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My Sister’s Keeper

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  1. My Sister’s Keeper Jodi Picoult

  2. Context • In 2004, Picoult published My Sister’s Keeper. Like most of her works, the novel takes on a range of morally complex issues, from the ethics of genetic engineering, to the right of terminally-ill patients to elect to die, to a minor’s right to control her own body. • Genetic engineering alone has been the subject of controversy since its very first uses to help infertile couples conceive via in vitro fertilization. As the potential uses of the method have grown, so have the moral questions that such genetic manipulation raises. • Notably, the ethics of using science to create a so-called “designer baby,” meaning one whose physical traits are selected by the parents, has become the object of frequent and heated debates. • These quandaries, and those regarding the rights of terminally ill patients and minors to determine what happens to their bodies, all intertwine in My Sister’s Keeper, which tells the story of one family devastated by their eldest daugther Kate’s battle with acute promyelocyticleukemia, an extremely aggressive form of cancer

  3. Background Info • With My Sister’s Keeper, Picoult drew on her experiences with her middle son, who at the age of five needed ten surgeries over three years to treat a tumour in his ear. Picoult says the desperation she felt sitting in the hospital beside her anesthetized son and knowing she could do nothing to help him informed her depiction of Sara, the mother in the Fitzgerald family of My Sister’s Keeper. That emotion, combined with the knowledge Picoult gathered in her research, imbues the book with a sense of realism.

  4. In a nutshell... • narrator · Multiple narrators alternate throughout the book. These narrators are Anna, Jesse, Kate, Brian, and Sara Fitzgerald, Campbell Alexander, and Julia Romano. The chapters narrated by Sara largely take place in the past, while the rest of the narration occurs in present day. The prologue and epilogue take place several years after the main action has occurred. • point of view · Each narrator speaks in first person, allowing the reader to see the world from each narrator’s point of view. • tone · Each narrator speaks in a different tone. Anna is observant, thoughtful, and inquisitive. Jesse is sarcastic and angry. Brian is often discursive, wandering into musings on astronomy. Sara is practical and concise. Campbell is sarcastic and sometimes regretful. Julia is open and watchful of the characters around her. • setting (time) · The setting alternates between present action and events from the past fourteen years. • setting (place) · Rhode Island • CENTRAL protagonist · Anna Fitzgerald

  5. Prologue Summary • The prologue begins with an epigraph from Carl von Clausewitz’s Von Kriege. The epigraph states that no one in his right mind starts a war unless they are absolutely clear on two things: what he wants to achieve, and how he plans to achieve it. An unidentified person narrates the second part of the prologue from a first-person point of view. This narrator recalls the time she was three years old and attempted to kill her sister. Her father stopped her and implied she pretend the incident never happened. The narrator confesses that as she grew older she didn’t seem to exist except in relation to her sister. She thought of many different ways she could kill her, but ultimately the narrator says she didn’t do anything after all, because her sister did it on her own.

  6. Monday Anna Summary • Thirteen-year-old Anna Fitzgerald begins narrating the story. She talks about the different reasons babies come into being and admits that she was born for a very specific purpose. Scientists used her mother’s eggs and father’s sperm to create a specific combination of genes. They created her in this way so she would be able to save her sister, Kate. Anna talks about visiting a pawnshop to sell a locket. She has a difficult time parting from the locket because her father gave it to her as a gift after she donated bone marrow to Kate. Anna goes on to describe herself as skinny and a freak. She talks about her family, how her sister Kate has leukemia, and how she has had to undergo medical procedures to help Kate whenever Kate has gotten sick. Her mother, meanwhile, obsessively shops online, and her older brother, Jesse, behaves like a delinquent because their parents don’t have time to care about him.

  7. cntd. • Anna shows Jesse a newspaper clipping about a lawyer named Campbell Alexander. Jesse warns her not to mess with the system and the roles everyone in the family has, but he still agrees to drive her to Campbell’s office. Anna meets Campbell and notices he has a service dog, which Campbell sarcastically tells Anna prevents him from getting too close to magnets, because he has an iron lung. Campbell tries to send Anna away, and she explains that she wants Campbell to help her sue her parents for the right to her own body.

