My Sister's Keeper

by Jodi Picoult

  *

  Brian and I slide into our respective chairs in Dr. Chance's office. Five years have passed, but the seats fit like an old baseball glove. Even the photographs on the oncologist's desk have not changed--his wife is wearing the same broad-brimmed hat on a rocky Newport jetty; his son is frozen at age six, holding a speckled trout--contributing to the feeling that in spite of what I believed, we never really left here.

  The ATRA worked. For a month, Kate reverted to molecular remission. And then a CBC turned up more promyelocytes in her blood.

  "We can keep pulsing her with ATRA," Dr. Chance says, "but I think that its failure already tells us she's maxed out that course."

  "What about a bone marrow transplant?"

  "That's a risky call--particularly for a child who still isn't showing symptoms of a full-blown clinical relapse." Dr. Chance looks at us. "There's something else we can try first. It's called a donor lymphocyte infusion--a DLI. Sometimes a transfusion of white blood cells from a matched donor can help the original clone of cord blood cells fight the leukemia cells. Think of them as a relief army, supporting the front line."

  "Will it put her into remission?" Brian asks.

  Dr. Chance shakes his head. "It's a stop-gap measure--Kate will, in all probability, have a full-fledged relapse--but it buys time to build up her defenses before we have to rush into a more aggressive treatment."

  "And how long will it take to get the lymphocytes here?" I ask.

  Dr. Chance turns to me. "That depends. How soon can you bring in Anna?"

  *

  When the elevator doors open there is only one other person inside it, a homeless man with electric blue sunglasses and six plastic grocery bags filled with rags. "Close the doors, dammit," he yells as soon as we step inside. "Can't you see I'm blind?"

  I push the button for the lobby. "I can take Anna in after school. Kindergarten gets out at noon tomorrow."

  "Don't touch my bag," the homeless man growls.

  "I didn't," I answer, distant and polite.

  "I don't think you should," Brian says.

  "I'm nowhere near him!"

  "Sara, I meant the DLI. I don't think you should take Anna in to donate blood."

  For no reason at all, the elevator stops on the eleventh floor, then closes again.

  The homeless man begins to rummage in his plastic bags. "When we had Anna," I remind Brian, "we knew that she was going to be a donor for Kate."

  "Once. And she doesn't have any memory of us doing that to her."

  I wait until he looks at me. "Would you give blood for Kate?"

  "Jesus, Sara, what kind of question--"

  "I would, too. I'd give her half my heart, for God's sake, if it helped. You do whatever you have to, when it comes to people you love, right?" Brian ducks his head, nods. "What makes you think that Anna would feel any different?"

  The elevator doors open, but Brian and I remain inside, staring at each other. From the back, the homeless man shoves between us, his bounty rustling in his arms. "Stop yelling," he shouts, though we stand in utter silence. "Can't you tell that I'm deaf?"

  *

  To Anna, it is a holiday. Her mother and father are spending time with her, alone. She gets to hold both of our hands the whole way across the parking lot. So what if we're going to a hospital?

  I have explained to her that Kate isn't feeling good, and that the doctors need to take something from Anna and give it to Kate to make her feel better. I figured that was more than enough information.

  We wait in the examination room, coloring line drawings of pterodactyls and T-Rexes. "Today at snack Ethan said that the dinosaurs all died because they got a cold," Anna says, "but no one believed him."

  Brian grins. "Why do you think they died?"

  "Because, duh, they were a million years old." She looks up at him. "Did they have birthday parties back then?"

  The door opens, and the hematologist comes in. "Hello, gang. Mom, you want to hold her on your lap?"

  So I crawl onto the table and settle Anna in my arms. Brian gets stationed behind us, so that he can grab Anna's shoulder and elbow and keep it immobilized. "You ready?" the doctor asks Anna, who is still smiling.

  And then she holds up a syringe.

  "It's only a little stick," the doctor promises, exactly the wrong words, and Anna starts thrashing. Her arms clip me in the face, the belly. Brian cannot grab hold of her. Over her screams, he yells at me. "I thought you told her!"

  The doctor, who's left the room without me even noticing, returns with several nurses in tow. "Kids and phlebotomy never mix well," she says, as the nurses slide Anna off my lap and soothe her with their soft hands and softer words. "Don't worry; we're pros."

