My Sister’s Keeper
Jodi Picoult
Context
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In 2004, Picoult published My Sister’s Keeper. Like most of her works, the novel
takes on a range of morally complex issues, from the ethics of genetic
engineering, to the right of terminally-ill patients to elect to die, to a minor’s
right to control her own body.
Genetic engineering alone has been the subject of controversy since its very
first uses to help infertile couples conceive via in vitro fertilization. As the
potential uses of the method have grown, so have the moral questions that
such genetic manipulation raises.
Notably, the ethics of using science to create a so-called “designer baby,”
meaning one whose physical traits are selected by the parents, has become
the object of frequent and heated debates.
These quandaries, and those regarding the rights of terminally ill patients and
minors to determine what happens to their bodies, all intertwine in My Sister’s
Keeper, which tells the story of one family devastated by their eldest daugther
Kate’s battle with acute promyelocytic leukemia, an extremely aggressive form
of cancer
Background Info
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With My Sister’s Keeper, Picoult drew on her
experiences with her middle son, who at the
age of five needed ten surgeries over three
years to treat a tumour in his ear. Picoult says
the desperation she felt sitting in the hospital
beside her anesthetized son and knowing she
could do nothing to help him informed her
depiction of Sara, the mother in the Fitzgerald
family of My Sister’s Keeper. That emotion,
combined with the knowledge Picoult gathered
in her research, imbues the book with a sense
of realism.
In a nutshell...
· Multiple narrators alternate throughout the book.
These narrators are Anna, Jesse, Kate, Brian, and Sara Fitzgerald,
Campbell Alexander, and Julia Romano. The chapters narrated by
Sara largely take place in the past, while the rest of the narration
occurs in present day. The prologue and epilogue take place
several years after the main action has occurred.
POINT OF VIEW · Each narrator speaks in first person, allowing
the reader to see the world from each narrator’s point of view.
TONE · Each narrator speaks in a different tone. Anna is
observant, thoughtful, and inquisitive. Jesse is sarcastic and angry.
Brian is often discursive, wandering into musings on astronomy.
Sara is practical and concise. Campbell is sarcastic and sometimes
regretful. Julia is open and watchful of the characters around her.
SETTING (TIME) · The setting alternates between present action
and events from the past fourteen years.
SETTING (PLACE) · Rhode Island
CENTRAL PROTAGONIST · Anna Fitzgerald
 NARRATOR
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Prologue Summary
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The prologue begins with an epigraph from Carl von
Clausewitz’s Von Kriege. The epigraph states that no one in
his right mind starts a war unless they are absolutely clear
on two things: what he wants to achieve, and how he plans
to achieve it. An unidentified person narrates the second
part of the prologue from a first-person point of view. This
narrator recalls the time she was three years old and
attempted to kill her sister. Her father stopped her and
implied she pretend the incident never happened. The
narrator confesses that as she grew older she didn’t seem
to exist except in relation to her sister. She thought of many
different ways she could kill her, but ultimately the narrator
says she didn’t do anything after all, because her sister did it
on her own.
Monday Anna Summary
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Thirteen-year-old Anna Fitzgerald begins narrating the story. She
talks about the different reasons babies come into being and
admits that she was born for a very specific purpose. Scientists
used her mother’s eggs and father’s sperm to create a specific
combination of genes. They created her in this way so she would
be able to save her sister, Kate. Anna talks about visiting a
pawnshop to sell a locket. She has a difficult time parting from the
locket because her father gave it to her as a gift after she donated
bone marrow to Kate. Anna goes on to describe herself as skinny
and a freak. She talks about her family, how her sister Kate has
leukemia, and how she has had to undergo medical procedures to
help Kate whenever Kate has gotten sick. Her mother, meanwhile,
obsessively shops online, and her older brother, Jesse, behaves like
a delinquent because their parents don’t have time to care about
him.
cntd.
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Anna shows Jesse a newspaper clipping about a
lawyer named Campbell Alexander. Jesse warns
her not to mess with the system and the roles
everyone in the family has, but he still agrees to
drive her to Campbell’s office. Anna meets
Campbell and notices he has a service dog, which
Campbell sarcastically tells Anna prevents him
from getting too close to magnets, because he has
an iron lung. Campbell tries to send Anna away,
and she explains that she wants Campbell to help
her sue her parents for the right to her own body.
Campbell Summary
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Campbell gives his account of his meeting with Anna. He
talks with her about her case and notices how angry she
seems. He agrees to represent her because he thinks the
case will be easy to win and great publicity. He doesn’t
think they will even need to go to trial, because Anna’s
parents will give in before that. Anna leaves after
Campbell tells her he will file a petition in family court
for her medical emancipation. Campbell’s assistant, Kerri,
expresses her shock that Campbell is representing Anna.
She wonders where Anna will live during the trial, but
Campbell hasn’t thought about it. Campbell’s dog, Judge,
pushes against him, apparently alerting Campbell to
something. Campbell goes back into his office and locks
the door.
Sara Summary
Sara’s narration jumps back in time to 1990. While bathing
Kate and Jesse, Sara talks to Brian, her husband and a career
firefighter, and she recalls her decision to give up her career as
an attorney to become a stay-at-home mother. Sara notices a
bruise on two-year-old Kate’s shoulder blade.
 The next morning, bruises have spread up and down Kate’s
spine. Sara takes Kate to the hospital where Kate undergoes a
series of tests. The hospital refers Sara to an oncologist who,
after further tests, diagnoses Kate with acute promyelocytic
leukemia (APL), a rare and aggressive form of blood cancer.
 The doctor tells Sara and Brian that APL has a twenty to
thirty percent survival rate and they should begin treating
Kate immediately. At home Sara and Brian deal with the fallout
of the diagnosis and the realization that their daughter may
not survive. Sara refuses to let Kate die.
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Brian Summary
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In the present day again, Brian Fitzgerald describes a fire
at a medical school. The fire started because a body got
stuck in the cremation incinerator. He turns the story to
earlier that night, while he ate dinner with his family. Kate
upsets Sara because she wears a t-shirt with a picture of a
crab and the word “Cancer” across it. Jesse walks in
reeking of pot. Finally Anna arrives, and Brian immediately
notices something is wrong. Anna remains quiet and
withdrawn through the meal, and she does not have her
locket on. She leaves the table without saying a word.
After dinner, Brian and Sara discuss their daughters. Sara
talks about Kate, but Brian worries about Anna. Sara
mentions that she has to take Kate to dialysis the next
day. Later that night, Anna visits Brian at the station. She
doesn’t want to talk, but together they watch the stars
from the station’s roof.
Tuesday Anna summary
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Anna and Sara sit with Kate at the hospital
during her dialysis session. Sara talks about
kidney donation while Anna thinks about all of
the risks associated with the procedure.Vern
Stackhouse, a sheriff, comes to Kate’s room. He
awkwardly serves Sara papers for the lawsuit
Anna has filed for medical emancipation. Sara
responds angrily, but before she can talk to Anna
about the lawsuit, Kate cries out in pain. Sara
goes to Kate’s bedside while Anna runs out of
the hospital room. Jesse drives to the hospital to
pick Anna up, and they go home.
cntd.
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When Sara and Kate arrive home, Kate runs to her
room, and Sara demands to know what Anna is doing.
Anna refuses to drop the lawsuit, and despite Brian’s
protests, Sara grows even angrier until she slaps Anna.
Later, Kate talks to Anna. Kate says that even if she has
to lose Anna as a sister she can’t bear the thought of
losing her as a friend. Anna doesn’t respond, but in her
thoughts admits she couldn’t stand to lose Kate either.
Sara and Brian walk into Anna’s and Kate’s room at
night. Anna overhears her father saying that maybe
Anna’s actions aren’t crazy. He leaves, and Sara sits on
Anna’s bed. Anna thinks Sara hates her, but Sara insists
