My Sister's Keeper

by Jodie Picoult

  A car passes by, its radio playing one of those songs that stations never play in winter. A blue stream of smoke flares out from Jesse's mouth. I wonder if he's ever been sailing. If there's a memory he's held on to all these years—sitting on the front lawn and feeling the grass cool down after sunset, holding a sparkler on the Fourth of July until it burned his fingers. We all have something.

  She left the note underneath the windshield wiper of my Jeep seventeen days after graduation. Before I even opened it I wondered how she got to Newport, how she made her way back. I carried it out to the Bay to read on the rocks; and after I was done I held it up and miffed at it, in case it smelled like her.

  I was not technically allowed to drive, but that hardly mattered. We met, as per that note, at the cemetery.

  Julia sat in front of the headstone, her arms clasped around her knees. She looked up when she saw me. "I wanted you to be different."

  "Julia, it's not you."

  "No?" She got to her feet. "I don't have a trust fund, Campbell. My father doesn't own a yacht. If you were crossing your fingers, expecting me to turn into Cinderella one of these days, you got it all wrong."

  "I don't care about any of that."

  "Bullshit you don't." Her eyes narrowed. "What did you think, that it would be fun to go slumming? Did you do it to piss off your parents? And now you can scrape me off your shoe like I'm something you stepped in by accident?" She struck out at me, clipping me across the chest. "I don't need you. I never needed you."

  "Well, I fucking needed you!" I shouted back at her. When she turned I grabbed her shoulders and I kissed her. I took the things I couldn't bring myself to say, and poured them into her.

  There are some things we do because we convince ourselves it would be better for everyone involved. We tell ourselves that it's the right thing to do, the altruistic thing to do. It's far easier than telling ourselves the truth.

  I pushed Julia away from me. Walked down that cemetery hill. Didn't look back.

  Anna sits in the passenger seat, which doesn't go over well with Judge. He hangs his sorry face into the front, right between us, panting up a storm. "Today wasn't a very good harbinger of what's to come," I tell her.

  "What are you talking about?"

  "If you want the right to make major decisions, Anna, then you need to start making them now. Not relying on the rest of the world to clean up the messes."

  She scowls at me. "This is all because I called you to help my brother? I thought you were my friend."

  "I already told you once I'm not your friend; I'm your attorney. There's a seminal difference."

  "Fine." She fumbles with the lock. "I'll go back to the police and tell them to rearrest Jesse." She nearly succeeds in pushing the passenger door open, although we are traveling on a highway. I grab the handle and slam it shut. "Are you crazy?”

  “I don't know," she answers. "I'd ask you what you think, but it's probably not in the job description."

  With a yank of the wheel, I pull the car to the shoulder of the road. "You know what I think? The reason no one ever asks you for your opinion about anything important is because you change your mind so often they don't know what to believe. Take me, for example. I don't even know if we're still petitioning a judge for medical emancipation."

  "Why wouldn't we be?"

  "Ask your mother. Ask Julia. Every time I turn around someone informs me that you don't want to go through with this." I look down at the armrest, where her hand sits—purple sparkle polish, nails bitten to the quick. "If you want to be treated like an adult by the court, you need to start acting like one. The only way I can fight for you, Anna, is if you can prove to everyone that you can fight for yourself when I walk away."

  I pull the car back onto the road, and glance at her sidelong, but Anna sits with her hands wedged between her thighs, her face set mutinously ahead. "We're almost at your house," I say dryly. "Then you can get out and give the door a good slam in my face."

  "We're not going to my house. I need to go to the fire station. My dad and I are staying there for a while."

  "Is it my imagination, or did I not spend a couple of hours at the family court yesterday arguing this very point? And I thought you told Julia that you didn't want to be separated from your mother? This is exactly what I'm talking about, Anna," I say, banging my hand on the steering wheel. "What the hell do you really want?"

  When she blows, it is remarkable. "You want to know what I want? I'm sick of being a guinea pig. I'm sick of nobody asking me how I feel about all this. I'm sick, but I'm never fucking sick enough for this family." She opens the car door while it is still moving, and takes off at a dead run to the firehouse, a few hundred feet in the distance.