  It is a deja vu, just like the day Kate was diagnosed. Be careful what you wish for, I think. Anna is just like her sister.

  *

  I'm vacuuming the girls' room when the handle of the Electrolux smacks Hercules' bowl and sends the fish flying. No glass breaks, but it takes me a moment to find him, thrashing himself dry on the carpet beneath Kate's desk.

  "Hang on, buddy," I whisper, and I flip him into the bowl. I fill it with water from the bathroom sink.

  He floats to the top. Don't, I think. Please.

  I sit down on the edge of the bed. How can I possibly tell Kate I've killed her fish? Will she notice if I run to the pet store and get a replacement?

  Suddenly Anna is next to me, home from morning kindergarten. "Mommy? How come Hercules isn't moving?"

  I open my mouth, a confession melting on my tongue. But at that moment the goldfish shudders sideways, dives, and starts to swim again. "There," I say. "He's fine."

  *

  When five thousand lymphocytes don't seem to be enough, Dr. Chance calls for ten thousand. Anna's appointment for a second donor lymphocyte draw falls in the middle of the gymnastics birthday party of a girl in her class. I agree to let her go for a little while, and then drive to the hospital from the gym.

  The girl is a sugar-spun princess with fairy-white hair, a tiny replica of her mother. As I slip off my shoes to trek across the padded floor, I try desperately to remember their names. The child is . . . Mallory. And the mother is . . . Monica? Margaret?

  I spot Anna right away, sitting on the trampoline as an instructor bounces them up and down like popcorn. The mother comes over to me, a smile strung on her face like a row of Christmas lights. "You must be Anna's mom. I'm Mittie," she says. "I'm so sorry she has to leave, but of course, we understand. It must be amazing, going somewhere no one else ever gets to go."

  The hospital? "Well, just hope you never have to do the same."

  "Oh, I know. I get dizzy going up an elevator." She turns to the trampoline. "Anna, honey! Your mother's here!"

  Anna barrels across the padded floor. This is exactly what I'd wanted to do to my living room when the kids were all small: cushion the walls and floor and ceiling for protection. And yet it turned out that I could have rolled Kate in bubble wrap, the danger for her was already under the skin.

  "What do you say?" I prompt, and Anna thanks Mallory's mother.

  "Oh, you're welcome." She hands Anna a small bag of treats. "Now, have your husband call us anytime. We'd be happy to take Anna while you're in Texas."

  Anna hesitates in the middle of a shoelace knot. "Mittie?" I ask, "what exactly did Anna tell you?"

  "That she had to leave early so your whole family could take you to the airport. Because once training starts in Houston, you won't see them until after the flight."

  "The flight?"

  "On the space shuttle . . .?"

  For a moment I am stunned--that Anna would make up such a ridiculous story, that this woman would believe it. "I'm not an astronaut," I confess. "I don't know why Anna would even say something like that."

  I pull Anna to her feet, one shoelace still untied. Dragging her out of the gymnasium, we reach the car before I say a word. "Why did you lie to her?"

  Anna scowls. "Why did I have to l
eave the party?"

  Because your sister is more important than cake and ice cream; because I cannot do this for her; because I said so.

  I'm so angry that I have to try twice before I can unlock the van. "Stop acting like a five-year-old," I accuse, and then I remember that's exactly what she is.

  *

  "It was so hot," Brian says, "a silver tea set melted. Pencils were bent in half."

  I look up from the newspaper. "How did it start?"

  "Cat and dog chasing each other, when the owners were on vacation. They turned on a Jenn-Air range." He peels his jeans down, winces. "I got second-degree burns just kneeling on the roof."

  His skin is raw, blistered. I watch him apply Neosporin and gauze. He keeps talking, telling me something about a rookie nicknamed Caesar who just joined their company. But my eyes are drawn to the advice column in the newspaper:

  Dear Abby,

  Every time my mother-in-law visits, she insists on cleaning out the refrigerator. My husband says she's just trying to help, but it makes me feel like I'm being judged. She's made my life a wreck. How do I make this woman stop without ruining my marriage?

