My Sister's Keeper

It is raining on the morning Judge DeSalvo is to make a decision regarding Anna’s petition, with each character responding differently to the sight of it. For example, Sara is annoyed while Campbell is comforted. Brian thinks of Anna, perhaps conflicted over his testifying against her, while Jesse begins his journey toward recovery—the rain serving as a contrast to his past abuse of fire. Anna thinks of how water never truly goes away, illustrating the circle of life and foreshadowing her death later in the day.

Both Sara and Campbell’s closing remarks are powerful, both making strong points for their arguments. Sara sticks to her conviction that doing whatever it takes to save Kate is the right thing to do, while Campbell explores the idea of bodily autonomy. There are many arguments to be made for and against the use of a savior sibling, and many have taken place in a public forum such as a courthouse—yet both Sara and Campbell acknowledge that each situation is different and that decisions should be made accordingly. This seems to be the only real answer Picoult is able to offer on this highly-controversial conflict. If a reader were to look up real-life versions of the Fitzgeralds’ situation, they would find that savior siblings are illegal in some countries while others support the technology that allow similar solutions to childhood cancer.

Picoult has written an impossible situation that doesn’t seem to have a resolution, yet offers one in Judge DeSalvo’s decision. DeSalvo revokes Sara and Brian’s ability to make medical decisions for Anna, and gives it to both Anna and Campbell. The appointment of Campbell as Anna’s medical power of attorney is meant to provide educated, unbiased help with health-related decisions. The problem is, Campbell is not unbiased. He and Anna have developed a close relationship over the course of the novel that takes a turn when Anna is fatally wounded in his car—likely enabled by the roads being slick with rain.

While the other Fitzgeralds were focused on Kate’s potential death, none of them ever considered the possibility of one of them dying. For the novel’s one death to be Anna’s is even more tragic because she was born for the sake of providing for a sibling, never able to live life on her own terms. Her death is shocking, but results in the kidney transplant Sara fought so desperately for. Campbell ultimately allows the transplant, likely influenced by his final conversation with Anna—in which she expressed the desire to be Kate’s sister in 10 years. This, too, was foreshadowed, as Anna often stated that she couldn’t imagine a world without Kate, and that she didn’t want Kate to die.

One can assume Anna would have chosen to donate her kidney despite pursuing a petition for Kate’s sake. Anna simply wanted a choice in the matter, and wanted to give her sister a semblance of choice. In the end, however, neither of them was given a choice in their fate. An argument can be made regarding the “convenience” of Anna’s death and whether or not it detracts from the novel’s themes (i.e., whether or not Anna’s death renders her medical emancipation meaningless), but this is ultimately for readers to decide.

Desire for Control is a major theme in the novel, especially in regard to Sara’s desperate need to control the outcome of Kate’s illness. However, it is also a theme present in the Fitzgerald children’s stories. Jesse wants control so desperately that he becomes an arsonist to control the destruction of empty buildings, while his sisters want control over their bodies. However, Jesse regains control over his life, rescinding his destructive habit; Anna gains control temporarily, but loses it upon her death; and Kate is never given the opportunity to choose or deny her treatments. At the same time, Kate lives with the guilt of knowing her need to control her fate inadvertently led to Anna’s death. In the end, no one but Sara got what they initially wanted—but even in this case, Sara may very well carry the guilt of neglecting Anna for so long. With Anna gone, Sara will never be able to properly reconcile with her youngest.

In a way, Kate is also denied reconciliation with Anna, as the novel’s conclusion makes it clear that the Prologue is told from her perspective, not Anna’s. Despite not having much of a presence in the novel (aside from the Epilogue, which she narrates), Kate is very much at its core, as her relationship with Anna propels the plot. With that said, it’s surprising to learn that Kate often felt neglected and even felt the urge to kill Anna once. Perhaps Kate’s ire stems from Anna being healthy and relatively free to live her life compared to her—such being the nature of their sisterly relationship, vacillating between hate and love. Regardless of these feelings, an older Kate clearly loves her sister and values her sacrifice.