My Sister's Keeper

by Jodie Picoult

  Kate's dialysis sessions run three times a week, for two hours at a time. She has a Mahhukar catheter, which looks just like her central line used to look and protrudes from the same spot on her chest. This gets hooked up to a machine that does the work her kidneys aren't doing. Kate's blood (well, it's my blood if you want to get technical about it) leaves her body through one needle, gets cleaned, and then goes into her body again through a second needle. She says it doesn't hurt. Mostly, it's just boring. Kate usually brings a book or her CD player and headphones. Sometimes we play games. "Go out into the hall and tell me about the first gorgeous guy you find," Kate'll instruct, or, "Sneak up on the janitor who surfs the Net and see whose naked pictures he's downloading." When she is tied to the bed, I am her eyes and her ears.

  Today, she is reading Allure magazine. I wonder if she even knows that every V-necked model she comes across she touches at the breastbone, in the same place where she has a catheter and they don't. "Well," my mother announces out of the blue, "this is interesting." She waves a pamphlet she's taken from the bulletin board outside Kate's room: You and Your New Kidney. "Did you know that they don't take out the old kidney? They just transplant the new one into you and hook it up."

  "That creeps me out," Kate says. "Imagine the coroner who cuts you open and sees you've got three instead of two."

  "I think the point of a transplant is so that the coroner won't be cutting you open anytime soon," my mother replies. This fictional kidney she's discussing resides right now in my own body.

  I've read that pamphlet, too.

  Kidney donation is considered relatively safe surgery, but if you ask me, the writer must have been comparing it to something like a heart-lung transplant, or some brain tumor removal. In my opinion, safe surgery is the kind where you go into the doctor's office and you're awake the whole time and the procedure is finished in five minutes—like when you have a wart removed or a cavity drilled. On the other hand, when you donate a kidney, you spend the night before the operation fasting and taking laxatives. You're given anesthesia, the risks of which can include stroke, heart attack, and lung problems. The four-hour surgery isn't a walk in the park, either—you have a I in 3,000 chance of dying on the operating table. If you don't, you are hospitalized for four to seven days, although it takes four to six weeks to fully recover. And that doesn't even include the long-term effects: an increased chance of high blood pressure, a risk of complications with pregnancy, a recommendation to refrain from activities where your lone remaining kidney might be damaged.

  Then again, when you get a wart removed or a cavity drilled, the only person who benefits in the long run is yourself.

  There is a knock on the door, and a familiar face peeks in. Vern Stackhouse is a sheriff, and therefore a member of the same public servant community as my father. He used to come over to our house every now and then to say hi or leave off Christmas presents for us; more recently, he's saved Jesse's butt by bringing him home from a scrape, rather than letting the justice system deal with him. When you're part of the family with the dying daughter, people cut you slack.

  Vern's face is like a souffle, caving in at the most unexpected places. He doesn't seem to know whether it's all right for him to enter the room. "Uh," he says. "Hi, Sara."

  "Vern!" My mother gets to her feet. "What are you doing at the hospital? Everything all right?"

  "Oh yeah, fine. I'm just here on business."

  "Serving papers, I suppose."

  "Um-hmm." Vern shuffles his feet and stuffs his hand inside his jacket, like Napoleon. "I'm real sorry about this, Sara," he says, and then he holds out a document.

  Just like Kate, all the blood leaves my body. I couldn't move if I wanted to.

  "What the… Vern, am I being sued?" My mother's voice is far too quiet.

  "Look, I don't read them. I just serve them. And your name, it was right there on my list. If, uh, there's anything I…" He doesn't even finish his sentence. With his hat in his hands, he ducks back out the door.

  "Mom?" Kate asks. "What's going on?"

  "I have no idea." She unfolds the papers. I'm close enough to read them over her shoulder. THE STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS, it says right across the top, official as can be. FAMILY COURT FOR PROVIDENCE COUNTY. IN RE: ANNA FITZGERALD, A.K.A. JANE DOE.

  PETITION FOR MEDICAL EMANCIPATION.