  Sincerely,

  Past My Expiration Date,

  Seattle

  What sort of woman considers this to be her biggest problem? I picture her scrawling out a note to Dear Abby on linen-blend stationery. I wonder if she's ever felt a baby turn inside her, tiny hands and feet walking in slow circles, as if the inside of a mother is a place to be carefully mapped.

  "What are you glued to?" Brian asks, coming to read the column over my shoulder.

  I shake my head in disbelief. "A woman whose life is being ruined by rings from jelly jars."

  "Cream gone bad," Brian adds, chuckling.

  "Slimy lettuce. Oh my God, how can she stand to be alive?" We both start laughing then. Contagious, all we have to do is look at each other to laugh even harder.

  And then just as suddenly as all this was funny, it isn't anymore. Not all of us live in a world where our refrigerator contents are the barometer for our personal happiness. Some of us work in buildings that are burning down around us. Some of us have little girls who are dying. "Slimy fucking lettuce," I say, my voice hitching. "It's not fair."

  Brian is across the room in an instant; he folds me into his embrace. "It never is, baby," he answers.

  *

  One month later, we go back for a third lymphocyte donation. Anna and I take our seats in the doctor's office, waiting to be called. After a few minutes, she tugs on my sleeve. "Mommy," she says.

  I glance down at her. Anna is swinging her feet. On her fingernails is Kate's mood-changing nail polish. "What?"

  She smiles up at me. "In case I forget to tell you after, it wasn't as bad as I thought it was going to be."

  *

  One day my sister arrives unannounced, and with Brian's permission, spirits me away to a penthouse suite at the Ritz Carlton in Boston. "We can do anything you want," she tells me. "Art museums, Freedom Trail walks, dinners out on the Harbor." But what I really want to do is just forget, and so three hours later I am sitting on the floor beside her, finishing our second $100 bottle of wine.

  I lift the bottle by its neck. "I could have bought a dress with this."

  Zanne snorts. "At Filene's Basement, maybe." Her feet are on a brocade chair; her body is sprawled on the white carpet. On the TV, Oprah counsels us to minimize our lives. "Plus, when you zip up a great Pinot Noir, you never look fat."

  I look over at her, suddenly feeling sorry for myself.

  "No. You're not doing the crying thing. Crying is not included in the room rate."

  But suddenly all I can think of is how stupid the women on Oprah sound, with their stuffed Filofaxes and crammed closets. I wonder what Brian made for dinner. If Kate's all right. "I'm going to call home."

  She comes up on an elbow. "You are allowed to take a break, you know. No one has to be a martyr twenty-four/seven."

  But I hear her wrong. "I think once you sign on to be a mother, that's the only shift they offer."

  "I said martyr," Zanne laughs. "Not mother."

  I smile a little. "Is there a difference?"

  She takes the telephone receiver out of my hand. "Did you want to get your crown of thorns out of the suitcase first? Listen to yourself, Sara, and stop being such a drama queen. Yes, you drew a bad lot of fate. Yes, it sucks to be you."

  Bright color rises on my cheeks. "You have no idea what my life is like."

  "Neither do you," Zanne says. "You're not living, Sara. You're waiting for Kate to die."

  "I am not--" I begin, but then I stop. The thing is, I am.

  Zanne strokes my hair and lets me cry. "It is so hard sometimes," I confess, words I have not said to anyone, not even Brian.

  "As long as it's not all the time," Zanne says. "Honey, Kate is not going to die sooner because you have one more glass of wine, or because you stay overnight in a hotel, or because you let yourself crack up at a bad joke. So sit your ass back down and turn up the volume and act like you're a normal person."

  I look around at the opulence of the room, at our decadent sprawl of wine bottles and chocolate strawberries. "Zanne," I say, wiping my eyes, "this is not what normal people do."

  She follows my gaze. "You're absolutely right." She picks up the remote control, flipping channels until she finds Jerry Springer. "That better?"

  I start to laugh, and then she starts to laugh, and soon the room is spinning around me and we are lying on our backs, staring up at the crown molding edging the ceiling. I suddenly remember how, when we were kids, Zanne used to always walk ahead of me to the bus stop. I could have run and caught up--but I never did. I only wanted to follow her.

