My Sister's Keeper: A Novel

by Jodi Picoult

  One more moment, and then the woman storms away, her clogs striking the tile floor. The minute she is out of sight I wilt.

  “Sara,” Brian says. “What’s the matter with you?”

  “What’s the matter with me? I don’t know, Brian, because no one is coming to tell us what’s wrong with—”

  He wraps me in his arms, Kate caught between us like a gasp. “Ssh,” he says. He tells me it’s going to be all right, and for the first time in my life I don’t believe him.

  Suddenly Dr. Farquad, whom we have not seen for hours, comes into the room. “I hear there was a little problem with the coagulopathy panel.” She pulls up a chair in front of us. “Kate’s complete blood count had some abnormal results. Her white blood count is very low—1.3. Her hemoglobin is 7.5, her hematocrit is 18.4, her platelets are 81,000, and her neutrophils are 0.6. Numbers like that sometimes indicate an autoimmune disease. But Kate’s also presenting with twelve percent promyelocytes, and five percent blasts, and that suggests a leukemic syndrome.”

  “Leukemic,” I repeat. The word is runny, slippery, like the white of an egg.

  Dr. Farquad nods. “Leukemia is a blood cancer.”

  Brian only stares at her, his eyes fixed. “What does that mean?”

  “Think of bone marrow as a childcare center for developing cells. Healthy bodies make blood cells that stay in the marrow until they’re mature enough to go out and fight disease or clot or carry oxygen or whatever it is that they’re supposed to do. In a person with leukemia, the childcare-center doors are opened too early. Immature blood cells wind up circulating, unable to do their job. It’s not always odd to see promyelocytes in a CBC, but when we checked Kate’s under a microscope, we could see abnormalities.” She looks in turn at each of us. “I’ll need to do a bone marrow aspiration to confirm this, but it seems that Kate has acute promyelocytic leukemia.”

  My tongue is pinned by the weight of the question that, a moment later, Brian forces out of his own throat: “Is she . . . is she going to die?”

  I want to shake Dr. Farquad. I want to tell her I will draw the blood for the coag panel myself from Kate’s arms if it means she will take back what she said. “APL is a very rare subgroup of myeloid leukemia. Only about twelve hundred people a year are diagnosed with it. The rate of survival for APL patients is twenty to thirty percent, if treatment starts immediately.”

  I push the numbers out of my head and instead sink my teeth into the rest of her sentence. “There’s a treatment,” I repeat.

  “Yes. With aggressive treatment, myeloid leukemias carry a survival prognosis of nine months to three years.”

  Last week, I had stood in the doorway of Kate’s bedroom, watching her clutch a satin security blanket in her sleep, a shred of fabric she was rarely without. You mark my words, I had whispered to Brian. She’ll never give that up. I’m going to have to sew it into the lining of her wedding dress.

  “We’ll need to do that bone marrow aspiration. We’ll sedate her with a light general anesthetic. And we can draw the coag panel while she’s asleep.” The doctor leans forward, sympathetic. “You need to know that kids beat the odds. Every single day.”

  “Okay,” Brian says. He claps his hands together, as if he is gearing up for a football game. “Okay.”

  Kate pulls her head away from my shirt. Her cheeks are flushed, her expression wary.

  This is a mistake. This is someone else’s unfortunate vial of blood that the doctor has analyzed. Look at my child, at the shine of her flyaway curls and the butterfly flight of her smile—this is not the face of someone dying by degrees.

  I have only known her for two years. But if you took every memory, every moment, if you stretched them end to end—they’d reach forever.

  • • •

  They roll up a sheet and tuck it under Kate’s belly. They tape her down to the examination table, two long strips. One nurse strokes Kate’s hand, even after the anesthesia has kicked in and she’s asleep. Her lower back is bared for the long needle that will go into her iliac crest to extract marrow.

  When they gently turn Kate’s face to the other side, the tissue paper beneath her cheek is damp. I learn from my own daughter that you don’t have to be awake to cry.

  • • •

  Driving home, I am struck by the sudden thought that the world is inflatable—trees and grass and houses ready to collapse with the single prick of a pin. I have the sense that if I veer the car to the left, smash through the picket fence and the Little Tykes playground, it will bounce us back like a rubber bumper.