  Oh shit, I think. My cheeks are on fire; my heart starts to pound. I feel like I did the time the principal sent home a disciplinary notice because I drew a sketch of Mrs. Toohey and her colossal butt in the margin of my math textbook. No, actually, scratch that—it's a million times worse.

  That she gets to make all future medical decisions.

  That she not be forced to submit to medical treatment which is not in her best interests or for her benefit.

  That she not be required to undergo any more treatment for the benefit of her sister, Kate.

  My mother lifts her face to mine. "Anna," she whispers, "what the hell is this?"

  It feels like a fist in my gut, now that it's here and happening. I shake my head. What can I possibly tell her?

  "Anna!" She takes a step toward me.

  Behind her, Kate cries out. "Mom, ow, Mom… something hurts, get the nurse!"

  My mother turns halfway. Kate is curled onto her side, her hair spilling over her face. I think that through the fall of it, she's looking at me, but I cannot be sure. "Mommy," she moans, "please."

  For a moment, my mother is caught between us, a soap bubble. She looks from Kate to me and back again.

  My sister's in pain, and I'm relieved. What does that say about me?

  The last thing I see as I run out of the room is my mother pushing the nurse's call button over and over, as if it's the trigger to a bomb.

  I can't hide in the cafeteria, or the lobby, or anywhere else that they will expect me to go. So I take the stairs to the sixth floor, the maternity ward. In the lounge, there is only one phone, and it is being used. "Six pounds eleven ounces," the man says, smiling so hard I think his face might splinter. "She's perfect."

  Did my parents do this when I came along? Did my father send out smoke signals; did he count my fingers and toes, sure he'd come up with the finest number in the universe? Did my mother kiss the top of my head and refuse to let the nurse take me away to be cleaned up? Or did they simply hand me away, since the real prize had been clamped between my belly and the placenta?

  The new father finally hangs up the phone, laughing at absolutely nothing. "Congratulations," I say, when what I really want to tell him is to pick up that baby of his and hold her tight, to set the moon on the edge of her crib and to hang her name up in stars so that she never, ever does to him what I have done to my parents.

  I call Jesse collect. Twenty minutes later, he pulls up to the front entrance. By now, Deputy Stackhouse has been notified that I've gone missing; he's waiting at the door when I exit. "Anna, your mom's awfully worried about you. She's paged your dad. He's got the whole hospital being turned inside out."

  I take a deep breath. "Then you better go tell her I'm okay," I say, and I jump into the passenger door that Jesse's opened for me.

  He peels away from the curb and lights a Merit, although I know for a fact he told my mother he stopped smoking. He cranks up his music, hitting the flat of his hand on the edge of the steering wheel. It isn't until he pulls off the highway at the exit for Upper Darby that he shuts the radio off and slows down. "So. Did she blow a gasket?"

  "She paged Dad away from work."

  In our family, it is a cardinal sin to page my father away. Since his job is emergencies, what crisis could we possibly have that compares? "Last time she paged Dad," Jesse informs me, "Kate was getting diagnosed."

  "Great." I cross my arms. "That makes me feel infinitely better."

  Jesse just smiles. He blows a smoke ring. "Sis," he says, "welcome to the Dark Side."

  They come in like a hurricane. Kate barely manages to look at me before my father s
ends her upstairs to our room. My mother whacks her purse down, then her car keys, and then advances on me. "All right," she says, her voice so tight it might snap. "What's going on?"

  I clear my throat. "I got a lawyer."

  "Evidently." My mother grabs the portable phone and hands it to me. "Now get rid of him."

  It takes enormous effort, but I manage to shake my head and the phone into the cushions of the couch.

  "Anna, so help me—"

  "Sara." My father's voice is an ax. It comes between us, and sends us both spinning. "I think we need to give Anna a chance to explain- We agreed to give her a chance to explain, right?"

  I duck my head. "I don't want to do it anymore."

  That ignites my mother. "Well, you know Anna, neither do In fact, neither does Kate. But it's not something we have a choice about-'

  The thing is, I do have a choice. Which is exactly why I have the one to do this.