she could never hate her. Sara holds Anna and assures
her they can fix everything by talking to the judge. Anna
only nods.
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Sara Summary
In 1990, Sara and Brian see an oncologist named Dr. Chance, who
will be in charge of Kate’s treatments. Sara calls her older sister,
Zanne, whom she has fallen out of touch with, and later Zanne
arrives to help the family out. Sara and Brian feel overwhelmed
with the list of details and questions facing them about Kate’s
cancer and treatment. Since Kate’s form of cancer often resists
treatment, the doctors admit they can only do so much. Sara asks
what it will be like if Kate dies and wonders how she would
survive it. Kate starts chemotherapy and gets extremely sick. The
doctors test Jesse to see if he is a genetic match for Kate, since
she might need bone marrow if she relapses, but he is not.
Dr. Chance tells Sara that if she and Brian have more children,
one sibling could be a match. After chemo, Kate develops an
infection and has to be rushed to the hospital. While at the
hospital, Sara tells Brian she is thinking of having another child.
Brian thinks Sara wants to be able to replace Kate if she dies, but
Sara assures him she wants to have another child to see if the
child would be a genetic match for Kate.
Wednesday Campbell Summary
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Campbell, while on the phone with his mother, wonders
how much people are beholden to their parents. Campbell
stops for coffee and gives his waiter a new sarcastic
explanation of his service dog, Judge. He returns to his
office and finds Anna there. Sara calls while Anna is in the
room with Campbell. Sara tells Campbell that Anna has
changed her mind, but Anna tells Campbell she has not.
Campbell recalls a memory of his father. They competed in
a sailing competition, and Campbell ended up embarrassing
and disappointing his father. Campbell goes to the
courthouse where he meets Sara, who decides to act as
counsel for herself and Brian. Sara and Campbell speak with
Judge DeSalvo, the judge for the case. They argue about
what Anna really wants until Judge DeSalvo decides he
needs to speak with Anna.
Anna Summary
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Anna wonders what her funeral would be like. She
doesn’t think many people would come, unlike Kate’s
funeral, which would be crowded. At the courthouse,
Anna speaks with Judge DeSalvo alone. They discuss the
trial, and Anna tries to remain composed. But she recalls
a time when she and Kate pulled a prank on a nurse at
the hospital and starts to cry. She tells Judge DeSalvo
she can’t give a kidney to her sister. He assures her no
hospital would take a kidney from an unwilling donor,
but she says being a donor has never been her choice.
She says she never wanted to stop the lawsuit and only
told her mother she would because she loves her. Judge
DeSalvo decides to appoint Anna a guardian ad litem
who can decide what is best for her. The hearing, he
says, will take place the following week.
cntd.
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Anna goes home with her parents, even though
Campbell wants to speak with her. Brian pleads
with Sara to calm down, but Sara shouts that
Anna practically signed Kate’s death sentence.
Kate runs upstairs. Anna leaves the house to go
to a laundromat, a place she feels safe. She tries
to picture a future without Kate but can’t. They
are as connected, she thinks, as Siamese twins.
Jesse Summary
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Jesse thinks about when he was a child and would
light bath soap on fire to show Anna. He reflects
that Anna is the only proof he has that he belongs
in the family. While driving down the highway, he
imagines crashing his car because he would be
worth more dead and used as parts. He meets a
homeless man named Dan. Jesse has a deal with
Dan where he brings Dan food if Dan will watch
Jesse’s things, including stolen acid and sawdust.
Jesse goes to an abandoned warehouse and sets a
fire. He admits he has done it before. He watches
the fire from far away until he sees his father
arrive. Jesse goes home to find Sara frantic. Kate is
vomiting blood. Jesse drives Kate to the ER.
cntd.
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At the hospital, Dr. Chance tells Sara and Jesse
that Kate is in the end stages of kidney failure.
Sara asks if a transplant is possible, and Dr.
Chance tells her that the odds are not good. Sara
asks if they would do the transplant if a donor
were available. Jesse offers his kidney, but Dr.
Chance tells him it must be an exact match. Jesse
wonders why he thought he might suddenly be
worth something and why he thought he could
save his sister when he can’t save himself. Kate
tries to tell Jesse something, but all he can
understand is “tell Anna.”
Sara Summary
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The time is 1990–1991 and Sara is pregnant with Anna. Sara
knows everything about the baby, from the sex to the specific
combination of genes that will allow Anna to be a donor for
Kate. She admits that she has thought of Anna only in terms
of what she will be able to do for Kate. Sara reveals that
three months after chemo, Kate went into molecular relapse.
Sara recalls the television interview she and Brian did. They
explain why they went to a geneticist and deny wanting a
“designer baby.” They only wanted a child who would save
Kate’s life. Sara goes into labor on New Year’s Eve. Anna is
born, and the doctors take her umbilical cord to harvest the
cord blood. Kate begins a pre-transplant regimen of radiation
and chemotherapy, which makes her violently ill. The doctors
put her in isolation, then give her Anna’s cord blood.
Wednesday Julia Summary
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Julia argues with her twin sister, Izzy, until Judge DeSalvo
calls. The judge asks Julia if she will be the guardian ad
litem in Anna’s case. Julia agrees and goes to the
Fitzgerald house where she meets Anna. Julia takes Anna
to the zoo to talk, hoping it might loosen her up. Julia
can’t determine why exactly Anna filed the lawsuit, but
she realizes that Anna will either lose her sister or
herself. At the house Julia meets Sara. Julia tries to speak
with Sara, but Sara brushes her off. Julia realizes that it
will be difficult for Anna to live there during the course
of the legal proceedings without being swayed by her
mother. Afterward Julia goes to Campbell’s office. It
emerges that they have had a romance in the past and
that they haven’t spoken in years.
Campbell Summary
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Campbell works in his office when Julia walks in. He
feels shocked to see her for the first time in fifteen
years. After some awkward conversation, the two
discuss Anna. Campbell suggests removing Sara from
the house, but Julia thinks it is the wrong course of
action. The two argue and the dog, Judge, becomes
increasingly agitated. Finally, Campbell leaves Julia alone
in his office. In a flashback to their high-school years,
Campbell remembers when Julia arrived at their prep
school. She looked different than the other girls and
kept to herself. One day Campbell followed her to a
cemetery and asked for help with his homework. In the
present, Campbell straightens himself up in a bathroom.
When he goes back to his office, Julia has gone. In
another flashback, we see Campbell and Julia as
teenagers sharing their first kiss.
cntd.
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Back in the present, Campbell goes to see
Anna at her house. Initially, he feels awkward
around Anna and admits that he usually
doesn’t spend time with his clients. Later that
night, Campbell visits Julia. At first he confuses
her with her twin sister, Izzy, who acts angrily
toward Campbell. Campbell and Julia talk and
catch up. Julia admits to Campbell that it is
hard to be around him after everything that
happened between them.
Anna Summary
Anna asks Jesse to drive her to the hospital. Jesse tells
Anna that she is not doing the wrong thing, but she tells
him that she’s not doing the right thing either. Jesse agrees
to help Anna see Kate by distracting their mother. In a
flashback, Kate wants to talk to Anna about death and the
best way to die, but Anna refuses. In the present, Jesse
pretends to be drunk in order to get Sara away from
Kate’s hospital room.
 Anna goes into Kate’s room, and we see another flashback
in which the entire family plays football on Thanksgiving.
Jesse accidentally knocks Kate down, and Brian gets angry
at him. Jesse says he forgot, and Kate smiles. She’s thrilled
that, for a moment, Jesse forgot she had cancer. In the
present, Anna climbs into Kate’s bed with her. In her
thoughts she acknowledges that she didn’t come to see
Kate to feel better, but because without Kate, she can’t
remember who she is.
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Thursday Brian Summary
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Julia meets Brian at the fire station and helps
him cook breakfast. They discuss Anna, and
Brian hesitates to state his opinion. He thinks
about an incident where he saved a child from
a burning building. Brian admits he became a