  We pass a truck. Batchelder Casket Company, it reads on the side. Drive Safely. Isn’t that a conflict of interest?

  Kate sits in her car seat, eating animal crackers. “Play,” she commands.

  In the rearview mirror, her face is luminous. Objects are closer than they appear. I watch her hold up the first cracker. “What does the tiger say?” I manage.

  “Rrrroar.” She bites off its head, then waves another cracker.

  “What does the elephant say?”

  Kate giggles, then trumpets through her nose.

  I wonder if it will happen in her sleep. Or if she will cry. If there will be some kind nurse who gives her something for the pain. I envision my child dying, while she is happy and laughing two feet behind me.

  “Giraffe say?” Kate asks. “Giraffe?”

  Her voice, it’s so full of the future. “Giraffes don’t say anything,” I answer.

  “Why?”

  “Because that’s how they’re born,” I tell her, and then my throat swells shut.

  • • •

  The phone rings just as I come in from the neighbor’s house, having arranged for her to take care of Jesse while we take care of Kate. We have no protocol for this situation. Our only baby-sitters are still in high school; all four grandparents are deceased; we’ve never dealt with day care providers—taking care of the children is my job.

  By the time I come into the kitchen, Brian is well into conversation with the caller. The phone cord is wrapped around his knees, an umbilicus. “Yeah,” he says, “hard to believe. I haven’t made it into a single game this season . . . no point, now that they’ve traded him.” His eyes meet mine as I put on the kettle for tea. “Oh, Sara’s great. And the kids, uh-huh, they’re fine. Right. You give my best to Lucy. Thanks for calling, Don.” He hangs up. “Don Thurman,” he explains. “From the fire academy, remember? Nice guy.”

  As he stares at me, the genial smile sloughs off his face. The teakettle starts to whistle, but neither of us makes a motion to move it off the burner. I look at Brian, cross my arms.

  “I couldn’t,” he says quietly. “Sara, I just couldn’t.”

  • • •

  In bed that night, Brian is an obelisk, another shape breaking the darkness. Although we have not spoken for hours, I know that he is every bit as awake as I am.

  This is happening to us because I yelled at Jesse last week, yesterday, moments ago. This is happening because I didn’t buy Kate the M&Ms she wanted at the grocery store. This is happening because once, for a split second, I wondered what my life would have been like if I’d never had children. This is happening because I did not realize how good I have it.

  “Do you think we did it to her?” Brian asks.

  “Did it to her?” I turn to him. “How?”

  “Like, our genes. You know.”

  I don’t respond.

  “Providence Hospital doesn’t know anything,” he says fiercely. “Do you remember when the chief’s son broke his left arm, and they put a cast on the right one?”

  I stare at the ceiling again. “Just so you know,” I say, more loudly than I’ve intended, “I’m not going to let Kate die.”

  There is an awful sound beside me—an animal wounded, a drowning gasp. Then Brian presses his face against my shoulder, sobs into my skin. He wraps his arms around me and holds on as if he’s losing his balance. “I’m not,” I repeat, but even to myself, it sounds li
ke I am trying too hard.

  BRIAN

  FOR EVERY NINETEEN DEGREES HOTTER a fire burns, it doubles in size. This is what I am thinking while I watch sparks shoot out of the incinerator chimney, a thousand new stars. The dean of Brown University’s medical school wrings his hands beside me. In my heavy coat, I am sweating.

  We’ve brought an engine, a ladder, and a rescue truck. We have assessed all four sides of the building. We’ve confirmed that no one is inside. Well, except for the body that got stuck in the incinerator, and caused this.

  “He was a large man,” the dean says. “This is what we always do with the subjects when the anatomy classes are through.”

  “Hey, Cap,” Paulie yells. Today, he is my main pump operator. “Red’s got the hydrant dressed. You want me to charge a line?”

  I am not certain, yet, that I will take a hose up. This furnace was designed to consume remains at 1,600 degrees Fahrenheit. There is fire above and below the body.

  “Well?” the dean says. “Aren’t you going to do something?”

  It is the biggest mistake rookies make: the assumption that fighting a fire means rushing in with a stream of water. Sometimes, that makes it worse. In this case, it would spread biohazardous waste all over the place. I’m thinking we need to keep the furnace closed, and make sure the fire doesn’t get out of the chimney. A fire can’t burn forever. Eventually, it consumes itself.