  Well. Deep in the recesses of my little client is the potential to make other people listen. It means that on the stand, she'll hold up better than I imagined.

  And on the heels of that thought: Anna might be able to testify, but what she's said makes her seem unsympathetic. Immature, even. Or in other words, highly unlikely to convince the judge to rule in her favor.

  BRIAN

  FIRE AND HOPE ARE CONNECTED, just so you know. The way the Greeks told it, Zeus put Prometheus and Epimetheus in charge of creating life on earth. Epimetheus made the animals, giving out bonuses like swiftness and strength and fur and wings. By the time Prometheus made man, all the best qualities had been given out. He settled for making them walk upright, and he gave them fire.

  Zeus, pissed off, took it away. But Prometheus saw his pride and joy shivering and unable to cook. He lit a torch from the sun and brought it to man again. To punish Prometheus, Zeus had him chained to a rock, where an eagle fed on his liver. To punish man, Zeus created the first woman-Pandora-and gave her a gift, a box she was forbidden to open.

  Pandora's curiosity got the best of her, and one day she opened that box. Out came plagues and misery and mischief. She managed to shut the lid tight before hope escaped. It's the only weapon we have left to fight the others.

  Ask any fireman; he'll tell you it's true. Hell. Ask any father.

  "Come on up," I say to Campbell Alexander, when he arrives with Anna. "There's fresh coffee." He follows me up the stairs, his German shepherd trailing. I pour two cups. "What's the dog for?"

  "He's a chick magnet," the lawyer says. "Got any milk?"

  I pass him the carton from the fridge, then sit down with my own mug. It's quiet up here; the boys are downstairs washing the engines and doing their daily maintenance.

  "So." Alexander takes a sip of his coffee. "Anna tells me that you've both moved out."

  'Yeah. I sort of figured you might want to ask me about that."

  "You do realize that your wife is opposing counsel," he says carefully.

  I meet his eye. "I suppose by that you mean do I realize that I shouldn't be sitting here talking to you."

  "That only becomes an issue if your wife is still representing you."

  "I never asked Sara to represent me."

  Alexander frowns. "I'm not sure she's aware of that."

  "Look, with all due respect, this may seem like an incredibly big deal, and it is, but we have another incredibly big deal going on at the same time. Our older daughter's been hospitalized and… well, Sara's fighting on two fronts."

  "I know. And I'm sorry about Kate, Mr. Fitzgerald," he says.

  "Call me Brian." I cup my hands around my mug. "And I would like to speak to you… without Sara around."

  He leans back in the folding chair. "How about right now?"

  It's not a good time, but it will never be a good time for this. "Okay." I take a deep breath. "I think Anna's right."

  At first I'm not sure Campbell Alexander's even heard me. Then he asks, "Are you willing to tell that to the judge at a hearing?"

  I look down at my coffee. "I think I have to."

  By the time Paulie and I responded to this morning's ambulance call, the boyfriend already had the girl in a shower. She sat on the bottom, her legs splayed
around the drain, fully dressed. Her hair was matted to the front of her face, but even if it wasn't, I'd have known that she was unconscious.

  Paulie got right inside and started to drag her out. "Her name's Magda," the boyfriend said. "She's gonna be okay, right?"

  "Is she diabetic?"

  "What does that matter?"

  For Christ's sake. "Tell me what you were using," I demanded.

  "We were just getting drunk," the boyfriend said. 'Tequila."

  He was no more than seventeen. Old enough to have heard the myth that a shower will bring someone out of a heroin overdose. "Let me explain this to you. My buddy and I want to help Magda, to save her life. But if you tell me that she's got alcohol in her system and it turns out that it's a drug instead, whatever we give her could backfire and make her even worse. You get that?"

  By then, just outside the shower stall, Paulie had wrestled Magda out of her shirt. There were tracks up and down her arms. "If it's tequila, then they've been shooting it up. Coma cocktail?"