firefighter to save people but wishes he could
have been more specific about who to save.
He asks Julia if he can take her to meet
someone but doesn’t say who the person is.
Julia Summary
Julia rides with Brian in his car. In flashbacks, we see Julia at
her apartment sobbing the previous night after Campbell left,
then going to a bar where she drinks heavily. She remembers
how Campbell felt attracted to her because she was different
from everyone else at their school. They would meet after
school in the cemetery and talk. Their relationship blossomed
from there.
 In Brian’s car, he tells Julia they named Anna after the galaxy,
Andromeda. They find Anna at the house and decide to all go
to the hospital together. Anna confesses to Julia that she fears
Kate will hate her. Outside the hospital room, Sara begs Julia
not to tell Kate that Anna has not dropped the lawsuit. She
also insists to Julia that she loves both of her daughters. Julia
and Kate talk alone. Julia asks about Jesse, and Kate says that
he gets into a lot of trouble because it’s his only way of being
noticed. Kate talks about a year where she got sick on almost
every single holiday and how hard that was for Anna.
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Sara Summary
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In 1996, Sara throws Kate a party for her eighth birthday. Kate
has been in remission for five years, but soon after the party
Kate relapses. She starts on a new medication in an attempt to
put her in remission. In the midst of this, Jesse reminds Sara she
promised to take him to get new cleats after his orthodontist
appointment. Sara tells him they can’t do either, so Jesse attempts
to pry his braces off his teeth with a fork. The new medication
works at first, but Kate develops a resistance. Dr. Chance
recommends a donor lymphocyte infusion from Anna. Brian
suggests it might not be a good idea to make Anna donate blood,
since he and Sara only agreed she would act as a donor for Kate
once. Concerned about Kate, Sara dismisses the concern.
Anna arrives at the hospital to give blood and screams and cries
during the procedure. Later, when the doctors need to take
more blood, Sara forces Anna to leave a birthday party early. A
month later, Anna has to donate blood a third time. Sara also
talks about finding Kate’s goldfish nearly dead. Desperate to save
it, she calls a marine biologist who helps her revive the fish.
Thursday Anna Summary
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Anna recalls imagining what life would be like if Kate died. It
would be painful, but she also thinks of the exciting things
she could do if Kate weren’t alive. In the present, Anna sits
with her parents in the hospital cafeteria. Vern Stackhouse
serves Sara with a temporary restraining order requiring
her not to have contact with Anna. Anna says she never
asked for that but Sara is furious. Sara and Brian fight in the
car about hiring a “real” lawyer. Reporters have gathered at
the courthouse, and Anna and Brian wait outside while Sara
and Campbell talk to the judge. Julia arrives and asks if Anna
wants Sara to leave the house. Anna says that’s not what
she wants. She also says she’s changed her mind and doesn’t
want to go through with the lawsuit anymore. After Julia
leaves, Brian asks Anna if she wants to stay with him at the
fire station to give her distance from Sara. They leave
together.
Campbell Summary
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Outside the courthouse, Campbell speaks to the reporters.
He recognizes that he wants to draw attention to the case
to capitalize on it. Sara and Campbell speak to Judge
DeSalvo. Julia arrives, tells the judge that Anna is confused,
and it would be a mistake to remove Sara from the house.
Judge DeSalvo refuses to grant the restraining order, but he
orders Sara not to say one more word to Anna about the
case. Julia, Campbell, and Sara go outside to see Anna only
to discover she has left with Brian. Julia tries to talk to
Campbell but he avoids her. Once again, his dog, Judge,
clearly tries to alert Campbell to something. Julia yells at
Campbell while he tries to get away from her. She informs
Campbell that Anna said she changed her mind about the
petition. Finally, Campbell escapes into an empty room and
locks the door.
Jesse Summary
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Jesse arrives home to find Julia on his doorstep. He tries
to flirt with her. She asks for Anna, but Jesse says no
one is home. Julia brushes off Jesse’s continued
flirtations and asks him about his family. He tells her a
story about a Christmas Eve when he was 12 and Kate
was in the hospital. Anna had to be taken in to give
white blood cells, and Jesse was sent to a neighbor’s
house. He left and chopped down a tree from his
family’s front yard, then set it up in the living room and
decorated it. The next day when he opened his gifts he
realized they were all from the hospital gift shop. Brian
and Sara never even noticed the tree. Jesse says that the
story explains what it has been like to grow up in his
family. He says at least Anna is on their parents’ radar.
Brian Summary
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Brian takes Anna to the fire station. He recalls his visit
to the hospital earlier that afternoon. Kate slept, and
Brian talked to Sara. He told her Anna was going to
stay with him at the station. They argued when Brian
told Sara he was worried about Anna. Sara said that,
unlike him, she worries about both of their daughters.
Later that night, the fire station receives a call to a
nursing home where a woman has hit her head. Anna
goes along and helps. They take the woman to the
hospital, and Brian loses track of Anna. He finds her in
Kate’s room, curled up on Sara’s lap. He takes her back
to the station. Later, Anna and Brian watch a meteor
shower from the station’s roof. Anna wonders aloud if
it would be possible to find a fallen star.
Campbell Summary
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In flashbacks, Campbell recalls more scenes
from his high-school relationship with Julia.
Campbell’s friends teased him about Julia, but
he would not defend her. Campbell also
avoided telling his parents about Julia, which
Julia suspected. When he finally took her to
meet them, his parents behaved rudely and
refused to invite her to a party the rest of the
family was attending. Afterward, Campbell
began ignoring Julia. One day they met at the
cemetery, and Campbell told Julia their
relationship was over.
cntd.
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In the present, Campbell goes to the hospital to speak to Dr.
Bergen, the head of the ethics committee. Dr. Bergen says the
committee never met to discuss Anna, despite the fact that
Anna had been a patient at the hospital eight times. After his
meeting, Campbell runs into Julia. He convinces her to talk with
him about the case, and they go to an Italian restaurant.
Campbell avoids answering questions about his service dog and
why he took the case. He receives a phone call from Anna
asking him to meet her at the police station. When he and Julia
arrive, Anna tells them Jesse has been arrested for stealing a
judge’s car. She asks for Campbell’s help. Reluctantly, he
manages to get Jesse released on probation. In the car on the
way home, Campbell tries to get Anna to tell him what she
really wants. She explodes in anger and says she’s sick but never
sick enough for her family. Campbell is pleased at her anger but
also worried that she will sound unsympathetic on the witness
stand.
Brian Summary
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Campbell arrives at the firehouse with Anna.
When he and Brian talk alone, Brian admits he
agrees with Anna and says he is willing to say
so to the judge. Brian remembers an incident
from the night before in which he shouted at
a kid whose girlfriend overdosed on drugs.
Another firefighter told Brian he could take
time off, but Brian says that means he would
have to be at home instead. Back in the
present, as Campbell leaves he mentions
Jesse’s arrest
Sara Summary
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In 1997, Sara finds Kate with blood streaming down her legs.
Kate has relapsed and needs a bone marrow transplant. The
family’s insurance company refuses to cover the transplant. To
prepare Anna for the bone marrow donation, Sara gives her
growth-factor shots. Six-year-old Anna tells Sara she hates her.
Sara’s sister, Zanne, offers to pay for the transplant, but Brian
tells Sara the men at the fire-station raised enough money. Sara
takes Kate to the hospital to begin her pre-transplant regimen
of chemotherapy.
Before she leaves the house, Kate cleans her room in case she
doesn’t come back. Again, the chemo makes Kate violently ill.
The time arrives for Anna’s bone-marrow extraction, and Sara
tells her she doesn’t have to do it but that everyone is counting
on her. Sara goes to be with Kate. Brian arrives after Anna’s
procedure and says Anna has been asking for Sara. Sara feels
torn but goes to see Anna. Anna says she hurts, so Sara finds a
nurse to give her medication. When Sara goes back to Anna’s
room, she sees Brian putting the locket on Anna’s neck.
cntd.

