My Sister's Keeper

Anna reflects on all the ways children come into the world. She knows that her parents had her specifically because a scientist told them that she, as an embryo, was an allogeneic donor—an exact genetic match—to her older sister, Kate. Kate was diagnosed with acute promyelocytic leukemia (APL) when she was two. Anna has been donating blood cells and bone marrow to Kate since her birth 13 years ago.

Anna goes to a pawn shop to sell her locket, one her father gave her after she donated bone marrow to her sister when she was 5, and receives 20 dollars, much less than it’s worth. At home, Anna finds her mother, Sara, trying on evening dresses, a hobby she indulges when she can. As Anna helps her mother, Kate makes a noise down the hall and Sara rushes to check on her. It turns out Kate is crying over a couple on her favorite soap opera.

Late that afternoon, Anna counts the money she’s been saving. She has a total of roughly 137 dollars, and she hopes the lawyer she’s chosen, Campbell Alexander, will accept it. Anna goes to her 18-year-old brother’s room above the garage and asks him to drive her into town, as she has an appointment with Campbell. She waits in Campbell’s office, and he arrives a few minutes later with Judge, his service dog. Campbell tells her that he has an iron lung and Judge keeps him away from magnets. Anna tells Campbell that she wishes to sue her parents “for the rights to my body” (18).

Campbell mistakenly assumes Anna wants the right to take birth control, so he asks his secretary for the number to Planned Parenthood. However, Anna explains that her sister Kate is experiencing kidney failure and her parents want her to donate one of her own kidneys. She says her parents have never asked her for permission for such donations, and that she understands what will happen if she doesn’t. Campbell agrees to take her case, brushing off Anna’s attempt to pay him. After a brief conversation with his secretary, Kerri, Campbell locks himself in his office in response to Judge’s alerting.

The novel cuts to the past. Sara is an attorney who quit practicing in order to raise her two children, four-year-old Jesse and two-year-old Kate. As she bathes her children, she notices a bruise on Kate’s back. The following day, she oversleeps and learns that Kate is still asleep. When Sara goes to wake Kate, she finds a row of bruises on her back. At the pediatrician, Kate’s blood tests prompt the doctor to send her to the hospital. There, another doctor runs tests. Eventually, the doctor comes and tells Sara and her husband, Brian, that Kate has APL, an aggressive form of leukemia with a low survival rate. In bed that night, Brian cries while Sara promises not to allow Kate to die.

The novel returns to the present. Brian, a firefighter, goes home for family dinner and is the only one to notice among the usual family chaos that Anna seems quieter than usual. He asks Sara about Anna later, but Sara blows off his concern because she is focused on Kate. That night, Brian returns to the firehouse to have dinner with his crew, during which they briefly discuss a series of arsons they’ve been investigating. Anna visits her father at the fire station to enjoy the telescope on the roof, as he is an amateur astronomer.

Anna is at the hospital with Kate and Sara as Kate undergoes a dialysis treatment. Sara talks brightly about the way in which kidney transplants are done, but Anna thinks of all the things she’ll have to be cautious about if she were to donate a kidney (especially since she loves hockey). The sheriff, Vern Stackhouse, arrives and serves Sara legal papers. Anna knows these papers are for her petition for medical emancipation. Before Sara can react, Kate causes a distraction that allows Anna to leave the room and call Jesse for a ride home.

Sara and Brian confront Anna at home. The former insists that Anna doesn’t understand what she’s doing and demands she fire Campbell; Anna refuses despite her mother’s anger. Later, Kate expresses to Anna that Anna is her only friend. Anna’s parents eventually stand over her bed and discuss her actions. Sara insists that Anna is only looking for attention and suggests a few ways she and Brian can accommodate her. Brian suggests that the situation isn’t that simple, but Sara quickly dismisses him. After Brian leaves, Sara reassures Anna that they can fix things and that they’ll talk to Judge DeSalvo and make everything right.

The novel cuts to the past. Sara reaches out to her sister, Zanne (Suzanne), to inform her of Kate’s diagnosis. They meet with an oncologist, Dr. Harrison Chance, and learn that Kate will be given chemotherapy and, if necessary, the option of a bone marrow transplant. They are told that a sibling would be their best choice for a donor, but there is a list Kate can be placed on to find an unrelated donor. Sara and Brian have Jesse tested to see if he could be a match, but he isn’t.

Kate receives her first chemotherapy treatment and is left sick, suffering a serious infection after a few weeks. Zanne arrives and takes care of Jesse while Sara and Brian stay with Kate. Remembering something the oncologist said, Sara suggests to Brian that they have another child.