  8. Campbell Summary • Campbell gives his account of his meeting with Anna. He talks with her about her case and notices how angry she seems. He agrees to represent her because he thinks the case will be easy to win and great publicity. He doesn’t think they will even need to go to trial, because Anna’s parents will give in before that. Anna leaves after Campbell tells her he will file a petition in family court for her medical emancipation. Campbell’s assistant, Kerri, expresses her shock that Campbell is representing Anna. She wonders where Anna will live during the trial, but Campbell hasn’t thought about it. Campbell’s dog, Judge, pushes against him, apparently alerting Campbell to something. Campbell goes back into his office and locks the door.

  9. Sara Summary • Sara’s narration jumps back in time to 1990. While bathing Kate and Jesse, Sara talks to Brian, her husband and a career firefighter, and she recalls her decision to give up her career as an attorney to become a stay-at-home mother. Sara notices a bruise on two-year-old Kate’s shoulder blade. • The next morning, bruises have spread up and down Kate’s spine. Sara takes Kate to the hospital where Kate undergoes a series of tests. The hospital refers Sara to an oncologist who, after further tests, diagnoses Kate with acute promyelocyticleukemia (APL), a rare and aggressive form of blood cancer. • The doctor tells Sara and Brian that APL has a twenty to thirty percent survival rate and they should begin treating Kate immediately. At home Sara and Brian deal with the fallout of the diagnosis and the realization that their daughter may not survive. Sara refuses to let Kate die.

  10. Brian Summary • In the present day again, Brian Fitzgerald describes a fire at a medical school. The fire started because a body got stuck in the cremation incinerator. He turns the story to earlier that night, while he ate dinner with his family. Kate upsets Sara because she wears a t-shirt with a picture of a crab and the word “Cancer” across it. Jesse walks in reeking of pot. Finally Anna arrives, and Brian immediately notices something is wrong. Anna remains quiet and withdrawn through the meal, and she does not have her locket on. She leaves the table without saying a word. After dinner, Brian and Sara discuss their daughters. Sara talks about Kate, but Brian worries about Anna. Sara mentions that she has to take Kate to dialysis the next day. Later that night, Anna visits Brian at the station. She doesn’t want to talk, but together they watch the stars from the station’s roof.

  11. Tuesday Anna summary • Anna and Sara sit with Kate at the hospital during her dialysis session. Sara talks about kidney donation while Anna thinks about all of the risks associated with the procedure. Vern Stackhouse, a sheriff, comes to Kate’s room. He awkwardly serves Sara papers for the lawsuit Anna has filed for medical emancipation. Sara responds angrily, but before she can talk to Anna about the lawsuit, Kate cries out in pain. Sara goes to Kate’s bedside while Anna runs out of the hospital room. Jesse drives to the hospital to pick Anna up, and they go home.

  12. cntd. • When Sara and Kate arrive home, Kate runs to her room, and Sara demands to know what Anna is doing. Anna refuses to drop the lawsuit, and despite Brian’s protests, Sara grows even angrier until she slaps Anna. Later, Kate talks to Anna. Kate says that even if she has to lose Anna as a sister she can’t bear the thought of losing her as a friend. Anna doesn’t respond, but in her thoughts admits she couldn’t stand to lose Kate either. Sara and Brian walk into Anna’s and Kate’s room at night. Anna overhears her father saying that maybe Anna’s actions aren’t crazy. He leaves, and Sara sits on Anna’s bed. Anna thinks Sara hates her, but Sara insists she could never hate her. Sara holds Anna and assures her they can fix everything by talking to the judge. Anna only nods.

