My Sister's Keeper

by Jodi Picoult

  "Thirty-one," I tell him. This is my due date. "How about you?"

  "Nine. Because it can be a number, or how old you are, or a six standing on its head." He pauses only long enough to take a breath. "Mom? Do we have special scissors to cut meat?"

  "We do." I take a right and drive past a cemetery, headstones canted forward and back like a set of yellowed teeth.

  "Mom?" Jesse asks, "is that where Kate will go?"

  The question, just as innocent as any of the others Jesse would ask, makes my legs go weak. I pull the car over and put on my hazard lights. Then I unbuckle my seat belt and turn around. "No, Jess," I tell him. "She's staying with us."

  *

  "Mr. and Mrs. Fitzgerald?" the producer says. "This is where we'll put you."

  We sit down on the set at the TV studio. We've been invited here because of our baby's unorthodox conception. Somehow, in an effort to keep Kate healthy, we've unwittingly become the poster children for scientific debate.

  Brian reaches for my hand as we are approached by Nadya Carter, the reporter for the newsmagazine. "We're just about ready. I've already taped an intro about Kate. All I'm going to do is ask you a few questions, and we'll be finished before you know it."

  Just before the camera starts rolling, Brian wipes his cheeks on the sleeve of his shirt. The makeup artist, standing behind the lights, moans. "Well, for God's sake," he whispers to me. "I'm not going on national TV wearing blush."

  The camera comes to life with far less ceremony than I've expected, just a little hum that runs up my arms and legs.

  "Mr. Fitzgerald," Nadya says, "can you explain to us why you chose to visit a geneticist in the first place?"

  Brian looks at me. "Our three-year-old daughter has a very aggressive form of leukemia. Her oncologist suggested we find a bone marrow donor--but our oldest son wasn't a genetic match. There's a national registry, but by the time the right donor comes along for Kate, she might not . . . be around. So we thought it might be a good idea to see if another sibling of Kate's matched up."

  "A sibling," Nadya says, "who doesn't exist."

  "Not yet," Brian replies.

  "What made you turn to a geneticist?"

  "Time constraints," I say bluntly. "We couldn't keep having babies year after year until one was a match for Kate. The doctor was able to screen several embryos to see which one, if any, would be the ideal donor for Kate. We were lucky enough to have one out of four--and it was implanted through IVF."

  Nadya looks down at her notes. "You've received hate mail, haven't you?"

  Brian nods. "People seem to think that we're trying to make a designer baby."

  "Aren't you?"

  "We didn't ask for a baby with blue eyes, or one that would grow to be six feet tall, or one that would have an IQ of two hundred. Sure, we asked for specific characteristics--but they're not anything anyone would ever consider to be model human traits. They're just Kate's traits. We don't want a superbaby; we just want to save our daughter's life."

  I squeeze Brian's hand. God, I love him.

  "Mrs. Fitzgerald, what will you tell this baby when she grows up?" Nadya asks.

  "With any luck," I say, "I'll be able to tell her to stop bugging her sister."

  *

  I go into labor on New Year's Eve. The nurse taking care of me tries to distract me from my contractions by talking about the signs of the sun. "This one, she's gonna be a Capricorn," Emelda says as she rubs my shoulders.

  "Is that good?"

  "Oh, Capricorns, they get the job done."

  Inhale, exhale. "Good . . . to . . . know," I tell her.

  There are two other babies being born. One woman, Emelda says, has her legs crossed. She's trying to make it to 1991. The New Year's Baby is entitled to packs of free diapers and a $100 savings bond from Citizens Bank for that distant college education.

  When Emelda goes out to the nurse's desk, leaving us alone, Brian reaches for my hand. "You okay?"

  I grimace my way through another contraction. "I'd be better if this was over."

  He smiles at me. To a paramedic/firefighter, a routine hospital delivery is something to shrug at. If my water had broken during a train wreck, or if I was laboring in the back of a taxi--

  "I know what you're thinking," he interrupts, although I haven't said a word out loud, "and you're wrong." He lifts my hand, kisses the knuckles.

  Suddenly an anchor unspools inside me. The chain, thick as a fist, twists in my abdomen. "Brian," I gasp, "get the doctor."

