued for wrongful birth after her child was born with severe mental and physical impairment. I viscerally thought to myself, "Eww, who would stand up in court and say 'I wish my child hadn't been born!'"??? But then I wondered why I had reacted so quickly, and I did some research. Turns out not a single person I met who has sued for wrongful birth wanted to terminate the pregnancy - they LOVE their kids, but they are financially strapped by their disabilities and we all know insurance doesn't do much to help out families in that situation. A lawsuit -and a lie on the witness stand - seems like a small price to pay to make sure your child is taken care of during his/her life, and after you're gone (a very real fear for these parents). I began to wonder what would happen, though, if your child was only physically disabled - not mentally challenged - and could hear you saying "I wish she'd never been born." Even if you said you were doing it because you love her, that's a real mixed message...and hence, Handle With Care was born.


Charlotte, N.C.: Ms Picoult

Your books always seem to have extensive and thorough information about unusual subjects. How did you go about selecting osteogenisis imperfecta for this book and where did you learn so much about what seems to be a very rare disease? Thank you !

Jodi Picoult: I can't really recall where I first heard about OI, but it seemed perfect when I was crafting the idea for the book. After all, it's an illness where kids have severe physical challenges, but mentally, they're often brighter than their peers because when they can't run on the playground, they're reading! I met with lots of OI families when I was researching the book, who allowed me to hang out with their kids in school, on the playground, at home - and to see what life was really like when you faced those challenges daily. To a fault, the OI kids I met are the most amazing group of positive, matter-of-fact kids - they're heroes. I also had the opportunity to talk to Kara Sheridan, a young woman who is currently planning her wedding, getting a graduate degree in psychology, who holds world records in swimming and is a paralympian...and who has severe OI. She's an amazing inspiration and gave me lots of details for the book that I wouldn't otherwise have known. For example, an insurance company willl pay for one new wheelchair for a disabled child once every five years. I don't know about you, but my kids were very different in physique between age 2 and age 7! That's appalling!


Northern Virginia: I am SUCH a huge fan -- your new books always come out right around my birthday and I actually save gift cards from one birthday to the next so I can afford to run out and buy the hardback the first day it's available! My question is: do you ever receive negative feedback concerning any of the sensitive issues about which you write, from families who have actually lived through similar situations? If so, do you respond? Does it weigh heavily on you? I hope you keep writing for a long time -- there are no books I more look forward to or enjoy than yours!

Jodi Picoult: Much more often I hear from families who have faced these issues, who thank me for my sensitivity and for giving them a "voice" in the public. I've heard already from so many people with disabilities, who have written to thank me for HWC. It's always so humbling, and it's a honor to know they took the book the way it was intended: to show that NO ONE is ever the sum of their disabilities; and that if you have a disability, that doesn't mean it has YOU.


Bonaire, Ga.: Did you really write this to explore the question of whether or not abortion is ever acceptable, or did you write it to show the destruction of a friendship, a family, and ultimately the greed that exists in all of us?

Jodi Picoult: I wrote this book to examine the stressors that can break a family apart - even when we think we're doing our best to hold it together. It's not an abortion issue alone - it's about what kind of life is worth living, and who has the right to make that decision: the doctor, the parent, the child itself?

And okay, yeah, I did want to poke a stick into the litigiousness of American society right now! Does money really buy happiness??


Philadelphia, Pa.: Jodi -- Thanks for taking our questions -- I love your books. I just finished "Songs of the Humpback Whales" this week, and I have to say, I was very frustrated with the end! Aah! How could she go back to him? I loved the book, but was left wanting more. How did you envision Jane's future? Do you think she returns to Sam? Have you ever considered a sequel to any of your books? Thanks!

Jodi Picoult: Go reread the'll see who she winds up with. (Remember, the prologue happens LAST chronologically in that book). I don't plan to write sequels, but I do like bringing characters back from time to time!