  13. Sara Summary • In 1990, Sara and Brian see an oncologist named Dr. Chance, who will be in charge of Kate’s treatments. Sara calls her older sister, Zanne, whom she has fallen out of touch with, and later Zanne arrives to help the family out. Sara and Brian feel overwhelmed with the list of details and questions facing them about Kate’s cancer and treatment. Since Kate’s form of cancer often resists treatment, the doctors admit they can only do so much. Sara asks what it will be like if Kate dies and wonders how she would survive it. Kate starts chemotherapy and gets extremely sick. The doctors test Jesse to see if he is a genetic match for Kate, since she might need bone marrow if she relapses, but he is not. • Dr. Chance tells Sara that if she and Brian have more children, one sibling could be a match. After chemo, Kate develops an infection and has to be rushed to the hospital. While at the hospital, Sara tells Brian she is thinking of having another child. Brian thinks Sara wants to be able to replace Kate if she dies, but Sara assures him she wants to have another child to see if the child would be a genetic match for Kate.

  14. Wednesday Campbell Summary • Campbell, while on the phone with his mother, wonders how much people are beholden to their parents. Campbell stops for coffee and gives his waiter a new sarcastic explanation of his service dog, Judge. He returns to his office and finds Anna there. Sara calls while Anna is in the room with Campbell. Sara tells Campbell that Anna has changed her mind, but Anna tells Campbell she has not. Campbell recalls a memory of his father. They competed in a sailing competition, and Campbell ended up embarrassing and disappointing his father. Campbell goes to the courthouse where he meets Sara, who decides to act as counsel for herself and Brian. Sara and Campbell speak with Judge DeSalvo, the judge for the case. They argue about what Anna really wants until Judge DeSalvo decides he needs to speak with Anna.

  15. Anna Summary • Anna wonders what her funeral would be like. She doesn’t think many people would come, unlike Kate’s funeral, which would be crowded. At the courthouse, Anna speaks with Judge DeSalvo alone. They discuss the trial, and Anna tries to remain composed. But she recalls a time when she and Kate pulled a prank on a nurse at the hospital and starts to cry. She tells Judge DeSalvo she can’t give a kidney to her sister. He assures her no hospital would take a kidney from an unwilling donor, but she says being a donor has never been her choice. She says she never wanted to stop the lawsuit and only told her mother she would because she loves her. Judge DeSalvo decides to appoint Anna a guardian ad litem who can decide what is best for her. The hearing, he says, will take place the following week.

  16. cntd. • Anna goes home with her parents, even though Campbell wants to speak with her. Brian pleads with Sara to calm down, but Sara shouts that Anna practically signed Kate’s death sentence. Kate runs upstairs. Anna leaves the house to go to a laundromat, a place she feels safe. She tries to picture a future without Kate but can’t. They are as connected, she thinks, as Siamese twins.

  17. Jesse Summary • Jesse thinks about when he was a child and would light bath soap on fire to show Anna. He reflects that Anna is the only proof he has that he belongs in the family. While driving down the highway, he imagines crashing his car because he would be worth more dead and used as parts. He meets a homeless man named Dan. Jesse has a deal with Dan where he brings Dan food if Dan will watch Jesse’s things, including stolen acid and sawdust. Jesse goes to an abandoned warehouse and sets a fire. He admits he has done it before. He watches the fire from far away until he sees his father arrive. Jesse goes home to find Sara frantic. Kate is vomiting blood. Jesse drives Kate to the ER.

  18. cntd. • At the hospital, Dr. Chance tells Sara and Jesse that Kate is in the end stages of kidney failure. Sara asks if a transplant is possible, and Dr. Chance tells her that the odds are not good. Sara asks if they would do the transplant if a donor were available. Jesse offers his kidney, but Dr. Chance tells him it must be an exact match. Jesse wonders why he thought he might suddenly be worth something and why he thought he could save his sister when he can’t save himself. Kate tries to tell Jesse something, but all he can understand is “tell Anna.”