  My OB comes in and holds his hand between my legs. He glances up at the clock. "If you can hold on a minute, this kid's gonna be born famous," he says, but I shake my head.

  "Get it out," I tell him. "Now."

  The doctor looks at Brian. "Tax deduction?" he guesses.

  I am thinking of saving, but it has nothing to do with the IRS. The baby's head slips through the seal of my skin. The doctor's hand holds her, slides that gorgeous cord free of her neck, delivers her shoulder by shoulder.

  I struggle to my elbows to watch what is going on below. "The umbilical cord," I remind him. "Be careful." He cuts it, beautiful blood, and hurries it out of the room to a place where it will be cryogenically preserved until Kate is ready for it.

  *

  Day Zero of Kate's pre-transplant regimen starts the morning after Anna is born. I come down from the maternity ward and meet Kate in Radiology. We are both wearing yellow isolation gowns, and this makes her laugh. "Mommy," she says, "we match."

  She has been given a pediatric cocktail for sedation, and under any other circumstance, this would be funny. Kate can't find her own feet. Every time she stands up, she collapses. It strikes me that this is how Kate will look when she gets drunk on peach schnapps for the first time in high school or college; and then I quickly remind myself that Kate might never be that old.

  When the therapist comes to take her into the RT suite, Kate latches on to my leg. "Honey," Brian says, "it's gonna be fine."

  She shakes her head and burrows closer. When I crouch down, she throws herself into my arms. "I won't take my eyes off you," I promise.

  The room is large, with jungle murals painted on the walls. The linear accelerators are built into the ceiling and a pit below the treatment table, which is little more than a canvas cot covered with a sheet. The radiation therapist places thick lead pieces shaped like beans onto Kate's chest and tells her not to move. She promises that when it's all over, Kate can have a sticker.

  I stare at Kate through the protective glass wall. Gamma rays, leukemia, parenthood. It is the things you cannot see coming that are strong enough to kill you.

  *

  There is a Murphy's Law to oncology, one which is not written anywhere but held in widespread belief: if you don't get sick, you won't get well. Therefore, if your chemo makes you violently ill, if radiation sears your skin--it's all good. On the other hand, if you sail through therapy quickly with only negligible nausea or pain, chances are the drugs have somehow been excreted by your body and aren't doing their job.

  By this criterion, Kate should surely be cured by now. Unlike last year's chemo, this course of treatment has taken a little girl who didn't even have a runny nose and has turned her into a physical wreck. Three days of radiation has caused constant diarrhea, and put her back into a diaper. At first, this embarrassed her; now she is so sick she doesn't care. The following five days of chemo have lined her throat with mucus, which keeps her clutching at a suction tube as if it is a life preserver. When she is awake, all she does is cry.

  Since Day Six, when Kate's white blood cell and neutrophil counts began to plummet, she has been in reverse isolation. Any germ in the world might kill her now; for this reason, the world is made to keep its distance. Visitors to her room are restricted, and those who are allowed in look like spacemen, gowned and masked. Kate has to read picture books while wearing rubber gloves. No plants or flowers are permitted, because they carry bacteria that could kill her. Any toy given to her must b
e scrubbed down with antiseptic solution first. She sleeps with her teddy bear, sealed in a Ziploc bag, which rustles all night and sometimes wakes her up.

  Brian and I sit outside the anteroom, waiting. While Kate sleeps, I practice giving injections to an orange. After the transplant Kate will need growth factor shots, and the chore will fall to me. I prick the syringe under the thick skin of the fruit, until I feel the soft give of tissue underneath. The drug I will be giving is subcutaneous, injected just under the skin. I need to make sure the angle is right and that I am giving the proper amount of pressure. The speed with which you push the needle down can cause more or less pain. The orange, of course, doesn't cry when I make a mistake. But the nurses still tell me that injecting Kate won't feel much different.

  Brian picks up a second orange and begins to peel it. "Put that down!"

  "I'm hungry." He nods at the fruit in my hands. "And you've already got a patient."

  "For all you know that was someone else's. God knows what it's doped up with."