  My mother stands over me. "You went to a lawyer and made him think this is all about you—and it's not. It's about us. All of us—"

  My father's hands curl around her shoulders and squeeze-crouches down in front of me, I smell smoke. He's come from someone else's fire right into the middle of this one, and for this and nothing else. I'm embarrassed. "Anna, honey, we know you think you were something you needed to do—'

  "/ don't think that," my mother interrupts.

  My father closes his eyes. "Sara. Dammit, shut up." Then he looks at me again. "Can we talk, just us three, without a lawyer having to talk for us?"

  What he says makes my eyes fill up. But I knew this was coming—I lift my chin and let the tears go at the same time. "Daddy, I can't—“

  "For God's sake, Anna," my mother says. "Do you even realize what the consequences would be?"

  My throat closes like the shutter of a camera, so that any air must move through a tunnel as thin as a pin. I'm invisible I think, and realize too late I have spoken out loud.

  My mother moves so fast I do not even see it coming. But she slaps my face hard enough to make my head snap backward. She leaves a print that stains me long after it's faded. Just so you know: shame is five-fingered.

  Once, when Kate was eight and I was five, we had a fight and decided we no longer wanted to share a room. Given the size of our house, though, and the fact that Jesse lived in the other spare bedroom, we didn't have anywhere else to go. So Kate, being older and wiser, decided to split our space in half. "Which side do you want?" she asked diplomatically. "I'll even let you pick."

  Well, I wanted the part with my bed in it. Besides, if you divided the room in two, the half with my bed would also, by default, have the box that held all our Barbie dolls and the shelves where we kept our arts and crafts supplies. Kate went to reach for a marker there, but I stopped her. "That's on my side," I pointed out.

  "Then give me one," she demanded, so I handed her the red. She climbed up onto the desk, reaching as high as she could toward the ceiling. "Once we do this," she said, "you stay on your side, and I stay on my side, right?" I nodded, just as committed to keeping up this bargain as she was. After all, I had all the good toys. Kate would be begging me for a visit long before I'd be begging her.

  "Swear it?" she asked, and we made a pinky promise.

  She drew a jagged line from the ceiling, over the desk, across the tan carpet, and back up over the nightstand up the opposite wall. Then she handed me the marker. "Don't forget," she said. "Only cheats go back on a promise."

  I sat on the floor on my side of the room, removing every single Barbie we owned, dressing and undressing them, making a big fuss out of the fact that I had them and Kate didn't. She perched on her bed with her knees drawn up, watching me. She didn't react at all. Until, that is, my mother called us down for lunch.

  Then Kate smiled at me, and walked out the door of the bedroom—which was on her side.

  I went up to the line she had drawn on the carpet, kicking at it with my toes. I didn't want to be a cheat. But I didn't want to spend the rest of my life in my room, either.

  I do not know how long it took my mother to wonder why I wasn't coming to the kitchen for lunch, but when you are five, even a second can last forever. She stood in the doorway, staring at the line of marker on the walls and carpet, and closed her eyes for patience. She walked into our room and picked me up, which was when I started fighting her. "Don't," I cried. "I won't ever get back in!"

  A minute later she left, and returned with pot holders, dishtowels, and throw pillows. She placed these at odd distances, all along Kate's side of the room. "Come on," she urged, but I did not move. So she came and sat down beside me on my bed. "It may be Kate's pond," she said, "but these are my lily pads." Standing, she jumped onto a dish-towel, and from there, onto a pillow. She glanced over her shoulder, until I climbed onto the dishtowel. From the dishtowel, to the pillow, to a pot holder Jesse had made in first grade, all the way across Kate's side of the room. Following my mother's footsteps was the surest way out.

  I am taking a shower when Kate jimmies the lock and comes into the bathroom. "I want to talk to you," she says.

  I poke my head out from the side of the plastic curtain. "When I'm finished," I say, trying to buy time for the conversation I don't really want to have.

  "No, now." She sits down on the lid of the toilet and sighs. "Anna… what you're doing—"

  "It's already done," I say.