  *

  Laughter rises like steam, swims through the windows. After three days of a torrential downpour, the kids are delighted to be outside, kicking around a soccer ball with Brian. When life is normal, it is so normal.

  I duck into Jesse's room, trying to navigate strewn LEGO pieces and comic books so that I can set his clean clothes down on the bed. Then I go into Kate and Anna's room, and separate their folded laundry.

  When I place Kate's T-shirts on her dresser I see it: Hercules is swimming upside down. I reach into the bowl and turn him, holding his tail; he wafts for a few strokes and then floats slowly to the surface, white-bellied and gasping.

  I remember Jesse saying that with good care, a fish might live seven years. This has only been seven months.

  After carrying the fishbowl into my bedroom, I pick up the phone and dial Information. "Petco," I say.

  When I'm connected, I ask a clerk about Hercules. "Do you, like, want to buy a new fish?" she asks.

  "No, I want to save this one."

  "Ma'am," the girl says, "we're talking about a goldfish, right?"

  So I call three vets, none of whom treat fish. I watch Hercules in his death throes for another minute, and then ring the oceanography department at URI, asking for any professor that's available.

  Dr. Orestes studies tide pools, he tells me. Mollusks and shellfish and sea urchins, not goldfish. But I find myself telling him about my daughter, who has APL. About Hercules, who survived once against all odds.

  The marine biologist is silent for a moment. "Have you changed his water?"

  "This morning."

  "You get a lot of rain down there the past couple of days?"

  "Yes."

  "Got a well?"

  What does that have to do with anything? "Yes . . ."

  "It's just a hunch, but with runoff, your water might have too many minerals in it. Fill the bowl with bottled water, and maybe he'll perk up."

  So I empty out Hercules' bowl, scrub it, and add a half-gallon of Poland Spring. It takes twenty minutes, but then Hercules begins to swim around. He navigates between the lobes of the fake plant. He nibbles at food.

  Kate finds me watching him a half hour later. "You didn't have to change the water. I did it this morning."


  "Oh, I didn't know," I lie.

  She presses her face up to the glass bowl, her smile magnified. "Jesse says goldfish can only pay attention for nine seconds," Kate says, "but I think Hercules knows exactly who I am."

  I touch her hair. And wonder if I have used up my miracle.

  ANNA

  IF YOU LISTEN TO ENOUGH INFOMERCIALS you start to believe some crazy things: that Brazilian honey can be used as leg wax, that knives can cut metal, that the power of positive thinking can work like a pair of wings to get you where you need to be. Thanks to a little bout of insomnia and way too many doses of Tony Robbins, I decided one day to force myself into imagining what it would be like after Kate died. That way, or so Tony vowed, when it really happened, I'd be ready.

  I kept at it for weeks. It is harder than you think to keep yourself in the future, especially when my sister was walking around at the time being her usual pain-in-the-butt self. My way of dealing with this was to pretend Kate was already haunting me. When I stopped talking to her, she figured she'd done something wrong, which she probably had, anyway. There were entire days where I did nothing but cry; others where I felt like I'd swallowed a lead plate; some more where I worked really hard at going through the motions of getting dressed and making my bed and studying my vocab words because it was easier than doing anything else.

  But then, there were times when I let the veil lift a little, and other ideas would pop up. Like what it would be like to study oceanography at the University of Hawaii. Or try skydiving. Or move to Prague. Or any of a million other pipe dreams. I'd try to stuff myself into one of these scenarios, but it was like wearing a size five sneaker when your foot is a seven--you can get by for a few steps, and then you sit down and pull off the shoe because it just plain hurts too much. I am convinced that there is a censor sitting on my brain with a red stamp, reminding me what I am not supposed to even think about, no matter how seductive it might be.

  It's probably a good thing. I have a feeling that if I really try to figure out who I am without Kate in the equation, I'm not going to like who I see.

  *

  My parents and I are sitting together at a table in the hospital cafeteria, although I use the word together loosely. It's more like we're astronauts, each wearing a separate helmet, each sustained by our own private source of air. My mother has the little rectangular container of sugar packets in front of her. She is organizing them with ruthlessness, the Equal and then the Sweet 'n Low and then the nubbly brown natural crystals. She looks up at me. "Honey."