  19. Sara Summary • The time is 1990–1991 and Sara is pregnant with Anna. Sara knows everything about the baby, from the sex to the specific combination of genes that will allow Anna to be a donor for Kate. She admits that she has thought of Anna only in terms of what she will be able to do for Kate. Sara reveals that three months after chemo, Kate went into molecular relapse. Sara recalls the television interview she and Brian did. They explain why they went to a geneticist and deny wanting a “designer baby.” They only wanted a child who would save Kate’s life. Sara goes into labor on New Year’s Eve. Anna is born, and the doctors take her umbilical cord to harvest the cord blood. Kate begins a pre-transplant regimen of radiation and chemotherapy, which makes her violently ill. The doctors put her in isolation, then give her Anna’s cord blood.

  20. Wednesday Julia Summary • Julia argues with her twin sister, Izzy, until Judge DeSalvo calls. The judge asks Julia if she will be the guardian ad litem in Anna’s case. Julia agrees and goes to the Fitzgerald house where she meets Anna. Julia takes Anna to the zoo to talk, hoping it might loosen her up. Julia can’t determine why exactly Anna filed the lawsuit, but she realizes that Anna will either lose her sister or herself. At the house Julia meets Sara. Julia tries to speak with Sara, but Sara brushes her off. Julia realizes that it will be difficult for Anna to live there during the course of the legal proceedings without being swayed by her mother. Afterward Julia goes to Campbell’s office. It emerges that they have had a romance in the past and that they haven’t spoken in years.

  21. Campbell Summary • Campbell works in his office when Julia walks in. He feels shocked to see her for the first time in fifteen years. After some awkward conversation, the two discuss Anna. Campbell suggests removing Sara from the house, but Julia thinks it is the wrong course of action. The two argue and the dog, Judge, becomes increasingly agitated. Finally, Campbell leaves Julia alone in his office. In a flashback to their high-school years, Campbell remembers when Julia arrived at their prep school. She looked different than the other girls and kept to herself. One day Campbell followed her to a cemetery and asked for help with his homework. In the present, Campbell straightens himself up in a bathroom. When he goes back to his office, Julia has gone. In another flashback, we see Campbell and Julia as teenagers sharing their first kiss.

  22. cntd. • Back in the present, Campbell goes to see Anna at her house. Initially, he feels awkward around Anna and admits that he usually doesn’t spend time with his clients. Later that night, Campbell visits Julia. At first he confuses her with her twin sister, Izzy, who acts angrily toward Campbell. Campbell and Julia talk and catch up. Julia admits to Campbell that it is hard to be around him after everything that happened between them.

  23. Anna Summary • Anna asks Jesse to drive her to the hospital. Jesse tells Anna that she is not doing the wrong thing, but she tells him that she’s not doing the right thing either. Jesse agrees to help Anna see Kate by distracting their mother. In a flashback, Kate wants to talk to Anna about death and the best way to die, but Anna refuses. In the present, Jesse pretends to be drunk in order to get Sara away from Kate’s hospital room. • Anna goes into Kate’s room, and we see another flashback in which the entire family plays football on Thanksgiving. Jesse accidentally knocks Kate down, and Brian gets angry at him. Jesse says he forgot, and Kate smiles. She’s thrilled that, for a moment, Jesse forgot she had cancer. In the present, Anna climbs into Kate’s bed with her. In her thoughts she acknowledges that she didn’t come to see Kate to feel better, but because without Kate, she can’t remember who she is.

  24. Thursday Brian Summary • Julia meets Brian at the fire station and helps him cook breakfast. They discuss Anna, and Brian hesitates to state his opinion. He thinks about an incident where he saved a child from a burning building. Brian admits he became a firefighter to save people but wishes he could have been more specific about who to save. He asks Julia if he can take her to meet someone but doesn’t say who the person is.