  “Yes,” I tell him. “I’m going to wait and see.”

  • • •

  When I work the night shift, I eat dinner twice. The first meal is early, an accommodation made by my family so that we can all sit around a table together. Tonight, Sara makes a roast beef. It sits on the table like a sleeping infant as she calls us for supper.

  Kate is the first to slip into her seat. “Hey baby,” I say, squeezing her hand. When she smiles at me, it doesn’t reach her eyes. “What have you been up to?”

  She pushes her beans around her plate. “Saving Third World countries, splitting a few atoms, and finishing up the Great American Novel. In between dialysis, of course.”

  “Of course.”

  Sara turns around, brandishing a knife. “Whatever I did,” I say, shrinking away, “I’m sorry.”

  She ignores me. “Carve the roast, will you?”

  I take the carving utensils and slice into the roast beef just as Jesse sloughs into the kitchen. We allow him to live over the garage, but he is required to eat with us; it’s part of the bargain. His eyes are devil-red; his clothes are ringed with sweet smoke. “Look at that,” Sara sighs, but when I turn, she is staring at the roast. “It’s too rare.” She picks the pan up with her bare hands, as if her skin is coated with asbestos. She sticks the beef back into the oven.

  Jesse reaches for a bowl of mashed potatoes and begins to heap them onto his plate. More, and more, and more again.

  “You reek,” Kate says, waving her hand in front of her face.

  Jesse ignores her, taking a bite of his potatoes. I wonder what it says about me, that I am actually thrilled I can identify pot running through his system, as opposed to some of the others—Ecstasy, heroin, and God knows what else—which leave less of a trace.

  “Not all of us enjoy Eau de Stoned,” Kate mutters.

  “Not all of us can get our drugs through a portacath,” Jesse answers.

  Sara holds up her hands. “Please. Could we just . . . not?”

  “Where’s Anna?” Kate asks.

  “Wasn’t she in your room?”

  “Not since this morning.”

  Sara sticks her head through the kitchen door. “Anna! Dinner!”

  “Look at what I bought today,” Kate says, plucking at her T-shirt. It is a psychedelic tie-dye, with a crab on the front, and the word Cancer. “Get it?”

  “You’re a Leo.” Sara looks like she is on the verge of tears.

  “How’s that roast coming?” I ask, to distract her.

  Just then, Anna enters the kitchen. She throws herself into her chair and ducks her head. “Where have you been?” Kate says.

  “Around.” Anna looks down at her plate, but makes no effort to serve herself.

  This is not Anna. I am used to struggling with Jesse, to lightening Kate’s load; but Anna is our family’s constant. Anna comes in with a smile. Anna tells us about the robin she found with a broken wing and a blush on its cheek; or about the mother she saw at Wal-Mart with not one but two sets of twins. Anna gives us a backbeat, and seeing her sitting there unresponsive makes me realize that silence has a sound.

  “Something happen today?” I ask.

  She looks up at Kate, assuming the question has been put to her sister, and then startles when she realizes I am talking to her. “No.”

  “You feel okay?”

  Again, Anna does a double take; this is a question we usually reserve for Kate. “Fine.”

  “Because you’re, you know, not eating.”

  Anna looks down on her plate, notices that it’s empty, and then heaps it high with food. She shovels green beans into her mouth, two forkfuls.

  Out of the blue I remember when the kids were little, crammed into the back of the car like cigars wedged in a box, and I would sing to them. Anna anna bo banna, banana fanna fo fanna, me my mo manna . . . Anna. (“Chuck,” Jesse would yell out. “Do Chuck!”)

  “Hey.” Kate points to Anna’s neck. “Your locket’s missing.”

  It’s the one I gave her, years ago. Anna’s hand comes up to her collarbone. “Did you lose it?” I ask.

  She shrugs. “Maybe I’m just not in the mood to wear it.”

  She’s never taken it off, far as I know. Sara pulls the roast out of the oven and sets it on the table. As she picks up the knife to carve, she looks over at Kate. “Speaking of things we’re not in the mood to wear,” she says, “go put on another shirt.”