Woodcliff Lake, N.J.: I just read the interview you gave to The Bergen Record in anticipation of your signing at Bookends in Ridgewood, NJ. Please be aware that the term "was... severely retarded" is offensive to many. It is much more appropriate to say "a person with a cognitive impairment, or a person with a significant cognitive impairment".

You may want to check out for more information. Thank you.

Jodi Picoult: I think in that interview i actually said "mentally challenged" - but believe me, reporters are notorious for misquoting us!


Capitol Hill, D.C.: Ms. Picoult: "My Sister's Keeper" is one of my all-time favorite books and is what got my hooked on your novels. I was excited to hear it's being made into a movie, however I was disappointed with the casting choices. How much input do you have when your books are changed into other media and how hands-on were you with MSK coming to the big screen? Production info for "My Sister's Keeper" (

Jodi Picoult: It's hard for people to understand, but authors usually have very little involvement, if any, when it comes to the transition to film. I had absolutely no choice in the casting of MSK, or the script, or the changes they made to the film that make it different from the book. I'm looking forward to seeing the movie (I'll be looking at it in a few weeks) and judging it on its merits as a MOVIE. It's not my book, and never will be, but I think that many devoted readers of MSK will find lots to celebrate in the film.


Boston, Mass.: Go Sox!!!! :0)

What I really love about your books is that there is always a real good twist at the end... Will there be a twist in this book?

Jodi Picoult: There is a massive twist. But if you go peek at the end now, I'm going to hunt you down. :)


Annapolis, Md.: Hi Jodi,

Can you tell us about your 2010 book? I'm looking forward to seeing you in Baltimore on Tuesday!

Jodi Picoult: My 2010 book is called HOUSE RULES and is about a teenage boy with Asperger's syndrome who has a real passion for crime scene analysis, and who winds up accused of a murder. In America the legal system works if you communicate a certain way and if you don't...well, you're out of luck. Imagine a law enforcement agent running across an autistic kid who has nervous stims, can't look you in the eye, doesn't answer questions or speaks flatly without emotion, maybe even runs if you try to touch him -- doesn't that look a LOT like guilt???


Hamilton, Ontario: Hi. In "Handle With Care", why are they all writing as if towards Willow? I understand that it is because she is a central part of the book, but does she ever read this or is this just a way of making it more personal? Also, why does Amelia say "my mother" and "my father" when it is addressed to Willow? Shouldn't she be saying Mom and Dad or our mother and father, etc? Thanks!

Jodi Picoult: Amelia is talking to Willow, like everyone else. I wanted to write a book in the Second Person narrative for ages - and this is it! You as the reader are put in Willow's place, with everyone trying to explain themselves to you. I'm not going to tell you if she reads it, or how that manifests itself...just read the story! The reason Amelia says "my mother" or "my father" is just habit - remember that Sean is her adoptive dad, so she does make differentiations.


Centreville, Va.: Jodi -- I love your books!! I have read everything you have written in the past two years and have recommended them to all my friends. I am a Mom of two teenagers, in my late 40's, and your books seem to be written just for me. Since most of your stories are based on mother/child relationships, how do you 'get in the head' of your Mom characters? Have your kids read your work and do they ask you why the Moms in your books act they way they do? Is it hard switching roles from writing in the mindset of your character to going back to reality and being a real Mom? Keep up the writing!!

Jodi Picoult: My kids have read my stuff - they are the first ones to grab the advanced reader's copies! They haven't asked me about the moms in my books (but hey, maybe it's because they're grateful I'm not like that...!) It's not really hard for me to switch back into real life, because I don't think I act like these "blinder moms" as I call them (moms who think they're doing the right thing but don't see the big picture).

PS - my books ARE written just for you, didn't you know?! (Just kidding...!)


Baltimore, Md.: My friend's baby might have OI. Where can I find more information?

Jodi Picoult: - that's the OI Foundation website and they are FANTASTIC.


Rockville, Md.: Ms Picoult: I have read every single one of your books and "Handle With Care" arrived in the mail today! What do you think distinguishes this book from your other books?