A few weeks later, Brian takes Sara out to dinner. They
have nothing to talk about other than Kate and feel
like strangers. When it’s time to take Kate home from
the hospital, Sara notices how different Kate looks.
Later, Sara learns that Brian lied about the firefighters
having raised enough money to cover Kate’s bone
marrow transplant. When Sara confronts him, he says
he used the money from Kate’s college fund to help
pay for it, because Kate won’t live long enough for
college. Time passes and Sara tries to get Kate to leave
the house, but Kate feels self-conscious about her
appearance. Sara shaves her own head, and then Anna
asks to have her head shaved, too. All bald, they go to
the mall.
Weekend Jesse Summary

Jesse steals a dump truck and picks up Dan. In
flashbacks, Jesse recalls when he was eleven and
received a skateboard as a “guilt gift,” meaning a gift his
parents gave him whenever Kate became seriously ill.
Brian promised him he would take him to a parking lot
where he could ride it, but Kate’s nose started to bleed.
When Jesse reminded Brian of his promise, Brian looked
at Jesse like he didn’t see him. That day, Jesse walked into
the middle of traffic, hoping to get noticed. In the
present, Jesse takes Dan to a shed. Jesse lights it on fire
and admires his work, until Dan tells him that a
homeless man named Rat lives in there. Jesse runs in to
the burning shed, saves Rat, and runs away just as the
fire trucks arrive.
Anna Summary