  I took the Narcan out of the paramedic bag and handed Paulie the equipment for a microdrip. "So, urn," the boy said, "you're not going to tell the cops, are you?"

  In one quick move, I grabbed him by the neck of his shirt and pushed him up against the wall. "Are you that fucking stupid?"

  "It's just that my parents will kill me."

  "You didn't seem to care much if you killed yourself. Or her." I jerked his head toward the girl, who by then was vomiting all over the floor. "You think life is something you can throw out like a piece of trash? You think you OD, and get a second chance?"

  I was yelling hard into his face. I felt a hand on my shoulder—Paulie. "Step down, Cap," he said under his breath.

  Slowly I realized that the kid was trembling in front of me, that he really had nothing to do with the reason I was yelling. I walked away to clear my head. Paulie finished up with the patient and then came back to me. "You know, if it's too much, we can cover for you," he offered. "The chief'll give you as much time off as you want."

  "I need to work." Over his shoulder I could see the girl pinking up; the boy sobbing into his hands beside her. I looked Paulie in the eye. "When I'm not here," I explained, "I have to be there."

  The lawyer and I finish up our coffee. "Second cup?" I offer.

  "I'd better not. I have to get back to the office."

  We nod at each other, but there is really nothing left to say. "Don't worry about Anna," I add. "I'll make sure she gets whatever she needs."

  'You might want to check in at home, too," Alexander says. "I just got your son released on PR bail for stealing a judge's Humvee."

  He puts his coffee cup in the sink and leaves me holding this information, knowing sooner or later, it will force me to my knees.

  SARA

  No MATTER HOW MANY TIMES you drive to the emergency room, it never becomes routine. Brian carries our daughter in his arms, blood running down her face. The triage nurse waves us inside, shepherds the other kids to the bank of plastic chairs where they can wait. A resident comes into the cubicle, all business. "What happened?"

  "She went over the handlebars of her bike," I said. "She landed on concrete. There doesn't seem to be any evidence of concussion, but there's a scalp lac at the hairline of about an inch and a half."

  The doctor lays her down gently on the table, snaps on gloves, and peers at her forehead. "Are you a doctor or a nurse?"

  I try to smile. "Just used to this."

  It takes eighty-two stitches to sew up the gash. Afterward, with a bright white patch of gauze taped to her head, and a hefty dose of pediatric Tylenol swimming through her veins, we walk out to the waiting area, hand in hand.

  Jesse asks her how many stitches she needed. Brian tells her she was just as brave as a firefighter. Kate glances at Anna's fresh bandage. "I like it better when I get to sit out here," she says.

  It starts when Kate screams in the bathroom. I race upstairs and jimmy the lock to find my nine-year-old standing in front of a toilet spattered with blood. Blood runs down her legs, too, and has soaked through her underpants. This is the calling card for APL—hemorrhage in all sorts of masks and disguises. Kate's had rectal bleeding before, but she was a toddler; she would not remember. "It's all right," I say calmly.

  I get a warm washcloth to clean her up, and find a sanitary napkin for her underwear. I watch her try to position the bulk of the pad between her legs. This is the moment I would have had with her when she got her period; will she live long enough for that?

  "Mom," Kate says. "It's back."

  "Clinical relapse." Dr. Chance takes off his glasses and presses his thumbs to the corners of his eyes. "I think a bone marrow transplant's the way to go."

  My mind jumps to a memory of an inflatable Bozo punching bag I had when I was Anna's age; filled with sand at the bottom, I'd whack it only to have it pop back up.

  "But a few months ago," Brian says, "you told us they were dangerous."

  "They are. Fifty percent of patients who receive BMTs are cured. The other half don't survive the chemo and the radiation leading up to the transplant. Some are killed by the complications they develop after the transplant's done."

  Brian looks at me, and then speaks the fear that ripples between us. "Then why would we even put Kate at risk?"

  "Because if you don't," Dr. Chance explains, "she will die."