  Suddenly Dr. Chance turns the corner and approaches us. Donna, an oncology nurse, walks behind him, brandishing an IV bag filled with crimson liquid. "Drum roll," she says.

  I put down my orange, follow them into the anteroom, and suit up so that I can come within ten feet of my daughter. Within minutes Donna attaches the bag to a pole, and connects the drip to Kate's central line. It is so anticlimactic that Kate doesn't even wake up. I stand on one side, as Brian goes to the other. I hold my breath. I stare down at Kate's hips, the iliac crest, where bone marrow is made. Through some miracle, these stem cells of Anna's will go into Kate's bloodstream in her chest, but will find their way to the right spot.

  "Well," Dr. Chance says, and we all watch the cord blood slowly slide through the tubing, a Crazy Straw of possibility.

  JULIA

  AFTER TWO HOURS OF LIVING with my sister again, I'm finding it hard to believe we ever comfortably shared a womb. Isobel has already organized my CDs by year of release, swept under the couch, and tossed out half the food in my refrigerator. "Dates are our friend, Julia." She sighs. "You have yogurt in here from when Democrats ruled the White House."

  I slam the door shut and count to ten. But when Izzy moves toward the gas oven and starts looking for the cleaning controls, I lose my cool. "Sylvia doesn't need cleaning."

  "That's another thing: Sylvia the oven. Smilla the Fridge. Do we really need to name our kitchen appliances?"

  My kitchen appliances. Mine, not ours, goddammit. "I'm totally getting why Janet broke up with you," I mutter.

  At that, Izzy looks up, stricken. "You are horrible," she says. "You are horrible and after I was born I should have sewed Mom shut." She runs to the bathroom in tears.

  Isobel is three minutes older than me, but I've always been the one who takes care of her. I'm her nuclear bomb: when there's something upsetting her, I go in and lay waste to it, whether that's one of our six older brothers teasing her or the evil Janet, who decided she wasn't gay after seven years into a committed relationship with Izzy. Growing up, Izzy was the Goody Two-shoes and I was the one who came up fighting--swinging my fists or shaving my head to get a rise out of our parents or wearing combat boots with my high school uniform. Yet now that we're thirty-two, I'm a card-carrying member of the Rat Race; while Izzy is a lesbian who builds jewelry out of paper clips and bolts. Go figure.

  The door to the bathroom doesn't lock, but Izzy doesn't know that yet. So I walk in and wait till she finishes splashing cold water on her face, and I hand her a towel. "Iz. I didn't mean it."

  "I know." She looks at me in the mirror. Most people can't tell us apart now that I have a real job that requires conventional hair and conventional clothes. "At least you had a relationship," I point out. "The last time I had a date was when I bought that yogurt."

  Izzy's lips curve, and she turns to me. "Does the toilet have a name?"

  "I was thinking of Janet," I say, and my sister cracks up.

  The telephone rings, and I go into the living room to answer it. "Julia? This is Judge DeSalvo calling. I've got a case that needs a guardian ad litem, and I'm hoping you might be able to help me out."

  I became a guardian ad litem a year ago, when I realized that nonprofit work wasn't covering my rent. A GAL is appointed by a court to be a child's advocate during legal proceedings that involve a minor. You don't have to be a lawyer to be trained as a GAL, but you do have to have a moral compass and a heart. Which, actually, probably renders most lawyers unqualified for the job.

  "Julia? Are you there?"

  I would turn cartwheels for Judge DeSalvo; he pulled strings to get me a job when I first became a GAL. "Whatever you need," I promise. "What's going on?"

  He gives me background information--phrases like medical emancipation and thirteen and mother with legal background float by me. Only two items stick fast: the word urgent, and the name of the attorney.

  God, I can't do this.

  "I can be there in an hour," I say.

  "Good. Because I think this kid needs someone in her corner."

  "Who was that?" Izzy asks. She is unpacking the box that holds her work supplies: tools and wire and little containers of metal bits that sound like teeth gnashing when she sets them down.

  "A judge," I reply. "There's a girl who needs help."

  What I don't tell my sister is that I'm talking about me.

  *

  Nobody's home at the Fitzgerald house. I ring the doorbell twice, certain this must be a mistake. From what Judge DeSalvo's led me to believe, this is a family in crisis. But I find myself standing in front of a well-kept Cape, with carefully tended flower gardens lining the walk.