  25. Julia Summary • Julia rides with Brian in his car. In flashbacks, we see Julia at her apartment sobbing the previous night after Campbell left, then going to a bar where she drinks heavily. She remembers how Campbell felt attracted to her because she was different from everyone else at their school. They would meet after school in the cemetery and talk. Their relationship blossomed from there. • In Brian’s car, he tells Julia they named Anna after the galaxy, Andromeda. They find Anna at the house and decide to all go to the hospital together. Anna confesses to Julia that she fears Kate will hate her. Outside the hospital room, Sara begs Julia not to tell Kate that Anna has not dropped the lawsuit. She also insists to Julia that she loves both of her daughters. Julia and Kate talk alone. Julia asks about Jesse, and Kate says that he gets into a lot of trouble because it’s his only way of being noticed. Kate talks about a year where she got sick on almost every single holiday and how hard that was for Anna.

  26. Sara Summary • In 1996, Sara throws Kate a party for her eighth birthday. Kate has been in remission for five years, but soon after the party Kate relapses. She starts on a new medication in an attempt to put her in remission. In the midst of this, Jesse reminds Sara she promised to take him to get new cleats after his orthodontist appointment. Sara tells him they can’t do either, so Jesse attempts to pry his braces off his teeth with a fork. The new medication works at first, but Kate develops a resistance. Dr. Chance recommends a donor lymphocyte infusion from Anna. Brian suggests it might not be a good idea to make Anna donate blood, since he and Sara only agreed she would act as a donor for Kate once. Concerned about Kate, Sara dismisses the concern. • Anna arrives at the hospital to give blood and screams and cries during the procedure. Later, when the doctors need to take more blood, Sara forces Anna to leave a birthday party early. A month later, Anna has to donate blood a third time. Sara also talks about finding Kate’s goldfish nearly dead. Desperate to save it, she calls a marine biologist who helps her revive the fish.

  27. Thursday Anna Summary • Anna recalls imagining what life would be like if Kate died. It would be painful, but she also thinks of the exciting things she could do if Kate weren’t alive. In the present, Anna sits with her parents in the hospital cafeteria. Vern Stackhouse serves Sara with a temporary restraining order requiring her not to have contact with Anna. Anna says she never asked for that but Sara is furious. Sara and Brian fight in the car about hiring a “real” lawyer. Reporters have gathered at the courthouse, and Anna and Brian wait outside while Sara and Campbell talk to the judge. Julia arrives and asks if Anna wants Sara to leave the house. Anna says that’s not what she wants. She also says she’s changed her mind and doesn’t want to go through with the lawsuit anymore. After Julia leaves, Brian asks Anna if she wants to stay with him at the fire station to give her distance from Sara. They leave together.

  28. Campbell Summary • Outside the courthouse, Campbell speaks to the reporters. He recognizes that he wants to draw attention to the case to capitalize on it. Sara and Campbell speak to Judge DeSalvo. Julia arrives, tells the judge that Anna is confused, and it would be a mistake to remove Sara from the house. Judge DeSalvo refuses to grant the restraining order, but he orders Sara not to say one more word to Anna about the case. Julia, Campbell, and Sara go outside to see Anna only to discover she has left with Brian. Julia tries to talk to Campbell but he avoids her. Once again, his dog, Judge, clearly tries to alert Campbell to something. Julia yells at Campbell while he tries to get away from her. She informs Campbell that Anna said she changed her mind about the petition. Finally, Campbell escapes into an empty room and locks the door.

  29. Jesse Summary • Jesse arrives home to find Julia on his doorstep. He tries to flirt with her. She asks for Anna, but Jesse says no one is home. Julia brushes off Jesse’s continued flirtations and asks him about his family. He tells her a story about a Christmas Eve when he was 12 and Kate was in the hospital. Anna had to be taken in to give white blood cells, and Jesse was sent to a neighbor’s house. He left and chopped down a tree from his family’s front yard, then set it up in the living room and decorated it. The next day when he opened his gifts he realized they were all from the hospital gift shop. Brian and Sara never even noticed the tree. Jesse says that the story explains what it has been like to grow up in his family. He says at least Anna is on their parents’ radar.