Jodi Picoult: I think this book is the most "gray" one I've ever written - it's very hard to NOT feel sympathy for all characters, or to say that one person is patently wrong. Even Charlotte really truly loves Willow - in spite of her lawsuit. And this book is very sad -- which is saying a lot, coming from me!


Virginia: Hi,

I loved "Plain Truth" and "Tenth Circle". Your books are amazing, thanks for chatting with us.

Jodi Picoult: Thank YOU! Keep reading!


Mobile, Ala: I'm wondering how hard it was for you to write "Nineteen Minutes". I read it while pregnant with my first child and my heart was hurting so badly for Peter, particularly through the incident with the lunch box. Do you ever depress yourself when you cover topics like this?

Jodi Picoult: I cry sometimes when I'm writing. These characters are with me for a good nine months, so you can imagine how involved I am with them. The best thing, though, is that at the end of the day I can leave Peter and Josie in my office and go downstairs to my own kids, who thankfully are more well adjusted!


Washington, D.C.: As a pediatrician caring for children with chronic illness (pediatric diabetes), I echo Dr. Klass' comments in regard to Ms. Picoult's works. I have yet to read her newest novel, however, her previous novels, particularly "My Sister's Keeper" reflect an excellent understanding of pediatric illness as well as the psyche of teenagers. We appreciate your contributions to the medical community and the world of adolescents and their families. Well done, Ms. Picoult.

Jodi Picoult: I have to say, Dr. Klass's review is my favorite because of her singular point of view as a physician -- I'm so impressed that the Washington Post chose her as a reviewer! After I heard that My Sister's Keeper was being used in bioethics courses and nursing courses and med school programs, I was completely blown away - and very humbled. I think that adding the humanity back into a given medical situation can only be a good thing, and if my books help in some way, it's truly an honor.


Cincinnati, Ohio: Jodi -- I look forward to meeting you in Cincinnati on Thursday. I am so excited to have the opportunity to meet my favorite author. I just cannot decide which book to bring to have you sign, as I have read and own them all.

Jodi Picoult: Well, actually, the number of books I sign is usually dependent on the size of the crowd and the bookstore's policy! See you in OH!


Ann Arbor, Michigan: What advice would you give to new writers?

Jodi Picoult: WRITE. Daily, if you can. Don't do anything but write during the time you're suposed to be writing. READ a ton - it will inspire you to be as good as the book you're reading. Take a workshop course if possible, online or at a bookstore or school - so you learn to give and get feedback. And when you are stuck and certain that what you are writing is the worst piece of literature mankind has ever seen, force yourself to finish. Most beginning writers give up before they get to the end, and if you do that, how will you ever know if you CAN complete a story? Once you're done you can decide to scrap or keep it -- but you MUST finish!


Hillsborough, N.H.: Jodi, I'm reading "My Sister's Keeper" and you referred to a teacher by the name of Mr. Hume. I was wondering if he was fictional or if you had actually had him as a teacher? My freshman and sophomore science teacher was Mr. Doug Hume.

Jodi Picoult: Sorry, nope, that was made up. :)


Seattle, Wash.: Hi Jodi, I'm a big fan of your books, and about a year ago caught "Plain Truth" as a movie on Lifetime. Before that time, I hadn't realized any of your novels had been made into movies. Were you involved in that process? And will any more of your books be made into movies?

Jodi Picoult: I have had great luck with my TV movies - every time one's been adapted I've been invited to be part of the set, to rewrite certain scenes to make them flow better, to sometimes even be IN the movie. I'm not sure if any others will become TV movies, but I certainly hope so.


Snohomish, Wash.: Jodi, Do you pull your stories from real life? Your new book is so familiar to me and my family situation -- I have two girls with a very rare genetic disease. Some of the things Charlette goes through could have been written by me (if I had any writing talent, that is!). I was wondering if you watch medical mystery shows, or how did you come up with this plot line?

Jodi Picoult: I'm glad the book is feeling familiar to you - and it sounds like your girls are really lucky to have you as an advocate! I answered the plot question above, but I have to admit that sometimes, I am completely sucked into the TLC medical mystery shows...although I don't think any of them have inspired me to write a book yet!