  When I turn around to go back to my car, I see the girl. She still has that knobby, calf-like look of preteens; she jumps over every sidewalk crack. "Hi," I say, when she is close enough to hear me. "Are you Anna?"

  Her chin snaps up. "Maybe."

  "I'm Julia Romano. Judge DeSalvo asked me to be your guardian ad litem. Did he explain to you what that is?"

  Anna narrows her eyes. "There was a girl in Brockton who got kidnapped by someone who said they'd been asked by her mom to pick her up and drive her to the place where her mom worked."

  I rummage in my purse and pull out my driver's license, and a stack of papers. "Here," I say. "Be my guest." She glances at me, and then at the god-awful picture on my license; she reads through the copy of the emancipation petition I picked up at the family court before I came here. If I am a psychotic killer, then I have done my homework well. But there is a part of me already giving Anna credit for being wary: this is not a child who rushes headlong into situations. If she's thinking long and hard about going off with me, presumably she must have thought long and hard about untangling herself from the net of her family.

  She hands back everything I've given her. "Where is everyone?" she asks.

  "I don't know. I thought you could tell me."

  Anna's gaze slides to the front door, nervous. "I hope nothing happened to Kate."

  I tilt my head, considering this girl, who has already managed to surprise me. "Do you have time to talk?" I ask.

  *

  The zebras are the first stop in the Roger Williams Zoo. Of all the animals in the Africa section, these have always been my favorite. I can give or take elephants; I never can find the cheetah--but the zebras captivate me. They'd be one of the few things that would fit if we were lucky enough to live in a world that's black or white.

  We pass blue duikers, bongos, and something called a naked mole rat that doesn't come out of its cave. I often take kids to the zoo when I'm assigned to their cases. Unlike when we sit down face-to-face in the courthouse, or even at Dunkin' Donuts, at the zoo they are more likely to open up to me. They'll watch the gibbons swinging around like Olympic gymnasts and just start talking about what happens at home, without even realizing what they are doing.

  Anna, though, is older than all of the kids I've worked with, and less than thrilled to be here.
In retrospect, I realize this was a bad choice. I should have taken her to a mall, to a movie.

  We walk through the winding trails of the zoo, Anna talking only when forced to respond. She answers me politely when I ask her questions about her sister's health. She says that her mother is, indeed, the opposing attorney. She thanks me when I buy her an ice cream.

  "Tell me what you like to do," I say. "For fun."

  "Play hockey," Anna says. "I used to be a goaltender."

  "Used to be?"

  "The older you get, the less the coach forgives you if you miss a game." She shrugs. "I don't like letting a whole team down."

  Interesting way to put it, I think. "Do your friends still play hockey?"

  "Friends?" She shakes her head. "You can't really have anyone over to your house when your sister needs to be resting. You don't get invited back for sleepovers when your mom comes to pick you up at two in the morning to go to the hospital. It's probably been a while since you've been in middle school, but most people think freakhood is contagious."

  "So who do you talk to?"

  She looks at me. "Kate," she says. Then she asks if I have a cell phone.

  I take one out of my pocketbook and watch her dial the hospital's number by heart. "I'm looking for a patient," Anna says to the operator. "Kate Fitzgerald?" She glances up at me. "Thanks anyway." Punching the buttons, she hands the phone back to me. "Kate isn't registered."

  "That's good, right?"

  "It could just mean that the paperwork hasn't caught up to the operator yet. Sometimes it takes a few hours."

  I lean against a railing near the elephants. "You seem pretty worried about your sister right now," I point out. "Are you sure you're ready to face what's going to happen if you stop being a donor?"

  "I know what's going to happen." Anna's voice is low. "I never said I liked it." She raises her face to mine, challenging me to find fault with her.

  For a minute I look at her. What would I do, if I found out that Izzy needed a kidney, or part of my liver, or marrow? The answer isn't even questionable--I would ask how quickly we could go to the hospital and have it done.

  But then, it would have been my choice, my decision.

  "Have your parents ever asked you if you want to be a donor for your sister?"