  "You can undo it, you know, if you want."

  I am grateful for all the steam between us, because I couldn't bear the thought of her being able to see my face right now. "I know," I whisper.

  For a long time, Kate is silent. Her mind is running in circles, like a gerbil on a wheel, the same way mine is. Chase every rung of possibility, and you still get absolutely nowhere.

  After a while, I peek my head out again. Kate wipes her eyes and looks up at me. "You do realize," she says, "that you're the only friend I've got?"

  "That's not true," I immediately reply, but we both know I'm lying.

  Kate has spent too much time out of organized school to find a group she fits into. Most of the friends she has made during her long stretch of remission have disappeared—a mutual thing. It turned out to be too hard for an average kid to know how to act around someone on the verge of dying; and it was equally as difficult for Kate to get honestly excited about things like homecoming and SATs, when there was no guarantee she'd be around to experience them. She's got a few acquaintances, sure, but mostly when they come over they look like they're serving out a sentence, and sit on the edge of Kate's bed counting down the minutes until they can leave and thank God this didn't happen to them.

  A real friend isn't capable of feeling sorry for you.

  "I'm not your friend," I say, yanking the curtain back into place. "I'm your sister." And doing a damn lousy job at that, I think. I push my face into the shower spray, so that she cannot tell I'm crying, too.

  Suddenly, the curtain whips aside, leaving me totally bare. "That's what I wanted to talk about," Kate says. "If you don't want to be my sister anymore, that's one thing. But I don't think I could stand to lose you as a friend."

  She pulls the curtain back into place, and the steam rises around me. A moment later I hear the door open and close, and the knife-slice of cold air that comes on its heels.

  I can't stand the thought of losing her, either.

  That night, once Kate falls asleep, I crawl out of my bed and stand beside hers. When I hold my palm up under her nose to see if she's breathing, a mouthful of air presses against my hand. I could push down, now, over that nose and mouth, hold her when she fights. How would that really be any different than what I am already doing?

  The sound of footsteps in the hallway has me diving underneath the cave of my covers. I turn onto my side, away from the door, just in case my eyelids are still flickering by the time my parents enter the room. "I can't believe this," my mother whispers. "I just can't believe she's done this."

  My father is so quiet tha
t I wonder if maybe I have been mistaken, if maybe he isn't here at all.

  "This is Jesse, all over again," my mother adds. "She's doing it for the attention." I can feel her looking down at me, like I'm some kind of creature she's never seen before. "Maybe we need to take her some-where, alone. Go to a movie, or shopping, so she doesn't feel left out. Make her see that she doesn't have to do something crazy to get us to notice her. What do you think?"

  My father takes his time answering. "Well," he says quietly, "maybe this isn't crazy."

  You know how silence can push in at your eardrums in the dark, make you deaf? That's what happens, so that I almost miss my mother's answer. "For God's sake, Brian… whose side are you on?"

  And my father: "Who said there were sides?"

  But even I could answer that for him. There are always sides. There is always a winner, and a loser. For every person who gets, there's someone who must give.

  A few seconds later, the door closes, and the hall light that has been dancing on the ceiling disappears. Blinking, I roll onto my back—and find my mother still standing beside my bed. "I thought you were gone," I whisper.

  She sits down on the foot of my bed and I inch away. But she puts her hand on my calf before I move too far. "What else do you think, Anna?"

  My stomach squeezes tight. "I think… I think you must hate me."

  Even in the dark, I can see the shine of her eyes. "Oh, Anna," my mother sighs, "how can you not know how much I love you?"

  She holds out her arms and I crawl into them, as if I'm small again and I fit there. I press my face hard into her shoulder. What I want, more than anything, is to turn back time a little. To become the kid I used to be, who believed whatever my mother said was one hundred percent true and right without looking hard enough to see the hairline cracks.

  My mother holds me tighter. "We'll talk to the judge and explain it. We can fix this," she says. "We can fix everything." And because those words are really all I've ever wanted to hear, I nod.