Anna waits at the hospital with Kate and Sara. Kate feels
alert, but Dr. Chance cautions that Kate’s lucid moments
will occur less and less frequently because she is in endstage renal failure. Kate asks Dr. Chance how long it will
be before she dies, and he tells her maybe a week. Sara
begins crying. When Anna tells her to stop, Sara looks at
Anna and tells her to stop. Later at the fire station, Anna
talks to Julia about her crush, Kyle, and Julia asks Anna
what it will be like when Kate dies. Anna can’t answer.
Sara calls to apologize to Anna and say goodnight. On
the roof that night, Anna and Brian talks about the stars
and celestial navigation.
Brian Summary

Brian goes to the hospital to see Sara. He talks to
her about a trip they took to Nevada years ago.
They saw a fortune teller who told Sara her life
wouldn’t be good enough and told Brian to save
himself. Sara doesn’t remember the trip and only
wants to talk about Anna. Brian tells her he plans
to speak on Anna’s behalf. Sara can’t understand
this. She asks Brian to remember what it used to
be like between them. But Brian knows Sara is not
the same woman she used to be. He also knows
he is not the same man he used to be, a man who
believed Sara when she told him she would always
love him.
Sara Summary

In 2001, Anna asks for money for goaltender pads.
She has started playing ice hockey. Four years
have passed since Kate’s bone marrow transplant.
One night, the family goes to watch Anna play
hockey. Later, Kate wakes up bleeding badly. She
has relapsed and her body is failing. Dr. Chance
suggests a new and untested arsenic therapy. That
night, Sara finds Brian writing Kate’s eulogy. He
wants to bring Kate home to die in her own bed.
He tells Sara the arsenic will just postpone what
is coming. Sara tells him it’s not time.
cntd.

Kate slips into a coma. Sara receives a call from Jesse’s
school. He blew up a septic tank and has been expelled.
Sara picks him up from the school and notices needle
marks on his arms. She suspects drug use, but Jesse
reveals he has been donating platelets for Kate every
three days. Anna gets accepted to a prestigious hockey
camp, but Sara tells her she won’t be able to go because
they might need her for Kate. Anna says the camp is a
year away, implying that Kate won’t be alive then
anyway. Kate develops an infection and becomes
seriously ill. Jesse and Anna say their good-byes to Kate.
Brian tells Sara that Kate needs her permission to leave.
As Sara tells Kate that it’s okay for her to go, Kate grips
her hand and begins to claw her way back to life.
Anna Summary

Anna ponders what heaven will be like. She
wonders what age people are in heaven, and
how anyone recognizes each other. Sara calls a
meeting at Campbell’s office. She tells Anna
that if Anna gives Kate a kidney she will never
ask Anna for anything again. Anna hugs her
mother but tells her she can’t do it. Without a
word, Sara tries to smile and then leaves.
Julia Summary

Julia admits to Izzy that she still has feelings
for Campbell. Just then, Campbell arrives and
asks Julia out to dinner to discuss Sara’s plea
bargain. He takes her out on his boat, and
though they’re having a good time, Julia
suspects Campbell wants to sway her
decision. Julia gets angry and wonders if
Campbell ever says anything that isn’t a lie, but
Campbell kisses her. She remarks that it feels
like the most natural thing in the world.
Monday Campbell Summary

Campbell wakes up in his boat after spending the night
with Julia. He thinks that he loved Julia because she
was an independent spirit and he couldn’t bear to take
that away from her. He leaves while Julia sleeps and
goes to the courthouse. Neither Sara nor Brian knows
where Anna is. Campbell finds her in Kate’s hospital
room and drives her back to the courthouse. On the
way, Campbell pulls over and asks Anna why they’re
going to court. Anna counters by asking him about his
dog. Campbell says that the dog is for a hearing
problem. Anna says she’s sick of things always being
about Kate. Campbell points out that Anna is lying, and
Anna says Campbell is also lying about the dog.
cntd.

Campbell and Anna arrive at the courthouse, and
everyone moves into the courtroom. Anna asks
Campbell if she’ll have to speak. He lies and says she
probably won’t. Campbell speaks first and says in the
justice system what is legal differs from what is moral.
Sometimes is hard to tell them apart, but the court is
there to help. Campbell calls Sara to the stand. She
talks about Anna’s conception, and Campbell asks her
about all the times Anna has undergone a medical
procedure to help Kate. He also asks if Anna had a
choice in any of these cases. Sara says Campbell can
see things in black and white because he only
represents one of her daughters, but Sara represents
both of her daughters.
Anna Summary

During a recess in the trial, Campbell and Anna speak
alone. Anna says even if they win they still lose. When
the trial resumes, Campbell calls Dr. Bergen as his
second witness. Dr. Bergen says the ethics committee
has discussed whether Kate should have a kidney
transplant and that they arrived at a split decision.
Campbell asks if the committee discussed the risks to
the donor, and Dr. Bergen said it wasn’t an issue since
Anna wasn’t a patient. Campbell shows Dr. Bergen
Anna’s hospital records, and the doctor admits that
Anna has had several invasive procedures. He also
admits he voted against the kidney donation since he
did not believe Kate would live through the procedure.
cntd.