  30. Brian Summary • Brian takes Anna to the fire station. He recalls his visit to the hospital earlier that afternoon. Kate slept, and Brian talked to Sara. He told her Anna was going to stay with him at the station. They argued when Brian told Sara he was worried about Anna. Sara said that, unlike him, she worries about both of their daughters. Later that night, the fire station receives a call to a nursing home where a woman has hit her head. Anna goes along and helps. They take the woman to the hospital, and Brian loses track of Anna. He finds her in Kate’s room, curled up on Sara’s lap. He takes her back to the station. Later, Anna and Brian watch a meteor shower from the station’s roof. Anna wonders aloud if it would be possible to find a fallen star.

  31. Campbell Summary • In flashbacks, Campbell recalls more scenes from his high-school relationship with Julia. Campbell’s friends teased him about Julia, but he would not defend her. Campbell also avoided telling his parents about Julia, which Julia suspected. When he finally took her to meet them, his parents behaved rudely and refused to invite her to a party the rest of the family was attending. Afterward, Campbell began ignoring Julia. One day they met at the cemetery, and Campbell told Julia their relationship was over.

  32. cntd. • In the present, Campbell goes to the hospital to speak to Dr. Bergen, the head of the ethics committee. Dr. Bergen says the committee never met to discuss Anna, despite the fact that Anna had been a patient at the hospital eight times. After his meeting, Campbell runs into Julia. He convinces her to talk with him about the case, and they go to an Italian restaurant. Campbell avoids answering questions about his service dog and why he took the case. He receives a phone call from Anna asking him to meet her at the police station. When he and Julia arrive, Anna tells them Jesse has been arrested for stealing a judge’s car. She asks for Campbell’s help. Reluctantly, he manages to get Jesse released on probation. In the car on the way home, Campbell tries to get Anna to tell him what she really wants. She explodes in anger and says she’s sick but never sick enough for her family. Campbell is pleased at her anger but also worried that she will sound unsympathetic on the witness stand.

  33. Brian Summary • Campbell arrives at the firehouse with Anna. When he and Brian talk alone, Brian admits he agrees with Anna and says he is willing to say so to the judge. Brian remembers an incident from the night before in which he shouted at a kid whose girlfriend overdosed on drugs. Another firefighter told Brian he could take time off, but Brian says that means he would have to be at home instead. Back in the present, as Campbell leaves he mentions Jesse’s arrest

  34. Sara Summary • In 1997, Sara finds Kate with blood streaming down her legs. Kate has relapsed and needs a bone marrow transplant. The family’s insurance company refuses to cover the transplant. To prepare Anna for the bone marrow donation, Sara gives her growth-factor shots. Six-year-old Anna tells Sara she hates her. Sara’s sister, Zanne, offers to pay for the transplant, but Brian tells Sara the men at the fire-station raised enough money. Sara takes Kate to the hospital to begin her pre-transplant regimen of chemotherapy. • Before she leaves the house, Kate cleans her room in case she doesn’t come back. Again, the chemo makes Kate violently ill. The time arrives for Anna’s bone-marrow extraction, and Sara tells her she doesn’t have to do it but that everyone is counting on her. Sara goes to be with Kate. Brian arrives after Anna’s procedure and says Anna has been asking for Sara. Sara feels torn but goes to see Anna. Anna says she hurts, so Sara finds a nurse to give her medication. When Sara goes back to Anna’s room, she sees Brian putting the locket on Anna’s neck.

  35. cntd. • A few weeks later, Brian takes Sara out to dinner. They have nothing to talk about other than Kate and feel like strangers. When it’s time to take Kate home from the hospital, Sara notices how different Kate looks. Later, Sara learns that Brian lied about the firefighters having raised enough money to cover Kate’s bone marrow transplant. When Sara confronts him, he says he used the money from Kate’s college fund to help pay for it, because Kate won’t live long enough for college. Time passes and Sara tries to get Kate to leave the house, but Kate feels self-conscious about her appearance. Sara shaves her own head, and then Anna asks to have her head shaved, too. All bald, they go to the mall.