  The first time I call the insurance company, they hang up on me by mistake. The second time, I wait through Muzak for twenty-two minutes before reaching a customer service representative. "Can I have your policy number?"

  I give her the one all municipal employees get, and Brian's Social Security number. "How can I help you?"

  "I spoke to someone there a week ago," I explain. "My daughter has leukemia, and needs a bone marrow transplant. The hospital explained that our insurance company needs to sign off on coverage."

  A bone marrow transplant costs from $100,000 upward. Needless to say, we don't have that kind of cash lying around. But just because a doctor has recommended the transplant doesn't mean that our insurance company will agree.

  "That sort of procedure needs a special review—"

  "Yes, I know. That's where we were a week ago. I'm calling because I haven't heard back from you yet."

  She puts me on hold, so that she can look up my file. I hear a subtle click, and then the tinny voice of a recorded operator. If you'd like to make a call…

  "Shit!" I slam down the phone.

  Anna, vigilant, pokes her head around the doorway. "You said a bad word."

  "I know." I pick up the receiver and hit the redial button. I wind my way through the touch-tone menu. Finally, I reach a living person. "I was just disconnected. Again."

  It takes this rep five more minutes to take down all the same numbers and names and history I have already given her predecessors. "We actually have reviewed your daughter's case," the woman says. "Unfortunately, at this time, we don't think that procedure is in her best interests."

  I feel heat rush to my face. "Is dying?"

  In preparation for the bone marrow harvest, I have to give Anna ongoing growth factor shots, just like I once gave Kate after her initial cord blood transplant. The intent is to hyper-pack Anna's marrow, so that when it is time to withdraw the cells, there will be plenty for Kate.

  Anna has been told this, too, but all she knows is that twice a day, her mother has to give her a shot.

  We use EMLA cream, a topical anesthetic. The cream is supposed to keep her from feeling the prick of the needle, but she still yells. I wonder if it hurts as much as having your six-year-old stare you in the eye and say she hates you.

  "Mrs. Fitzgerald," the insurance company's customer service supervisor says, "we appreciate where you're coming from. Truly.”

  “Somehow, I find that very hard to believe," I say. "Somehow I doubt that you have a daughter in a life-or-death situation, and that your advisory board isn't looking solely at the bottom line cost of a transplant."
I have told myself that I will not lose my temper, and already thirty seconds into this phone call with the insurance company, I have ceded the battle.

  "AmeriLife will pay ninety percent of what's considered reasonable and customary for a donor lymphocyte infusion. However, should you still choose to do a bone marrow transplant, we are willing to cover ten percent of the costs."

  I take a deep breath. "The doctors on your board who recommended this—what's their specialty?"

  "I don't—"

  "It’s not acute promyelocytic leukemia, though, is it? Because even an oncologist who graduated last in his class from some hack medical school in Guam could probably tell you that a DLI isn't going to work as a cure. That three months from now, we'll be having this same discussion again. Plus, if you'd asked a doctor who had any familiarity with my daughter's particular disease burden, he'd tell you that repeating a treatment that's already been tried is highly unlikely to produce results in an APL patient, because they develop a resistance. Which means that AmeriLife is basically agreeing to throw money down a toilet, but not to spend it on the one thing that might actually have a chance of saving my child's life."

  There is a pregnant bubble of silence on the other end of the phone. "Mrs. Fitzgerald," the supervisor suggests, "it is my understanding that if you follow this protocol, the insurance company would have no problems then paying for the transplant."

  "Except that my daughter might not be alive by then to get it. We aren't talking about a car, where we can try a used part first and if it doesn't work, get a new one shipped in. We're talking about a human being. A human being. Do you automatons there even know what the hell that is?"

  This time, I'm expecting the click when I am disconnected.

  Zanne shows up the night before we are due to go to the hospital to begin Kate's preparatory transplant regimen. She lets Jesse help her set up her portable office, takes a phone call from Australia, and then comes into the kitchen so that Brian and I can catch her up on daily routines. "Anna's got gymnastics on Tuesday," I tell her. "Three o'clock. And I expect the oil truck to come sometime this week."