Anna recalls how Kate saved her when she
was a baby. She was in a walker and almost
rolled onto the street before Kate caught her.
In the present, Sara questions Dr. Bergen and
asks if he has children. She then asks if he ever
puts himself into a patient’s shoes. She asks if,
offered a course of action that could save his
child’s life, would he question it or try it. He
doesn’t answer. Another break follows. As
Anna leaves the courtroom, she tells her
mother she did great.
Sara Summary

In 2002, Kate meets a boy named Taylor while she
receives platelets and he receives chemo. Sara
watches them flirt and feels happy that her daughter
likes a boy. Kate goes on a date with Taylor. That
night, Sara overhears Kate gushing about it to Anna.
Kate goes into relapse, and Sara has difficulty
convincing Kate, who does not want to be
hospitalized again, to undergo a stem cell transplant.
The oncology team lets Kate begin chemo as an
outpatient. Taylor visits Kate during her chemo,
helps her when she throws up, and asks her to a
dance for patients hosted by the hospital.
cntd.

Sara, Kate, and Anna shop for a dress for Kate. Kate fells
self conscious about her baldness, her chest catheter, and
all of the scars on her body from chemo. Sara tries to
comfort her, but Kate says she can’t fix it every time.
Anna drags Kate into a hair salon and asks the hairstylist
if she can give Kate, who has no hair, an up-do or a perm.
Anna and Kate laugh at the stunned reaction they get.
Kate attends the dance with Taylor, and Sara see them
kiss. Soon after the dance, Kate goes into the hospital for
her transplant. She worries because she hasn’t heard
from Taylor. Sara finds out that Taylor died suddenly, but
she waits to tell Kate until a month after her transplant.
When Kate finds out, she says she loved him and doesn’t
speak to Sara for a week. Sara finds Kate looking at old
pictures, including one of Kate when she was a baby,
before cancer. Kate remarks that she was beautiful.
Monday Jesse Summary

Jesse recalls the time he went to boot camp on a
farm as a fourteen-year-old. While there, he helped
a sheep give birth. The baby sheep almost died, and
he thought that, afterward, the sheep always
looked like it had seen the other side. In the
present, Jesse sits with Kate at the hospital and
sees a similar look on her face. They talk about
dying, and Jesse asks if she feels afraid. She smiles
and says she will let him know. In his head, he tries
bargaining to keep Kate alive. Kate tells Jesse how
much she will miss him. After she falls asleep, Jesse
walks into the hall and punches a wall.
Brian Summary
In flashbacks to the morning of the hearing, Brian goes
home to look for Anna. He searches Jesse’s room and
finds materials that could be used to start a large fire. In
the present, Brian gets called to work and leaves the
courthouse during the hearing. He goes to the site of a
recent arson fire at an abandoned elementary school and
finds a cigarette left by the arsonist.
 At home, Brian accuses Jesse of starting the arson fires.
Jesse tries to deny it until Brian shows him the cigarette
butt. Jesse breaks down, saying he couldn’t save her (he
doesn’t specify who), and asks if Brian has told anyone.
Brian hugs Jesse. He thinks he can’t blame Jesse and
understands that Jesse chose to use fire for the same
reason Brian did: both wanted to control something
uncontrollable. Brian resolves not to tell anyone about
what Jesse has done.

Campbell Summary

At the courthouse, Campbell questions Dr. Chance.
He asks about Anna’s conception and about any
risks to Anna from the procedures she’s undergone
or will undergo. Dr. Chance concedes there are
some risks and complications, but most of them are
minor. Dr. Chance admits that having one kidney
might affect Anna later in life and could make it risky
for her to play contact sports, such as hockey. He
states that up to that point she has not experienced
significant harm from any procedures, but she has
experienced the benefit of saving her sister.
cntd.

During a recess, Julia asks Campbell if the previous
night was a joke to him, and Campbell tells her she
doesn’t want to know the real answer. When the
hearing adjourns for the day, Campbell drives Anna
to the fire station. Once there, Anna confesses
that sometimes she hates herself. Campbell says
he sometimes feels the same way. Anna asks about
Campbell’s relationship with his parents, and he
tells her that somewhere along the way he
stopped wanting to be like them. Anna tells him
that she gets it, that Campbell was invisible, too.
Tuesday Campbell Summary

Campbell questions Brian on the stand, confident that
Brian will help him win the case by disagreeing with Sara’s
position. Brian admits there have been times he’s
disagreed with Sara, such as the time they needed Anna to
donate lymphocytes. However, he says that while he
doesn’t want to hurt Anna, he can’t lose Kate, and that
when your child is dying you do not always have a choice.
He notes that he disagreed with Sara’s decision to start
Kate on arsenic therapy, but that Kate ended up surviving.
Although he hates to see Kate suffer, he says he doesn’t
want to make the same mistake twice and agrees with
Sara’s wish to have Anna continue as a donor. Campbell
feels stunned by Brian’s reversal. Brian acknowledges he
doesn’t know—and has never known—the right answer,
and begins to cry.
cntd.