  36. Weekend Jesse Summary • Jesse steals a dump truck and picks up Dan. In flashbacks, Jesse recalls when he was eleven and received a skateboard as a “guilt gift,” meaning a gift his parents gave him whenever Kate became seriously ill. Brian promised him he would take him to a parking lot where he could ride it, but Kate’s nose started to bleed. When Jesse reminded Brian of his promise, Brian looked at Jesse like he didn’t see him. That day, Jesse walked into the middle of traffic, hoping to get noticed. In the present, Jesse takes Dan to a shed. Jesse lights it on fire and admires his work, until Dan tells him that a homeless man named Rat lives in there. Jesse runs in to the burning shed, saves Rat, and runs away just as the fire trucks arrive.

  37. Anna Summary • Anna waits at the hospital with Kate and Sara. Kate feels alert, but Dr. Chance cautions that Kate’s lucid moments will occur less and less frequently because she is in end-stage renal failure. Kate asks Dr. Chance how long it will be before she dies, and he tells her maybe a week. Sara begins crying. When Anna tells her to stop, Sara looks at Anna and tells her to stop. Later at the fire station, Anna talks to Julia about her crush, Kyle, and Julia asks Anna what it will be like when Kate dies. Anna can’t answer. Sara calls to apologize to Anna and say goodnight. On the roof that night, Anna and Brian talks about the stars and celestial navigation.

  38. Brian Summary • Brian goes to the hospital to see Sara. He talks to her about a trip they took to Nevada years ago. They saw a fortune teller who told Sara her life wouldn’t be good enough and told Brian to save himself. Sara doesn’t remember the trip and only wants to talk about Anna. Brian tells her he plans to speak on Anna’s behalf. Sara can’t understand this. She asks Brian to remember what it used to be like between them. But Brian knows Sara is not the same woman she used to be. He also knows he is not the same man he used to be, a man who believed Sara when she told him she would always love him.

  39. Sara Summary • In 2001, Anna asks for money for goaltender pads. She has started playing ice hockey. Four years have passed since Kate’s bone marrow transplant. One night, the family goes to watch Anna play hockey. Later, Kate wakes up bleeding badly. She has relapsed and her body is failing. Dr. Chance suggests a new and untested arsenic therapy. That night, Sara finds Brian writing Kate’s eulogy. He wants to bring Kate home to die in her own bed. He tells Sara the arsenic will just postpone what is coming. Sara tells him it’s not time.

  40. cntd. • Kate slips into a coma. Sara receives a call from Jesse’s school. He blew up a septic tank and has been expelled. Sara picks him up from the school and notices needle marks on his arms. She suspects drug use, but Jesse reveals he has been donating platelets for Kate every three days. Anna gets accepted to a prestigious hockey camp, but Sara tells her she won’t be able to go because they might need her for Kate. Anna says the camp is a year away, implying that Kate won’t be alive then anyway. Kate develops an infection and becomes seriously ill. Jesse and Anna say their good-byes to Kate. Brian tells Sara that Kate needs her permission to leave. As Sara tells Kate that it’s okay for her to go, Kate grips her hand and begins to claw her way back to life.

  41. Anna Summary • Anna ponders what heaven will be like. She wonders what age people are in heaven, and how anyone recognizes each other. Sara calls a meeting at Campbell’s office. She tells Anna that if Anna gives Kate a kidney she will never ask Anna for anything again. Anna hugs her mother but tells her she can’t do it. Without a word, Sara tries to smile and then leaves.

  42. Julia Summary • Julia admits to Izzy that she still has feelings for Campbell. Just then, Campbell arrives and asks Julia out to dinner to discuss Sara’s plea bargain. He takes her out on his boat, and though they’re having a good time, Julia suspects Campbell wants to sway her decision. Julia gets angry and wonders if Campbell ever says anything that isn’t a lie, but Campbell kisses her. She remarks that it feels like the most natural thing in the world.