  “Why?”

  “Because I said so.”

  “That’s not a reason.”

  Sara spears the roast with the knife. “Because I find it offensive at the dinner table.”

  “It’s not any more offensive than Jesse’s metalhead shirts. What’s the one you had on yesterday? Alabama Thunder Pussy?”

  Jesse rolls his eyes toward her. It’s an expression I’ve seen before: the horse in a spaghetti Western, gone lame, the moment before it’s shot for mercy.

  Sara saws through the meat. Pink before, now it is an overcooked log. “Now look,” she says. “It’s ruined.”

  “It’s fine.” I take the one piece she has managed to dissect from the rest and cut a smaller bite. I might as well be chewing leather. “Delicious. I’m just gonna run down to the station and get a blowtorch so that we can serve everyone else.”

  Sara blinks, and then a laugh bubbles out of her. Kate giggles. Even Jesse cracks a smile.

  This is when I realize that Anna has already left the table, and more importantly, that nobody noticed.

  • • •

  Back at the station, the four of us sit upstairs in the kitchen. Red’s got some kind of sauce going on the stove; Paulie reads the ProJo, and Caesar’s writing a letter to this week’s object of lust. Watching him, Red shakes his head. “You ought to just keep that filed on disk and print multiple copies at a time.”

  Caesar’s just a nickname. Paulie coined it years ago, because he’s always roamin’. “Well, this one’s different,” Caesar says.

  “Yeah. She’s lasted two whole days.” Red pours the pasta into the colander in the sink, steam rising up around his face. “Fitz, give the boy some pointers, will you?”

  “Why me?”

  Paulie glances up over the rim of the paper. “Default,” he says, and it’s true. Paulie’s wife left him two years ago for a cellist who’d swung through Providence on a symphony tour; Red’s such a confirmed bachelor he wouldn’t know what a lady was if she came up and bit him. On the other hand, Sara and I have been married twenty years.

  Red sets a plate down in front of me as I start to talk. “A woman,” I say,
“isn’t all that different from a bonfire.”

  Paulie tosses down the paper and hoots. “Here we go: the Tao of Captain Fitzgerald.”

  I ignore him. “A fire’s a beautiful thing, right? Something you can’t take your eyes off, when it’s burning. If you can keep it contained, it’ll throw light and heat for you. It’s only when it gets out of control that you have to go on the offensive.”

  “What Cap is trying to tell you,” Paulie says, “is that you need to keep your date away from crosswinds. Hey, Red, you got any Parmesan?”

  We sit down to my second dinner, which usually means that the bells will ring within minutes. Firefighting is a world of Murphy’s Law; it is when you can least afford a crisis that one crops up.

  “Hey, Fitz, do you remember the last dead guy who got stuck?” Paulie asks. “Back when we were vollies?”

  God, yes. A fellow who weighed five hundred pounds if he weighed an ounce, who’d died of heart failure in his bed. The fire department had been called in on that one by the funeral home, which couldn’t get the body downstairs. “Ropes and pulleys,” I recall out loud.

  “And he was supposed to be cremated, but he was too big . . .” Paulie grins. “Swear to God, as my mother’s up in Heaven, they had to take him to a vet instead.”

  Caesar blinks up at him. “What for?”

  “How do you think they get rid of a dead horse, Einstein?”

  Putting two and two together, Caesar’s eyes widen. “No kidding,” he says, and on second thought, pushes away Red’s pasta Bolognese.

  “Who do you think they’ll ask to clean out the med school chimney?” Red says.

  “The poor OSHA bastards,” Paulie answers.

  “Ten bucks says they call here and tell us it’s our job.”

  “There won’t be any call,” I say, “because there won’t be anything left to clean out. That fire was burning too hot.”

  “Well, at least we know this one wasn’t arson,” Paulie mutters.

  In the past month, we have had a rash of fires set intentionally. You can always tell—there will be splash patterns of flammable liquid, or multiple points of origin, or smoke that burns black, or an unusual concentration of fire in one spot. Whoever is doing this is smart, too—at several structures the combustibles have been put beneath stairs, to cut off our access to the flames. Arson fires are dangerous because they don’t follow the science we use to combat them. Arson fires are the structures most likely to collapse around you while you’re inside fighting them.