During a recess, Anna wonders whether she
made Brian fall apart. She says she had never
seen him cry before. Campbell tells her she will
need to testify if they want to win. Anna
declines, despite Campbell’s insistence that they
will lose. She yells at Campbell that he needs to
find another way to win the case. Campbell
assures Anna that, this time, when she speaks
people will listen. Anna refuses, but when
Campbell asks why, she won’t say.
Sara Summary

For the first time, Sara narrates in the present. She
prepares to question Brian and notices all of the qualities
that made her fall in love with him. She also notices how
much he has changed but doesn’t necessarily for the
worse. She begins questioning him but finds herself
talking about a family trip they took. Suddenly Sara
realizes they are no longer pushing each other away but
are fighting on the same side. She feels like none of the
past arguments matter. She thinks that they will have each
other to remember what their family used to be like, to
share the fact that they had Kate for sixteen years. Sara
decides she doesn’t need to cross-examine Brian. She
simply asks when he is coming home.
cntd.

Brian and Anna move back home that night.
After Brian and Sara tuck Anna in, Sara tells
Anna she is not a bad person because she
wants to be herself. She also says Anna reminds
her of herself. Later that night, Brian and Sara
make love. Afterward, Sara tells Brian that they
are going to lose her, and she doesn’t know
which daughter she is talking about.
Wednesday Julia Summary

At their apartment, Julia and Izzy talk, and Julia
cries over Campbell. He did the exact same thing
to her that he did in high school. The next
morning at the courthouse, Julia hears Campbell
and Anna fighting over Anna’s refusal to take the
stand. Julia confronts Campbell and tells him that
both he and Anna are cowards afraid of facing
consequences. Julia also tells Campbell he runs
away every time someone gets close to him.
Campbell starts to tell Julia something about his
dog, but Vern Stackhouse interrupts to tell them
the hearing needs to begin.
Campbell Summary

In the courtroom, Sara questions a psychiatrist named
Dr. Neaux. She asks him about the potential harm Anna
will suffer if Kate dies. Dr. Neaux says that if Anna
donates her kidney and keeps Kate alive she will
experience an immense benefit. He also does not
believe Anna capable of making her own medical
decisions. While Sara questions the doctor, Campbell
jokes with Anna about the names of Dr. Neaux and Dr.
Chance. Campbell then questions Dr. Neaux. He
suggests Sara defines whether or not she is a good
mother by her ability to keep Kate healthy. Campbell
also suggests that Sara, who also stands to benefit by
Kate staying alive, can’t make independent decisions any
better than Anna.
Julia Summary

Campbell questions Julia on the stand. Julia says
she can see how the Fitzgeralds want to do
everything possible to save Kate, but how
medically it does not serve Anna’s best
interests to donate a kidney. Julia says that no
one in Anna’s family has the ability to make
unbiased decisions regarding Anna’s health care,
but Anna also lacks the ability to make her own
decisions.
Campbell Summary

Campbell realizes Julia will not veto Anna’s
petition. He also recognizes how much the case
has affected Julia, the same way it has affected
him. Julia, however, expresses those feelings.
Judge DeSalvo asks for Julia’s recommendation
to the court, but she says she hasn’t been able
to reach a decision. Anna stands up and tells
Judge DeSalvo she has something to say.
Anna Summary
On the witness stand, Anna notices that Campbell looks
awful and sweats. Campbell walks up to Anna and cracks
a joke, giving Anna the courage to continue. She notices
Campbell’s dog behaving excitedly, and Judge DeSalvo
asks Campbell to control him. Campbell begins to
question Anna and asks her why she wanted to file the
petition.
 In a flashback to two months before, Sara and Brian sit
Kate and Anna down to talk. They say Kate needs a
kidney transplant, and the kidney will have to come from
Anna. Before Anna can reply, Kate says she doesn’t want
the transplant. Sara snaps that if Kate won’t accept the
kidney it will be just like suicide. Kate says if she’s already
dying it’s not suicide.

cntd.

In the present, Campbell’s dog barks and jumps,
but Campbell ignores him and continues with
his questions. He asks Anna if she decided to file
the lawsuit herself. Anna tries to lie but
responds that someone else convinced her.
Campbell asks Anna who, and Anna tells him it
was Kate. Just then, Campbell collapses to the
floor.
Wednesday Brian Summary

Brian rushes to Campbell, who has had a seizure.
Julia asks if Campbell will be okay, and Brian
assures her that Campbell will be fine. In the
Judge’s chambers, Campbell regains
consciousness. He doesn’t remember what
happened, but Brian fills him in. Campbell
apologizes to his dog for not listening. Brian
helps Campbell change into clean clothes, and
Campbell admits that he’s been hiding his
seizures since he was eighteen. He says they
started after a car crash. Julia enters the room,
and Brian leaves. Brian observes that things don’t
always look as they seem.
Campbell Summary

Campbell tells Julia he had a car accident the
night he took her home from his parent’s
house. The seizures started that night, and he
has hidden them from everyone ever since.
Judge, he explains, is an epilepsy dog, and he
broke up with Julia he didn’t think she should
have to live with his seizures. Julia tells
Campbell that you don’t love someone
because they’re perfect but in spite of their
imperfection. She also tells Campbell that she
will never leave him.
Anna Summary
Anna talks to Campbell alone. She asks him if he took her
case because he knows what it’s like not to have control
over his own body. He says “maybe.” They go back to the
courtroom and Anna takes the stand again. Campbell asks
Anna to confirm that Kate asked her to file the petition,
and Anna says that’s not exactly true. She says Kate asked
Anna to kill her.
 In a flashback, Anna finds Kate drunk with a bottle of pills.
Kate tells Anna she’s sick of waiting for something that’s
going to happen anyway, and she’s tired of ruining
everyone’s lives. But she admits that she can’t kill herself.
Anna realizes this means Kate has tried before. Back in the
courtroom in the present, Sara says Anna’s story isn’t true.
Anna tells her mother that Kate didn’t say anything because
she knew telling Sara would kill her, too. Anna also says she
doesn’t want Kate to die, but Kate doesn’t want to live the
way she’s been living. Anna, as always, is the only one who
can give her what she wants.

cntd.