  43. Monday Campbell Summary • Campbell wakes up in his boat after spending the night with Julia. He thinks that he loved Julia because she was an independent spirit and he couldn’t bear to take that away from her. He leaves while Julia sleeps and goes to the courthouse. Neither Sara nor Brian knows where Anna is. Campbell finds her in Kate’s hospital room and drives her back to the courthouse. On the way, Campbell pulls over and asks Anna why they’re going to court. Anna counters by asking him about his dog. Campbell says that the dog is for a hearing problem. Anna says she’s sick of things always being about Kate. Campbell points out that Anna is lying, and Anna says Campbell is also lying about the dog.

  44. cntd. • Campbell and Anna arrive at the courthouse, and everyone moves into the courtroom. Anna asks Campbell if she’ll have to speak. He lies and says she probably won’t. Campbell speaks first and says in the justice system what is legal differs from what is moral. Sometimes is hard to tell them apart, but the court is there to help. Campbell calls Sara to the stand. She talks about Anna’s conception, and Campbell asks her about all the times Anna has undergone a medical procedure to help Kate. He also asks if Anna had a choice in any of these cases. Sara says Campbell can see things in black and white because he only represents one of her daughters, but Sara represents both of her daughters.

  45. Anna Summary • During a recess in the trial, Campbell and Anna speak alone. Anna says even if they win they still lose. When the trial resumes, Campbell calls Dr. Bergen as his second witness. Dr. Bergen says the ethics committee has discussed whether Kate should have a kidney transplant and that they arrived at a split decision. Campbell asks if the committee discussed the risks to the donor, and Dr. Bergen said it wasn’t an issue since Anna wasn’t a patient. Campbell shows Dr. Bergen Anna’s hospital records, and the doctor admits that Anna has had several invasive procedures. He also admits he voted against the kidney donation since he did not believe Kate would live through the procedure.

  46. cntd. • Anna recalls how Kate saved her when she was a baby. She was in a walker and almost rolled onto the street before Kate caught her. In the present, Sara questions Dr. Bergen and asks if he has children. She then asks if he ever puts himself into a patient’s shoes. She asks if, offered a course of action that could save his child’s life, would he question it or try it. He doesn’t answer. Another break follows. As Anna leaves the courtroom, she tells her mother she did great.

  47. Sara Summary • In 2002, Kate meets a boy named Taylor while she receives platelets and he receives chemo. Sara watches them flirt and feels happy that her daughter likes a boy. Kate goes on a date with Taylor. That night, Sara overhears Kate gushing about it to Anna. Kate goes into relapse, and Sara has difficulty convincing Kate, who does not want to be hospitalized again, to undergo a stem cell transplant. The oncology team lets Kate begin chemo as an outpatient. Taylor visits Kate during her chemo, helps her when she throws up, and asks her to a dance for patients hosted by the hospital.

  48. cntd. • Sara, Kate, and Anna shop for a dress for Kate. Kate fells self conscious about her baldness, her chest catheter, and all of the scars on her body from chemo. Sara tries to comfort her, but Kate says she can’t fix it every time. Anna drags Kate into a hair salon and asks the hairstylist if she can give Kate, who has no hair, an up-do or a perm. Anna and Kate laugh at the stunned reaction they get. Kate attends the dance with Taylor, and Sara see them kiss. Soon after the dance, Kate goes into the hospital for her transplant. She worries because she hasn’t heard from Taylor. Sara finds out that Taylor died suddenly, but she waits to tell Kate until a month after her transplant. When Kate finds out, she says she loved him and doesn’t speak to Sara for a week. Sara finds Kate looking at old pictures, including one of Kate when she was a baby, before cancer. Kate remarks that she was beautiful.

  49. Monday Jesse Summary • Jesse recalls the time he went to boot camp on a farm as a fourteen-year-old. While there, he helped a sheep give birth. The baby sheep almost died, and he thought that, afterward, the sheep always looked like it had seen the other side. In the present, Jesse sits with Kate at the hospital and sees a similar look on her face. They talk about dying, and Jesse asks if she feels afraid. She smiles and says she will let him know. In his head, he tries bargaining to keep Kate alive. Kate tells Jesse how much she will miss him. After she falls asleep, Jesse walks into the hall and punches a wall.