My Sister’s Keeper

Sara and Brian take Kate to see Dr. Harrison Chance, Kate’s new oncologist. Sara feels a sense of comfort and inclusion in the oncology ward, “a sense that I am a member of the club,” but she is impatient with Dr. Chance’s lateness and dislikes the dying plant in his office. She blows up a rubber glove to entertain Kate; the two are playing when Dr. Chance arrives. He sternly looks at the balloon and says that “there’s already a problem”—but then he takes the balloon and draws a face on the glove, handing it back to Kate with a smile.

Sara reflects on her relative lack of contact with her sister Suzanne, whom she only sees once or twice a year despite living close to her. Suzanne, who is 10 years older than Sara, became a parental figure to Sara after their father died and their mother never recovered from her grief. Sara envies her confidence and competence but laments that Suzanne views her as a failure due to marrying someone without a college degree and having children. Even so, Sara decides to call Suzanne, managing to get her on the line despite her being in a meeting. As soon as the two talk, Sara remembers all of her fond sisterly memories of Suzanne and realizes that Suzanne is her “built-in best friend.” On the phone, she asks Suzanne how she is.

During the process of Kate’s diagnosis, Sara and Brian meet with a team of specialists to have their questions answered. Sara quickly learns that the nurses, rather than the doctors, provide them the vital information. One nurse explains the aggressive nature of acute promyelocytic leukemia and warns that there are “no guarantees,” while another outlines the side effects of chemotherapy, such as nausea, immune suppression that will likely give her an infection, and hair loss. This last side effect, though minor in comparison to the others, upsets Sara since it will mark Kate as visibly ill. She thinks of Kate’s first haircut just six months earlier.

Dr. Chance explains that, after chemo, they will have to watch Kate closely for relapse. Unless she goes into remission, they will have to rely on a bone marrow donor. The best-case scenario is that Jesse is a match for a transplant, but if not, Kate will be placed on a registry for an unrelated donor. However, Dr. Chance warns, this is a riskier procedure. Sara asks what it will look like if Kate dies. Dr. Chance tells her it will depend on what she succumbs to. Sara asks if Kate will know what’s happening, to which Dr. Chance says that out of the 20 children in the ward, 10 will be dead in a few years, and he has no way of knowing which group Kate will be in.

Kate begins chemotherapy, which requires a central line to be placed beneath her collarbone; it makes Sara think of a sci-fi movie. She has undergone multiple tests to ensure that she can withstand the chemo, and the nurse reassures Sara that Kate won’t feel anything. As the chemicals course through Kate’s body, Sara imagines an army battling inside her. Kate begins to vomit within two hours, and while the nurses are able to briefly stop by to administer anti-emetics, it’s largely up to Sara and Brian to take care of her. Brian wipes Kate’s face while Sara empties the emesis basin over and over. She tells the reader that “if you focus on sandbagging the beachhead, you can ignore the tsunami that’s approaching.”

Brian brings Jesse to the hospital so that he can receive a blood test. It’s only a finger stick, but Jesse is so terrified that it requires Brian and two residents to hold him down. Sara watches with her arms crossed, thinking of how Kate stopped crying over her procedures two days ago. All six of the proteins in Jesse’s blood must match Kate’s for him to be a potential donor; Sara muses that the odds for this are just as slim as getting leukemia in the first place. When Jesse is done, he goes to Sara for comfort. She gives it to him, but she finds it difficult to feel sorry for him.

Dr. Chance tells Sara and Brian that Jesse is unfortunately not a match. Sara stares at his dying plant, wishing someone would replace it with flowers. Dr. Chance continues that they’ll have to look for a donor on the registry, but if not, they’ll simply have to hope that cancer research progresses quickly enough to save her. Sara, upset by this, picks up the plant and leaves the office to throw it away. Dr. Chance follows her out to check on her, and she says she’s fine; after all, she’s going to live a long, healthy life. She hands him the planter and apologizes. Dr. Chance reassures her that survival rates have increased, and even though Jesse wasn’t a match, another sibling might be. Sara realizes he’s talking about a sibling that isn’t born yet.

One evening, Kate leaves the dinner table despite barely having eaten. Jesse tries to leave as well, but Brian won’t let him. Jesse complains that it’s not fair that Kate gets to be finished but he doesn’t, causing Brian to lose his temper. He tells Jesse that if he wants things to be fair, he can get every painful procedure that Kate gets. Sara, shocked, cuts him off. Brian, suddenly aware of his own behavior, apologizes to the cowed Jesse and leaves the room. Jesse asks if Brian is sick too, and Sara reassures him that they’re all going to be fine.

A week after Kate returns, a crash comes from her room. Sara and Brian find her convulsing from a fever. Neither of them is willing to leave her to watch Jesse, so they wake him up and take him along to the ER. Kate undergoes a variety of tests, including a spinal tap and a chest X-ray, to determine the root of her infection. When they view the chest X-ray, Sara is horrified to see a large blot, which she immediately assumes is a tumor from the cancer metastasizing. The doctor places a hand on her shoulder and tells her that the blot is Kate’s heart.

Kate has pancytopenia, meaning that she has nothing protecting her from infection—a sign that the chemo has worked. As a result, she has contracted nadir sepsis, a post-chemo infection. She is given Tylenol and antibiotics, and it takes six hours before she stops shaking. Eventually, Kate’s temperature drops to a safe level and she falls asleep. Sara thinks she looks like a corpse, which, horribly, is preferable to watching her suffer. Brian takes Jesse downstairs to get lunch, but Sara opts to stay with Kate, who wakes up. Sara tells her that when she grows up, she wants to be just like Kate. Kate shakes her head and tells Sara that, if she grew up to be like Kate, she’d be sick.

Sara has two dreams following Kate’s treatment. In the first, IV fluid is flowing too quickly into Kate’s central line, inflating her like a balloon. Sara attempts to pull it out, but she’s too late, and Kate’s face balloons until it’s a smooth white oval. In the second dream, Sara is giving birth. The nurse tells her it’s a girl and hands her the baby, at which point Sara realizes that it isn’t Kate. She tells the nurse that the baby isn’t Kate, and the nurse agrees but tells Sara, “[S]he’s still yours.”

Suzanne arrives at Kate’s hospital room. Sara immediately starts crying. Suzanne tells her she was never going to listen to Sara’s request for her not to come, and that she’ll be able to work remotely. She offers to watch Jesse, and both Sara and Brian realize they hadn’t even considered who would do this during Kate’s treatments. Immediately, Suzanne sets to work getting things done: playing with Jesse, convincing a restaurant to deliver to the hospital. Sara is able to relax a little, letting herself pretend that Suzanne can fix the problems that she can’t.

After Suzanne leaves with Jesse, Sara and Brian stay alone with Kate. Sara tells Brian that she’s been thinking about having another baby. Brian is disgusted, but Sara tells him that it’s not what he thinks. He tells her that they can’t simply replace Kate if she dies. Sara, forcing herself to think of Kate alive at age four, 12, 20, tells him that that’s why they have to make sure she survives.