Washington, D.C.: How do you generate your plots for your books? Do they come from your own real-life experiences or borrowed from people you have met?

Jodi Picoult: I don't write from my own experiences, although sometimes experiences I've had will somehow inform my characters. In MSK, for example, a lot of what the family experiences traipsing back and forth to the hospital felt familiar to me, because I had a son with benign ear tumors that required surgery 11 times in three years. Also, I knew what it was like to have the balance of a family disrupted by that medical condition -- which in turn helped me write Handle With Care. I don't write people I know into books...but I do steal mercilessly from conversations I have or overhear. In The Pact, there's an argument between Gus and James that I had with my own husband...except now, when you read it, I win every time!


Cincinnati, Ohio: It is always a letdown for me when I finish one of your books -- I want them to go on forever!

Jodi Picoult: Awww....thanks :)

Just think, the next book is only twelve months away!


Lewiston, Idaho: I love your books. You should write a sequel for "Nineteen Minutes" going off of Patrick and Alex's baby.

Jodi Picoult: Thanks...but I doubt I'll write a sequel. And yet, who knows? I have a wicked crush on Patrick DuCharme and may need him to come visit again!


Columbus, Ohio: Hi Jodi! I wanted to say "Thank you" for writing such wonderful novels, but especially this latest one (I read it in one sitting!) and "My Sister's Keeper." I had cystic fibrosis (I had a double lung transplant in '05) and it is so wonderful to read books that speak to MY experience, and that of my families. Knowing that so many people read your books means, to me, that many more people will really understand my life. And, like Willow, I -love- my life! Thank you so much for making that clear in Handle With Care.

Jodi Picoult: Thank you SO much for saying that! I really wanted this book to leave people understanding that you can't be defined by a disability. You sound like you're living proof.


Washington, D.C.: I've read all of your novels and "My Sister's Keeper" was one that really touched me. I like how you can show all sides of relationships and make it come alive. One question, how do you come up with your ideas for your novels?

Jodi Picoult: I've talked a bit about this already, but I don't feel particularly creative - I feel like the ideas land on my lap. There are tons of moral and ethical dilemmas out there, but one has to "hit" me at a given moment to make me want to write about it then and there. MSK came about because I was sick of hearing the words "Stem Cell" in a politician's mouth and wanted to show people the reality of a family struggling with that situation.


Charlottesville, Va.: I have just started reading "Handle with Care" -- about halfway through. As all your books are such page turners, this one isn't an exception.

I'm curious as to the reason you chose Amelia's coping mechanism through purging? At least so far in the amount of book I've read, there are several references to this.

In the future, do you think you will ever focus on eating disorders as a plot line? It is often an issue of the family that causes much unraveling. I only ask, because I think this would be an excellent topic as it is rising, and you'd make brilliant, in-depth, accurate characters.

Jodi Picoult: In a family like the O'Keefes', Amelia's perception of her mom's lawsuit includes the fact that if you're not perfect, mom might not have wanted you. The self-hatred she feels because she's jealous of the attention Willow receives (among other things) is what leads to her bulimia. Like many bulimics, she also is a cutter - and of course this is cardinal proof of what else Charlotte's missing that's going on under her roof while she's focused on her wrongful birth lawsuit! I am not sure if I'll write about eating disorders again anytime soon - but I knew it would dovetail beautifully with the story of a family breaking apart here in HWC.


Annapolis, Md.: Jodi,

What are you reading? Who are your favorite authors?

Jodi Picoult: I love, love, LOVE Alice Hoffman, and I'm currently reading an advance copy of her June book, The Story Sisters. I also like Chris Bohjalian, Sue Miller, Ann Tyler, Anita Shreve. Two terrific books I liked last year were by first time authors: The Art of Racing in the Rain (Garth Stein) and The Story of Forgetting (Stefan Merrill Block).


Jodi Picoult: I'd like to thank you all so much for chatting - and please do keep reading!!!


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