In another flashback, Kate asks Anna not to
donate her kidney. She acknowledges that there
are so many things Anna could do if she weren’t
around. Anna feels ashamed to admit that she has
had the same thought. In the present, Campbell
asks Anna if she’s willing to take an action that
might kill her sister. Anna says Kate wanted it, but
admits that she wanted it, too. It would be the
worst and best thing to happen to her. Anna told
Kate she was going to be stop being a donor.
Kate thanked her.
Sara Summary

Judge DeSalvo moves the proceeding to the
hospital so he can talk to Kate. When they arrive,
Kate is watching TV with Jesse. Judge DeSalvo
speaks with Kate alone. When he leaves Kate’s
room, he tells Sara, Brian, and Campbell that he will
announce his decision the following morning.
Before Julia and Campbell leave, Campbell tells Sara
he is sorry. The entire family gathers in Kate’s room.
Anna tells Kate that she tried. Jesse jokes with Kate
to lighten the mood. Everyone leaves except for
Sara. She climbs into bed with Kate and tells her
how sorry she is. Kate tells her not to be, because
she isn’t.
Thursday Campbell Summary

On a rainy morning, Campbell wakes up with
Julia at his apartment. Campbell thinks about
Judge DeSalvo’s decision and echoes what
Anna says. No matter if they win or lose, it
won’t be over. Julia tells Campbell she hates
his apartment.
Jesse Summary

In the rain, Jesse goes to a soccer field and lies
down. He recalls lying down in other storms,
hoping to be struck by lightning so he would
feel alive.
Anna Summary

Anna thinks about the rain and how it never
really stops moving. She notes that rain goes
through a cycle, evaporates like a soul into the
clouds, and then like everything else, starts
over again.
Brian Summary

Brian recalls another rainy day, the New Year’s
Eve when Anna was born. Brian remembers
there were no stars that night. He also
remembers his decision to name Anna after
Andromeda, a princess in the sky between her
mother and father.
Sara Summary

Sara gives her closing arguments. She has note cards but
quickly abandons them. She tells Anna she loves her and
says that every day she wonders if she’s doing the right
thing. Sara says that even if Anna and Kate don’t agree
with her, she wants to be the one who’s right ten years
later, when they are all still together. Sara says she knows
the lawsuit was never really about donating a kidney but
about choice. She also knows that no one ever really
makes decisions by themselves. Sara makes an analogy to
a burning building. She says that in her life one child has
been in a burning building, and her other child has been
the only one who knew the way to save her. She
acknowledges that she might be risking the one child to
save the other, and that it might be unfair, but it’s the only
way she can save both children. She doesn’t know if it
was legal or moral, but she knows it was right.
Campbell Summary

In his closing arguments, Campbell says the case isn’t
about donating a kidney, but about a thirteen-year-old girl
who deserves the chance to figure out who she is going
to be. He says ultimately nothing else matters except
what Anna thinks. After a short recess, Judge Desalvo
returns with a picture of his daughter, who was killed by a
drunk driver. He acknowledges that they have entered
into a debate about the quality of life versus the sanctity
of life. He says the sanctity of Kate’s life has become
intertwined with the quality of Anna’s. He admits there is
no good answer, because morals are more important than
ethics, and love is more important than law. But he
decides that only Anna can decide how to treat her body.
He declares her medically emancipated and gives
Campbell medical power of attorney. Anna and her
parents hug.
Anna Summary

Campbell drives Anna to the hospital in the
pouring rain. Anna asks Campbell what he thinks
she should do, and he says it’s her choice now.
Campbell tells Anna he thinks she will be
amazing in ten years. Anna thinks about what
she wants to be and knows only that in ten
years she wants to be Kate’s sister.
Brian Summary

Responding to a call, Brian arrives at the scene of a car
crash. A large truck has crushed a small car. Campbell’s
dog comes whimpering out of the car just as Brian
realizes that Anna is one of the passengers. His fellow
firefighters try and hold him back, but he insists on
pulling Campbell out of the car and then Anna, who is
unconscious. At the hospital, Sara finds Brian. He doesn’t
know how to explain what happened. Campbell comes
out with his arm in a sling and asks about Anna. A doctor
tells them that Anna is brain dead and asks if they want
to consider organ donation. Brian thinks about twin
stars and how the first one can shine so bright that the
other may be gone before you notice it. Back in the
present, Campbell tells the doctor that he has medical
power of attorney over Anna, and a girl upstairs needs
Anna’s kidney.
Sara Summary

Sara observes that in the English language no
word exists for someone who loses a child. After
doctors remove Anna’s organs, they bring her
back down to the family. Everyone is there, and
Sara and Brian sit beside Anna. Sara says she has
spent years anticipating the loss of a daughter,
but she is still at a loss. Brian reminds Sara that
Anna is gone and that her body is just a shell.
Finally Brian turns off the respirator. Sara puts
her hand on Anna’s chest as her heart stops.
Epilogue Summary
The year is 2010, and Kate narrates in the first person. She
discusses grief and how, after Anna’s death, Brian believed
he could see Anna in the night sky and Sara thought Anna
would come back to her. Kate says she began to hate
herself. She blamed herself for Anna’s death.
 Kate stayed sick for a long time after the transplant, but
suddenly got better. Dr. Chance had medical explanations,
but Kate believed it was because someone had to go and
Anna took her place. Kate talks about the immediate
stages of grief in her family, how much her mother cried
and how much her father kept away. But she said one day
she laughed, and the very act of living started to ease the
pain.

Kate wonders if Anna keeps tabs on them, if she knows
they stayed close to Julia and Campbell and even went to
their wedding, and whether Anna saw Jesse’s graduation
from the police academy or witnessed Brian’s drinking
problem and how he gradually got better. She also
wonders if Anna knows that she teaches dance to little
girls now.
 One year after Anna’s death, Sara came home with a roll
of developed film from Kate’s high school graduation. The
last picture on the roll showed Anna. Sara and Kate stared
at the picture until they memorized every detail. Kate
fears a day will come when it will be harder to remember
Anna. But she knows she can lift her shirt and feel the
scar from where she received Anna’s kidney. She says she
takes Anna with her, wherever she goes.
