It's the story of two sisters: Kate, who was diagnosed with a particularly virulent form of leukemia at the age of two; and Anna, who was conceived, genetically engineered, and born specifically to be a matched donor for her older sister. All her life, Anna has made medical donations to her sister - cord blood, lymphocytes, etc. etc., etc. Now, Kate is 16 (no one ever believed she'd live this long); Anna is 13. And this time Kate's kidneys are failing, and their parents - as always - assume that Anna will donate the needed kidney, without even being asked (she'd never been asked in the past; her parents have always made those decisions for her). But this time, Anna decides that she must speak up for herself, and she files a lawsuit against her parents, demanding that she be medically emancipated from them, so that, for the first time ever, she will be in control of her own body, and what is taken from it.
The story is told through the eyes of various family members and people involved with the lawsuit, and piece by piece, we see the parents struggle with their daughter's illness, and the high price that the other children have had to pay, too. It brings up a variety of ethical questions, and I knew from the first page that it would be a difficult read - a child with an serious illness is a parent's worst nightmare, and something I'd usually just choose to avoid reading. But for some reason, I decided to stick with this one, and before long I was completely caught up in it. This was a page-turner, which kept me feeling emotionally connected to the characters in so many ways. It's intense, heartbreaking, beautiful, compassionate, and a satisfying read - and one that packs a major punch in the last few pages.
I'm going to put the rest of this behind a cut, since I'd like to talk about specifics, but to do so will involve MAJOR SPOILERS. Like SERIOUSLY MAJOR SPOILERS. So, if you have not read this book, but intend to, for heaven's sake DON'T CLICK THIS LINK!
There is so much I could write about this, but I don't feel like thinking through a comprehensive essay, so I'm just going to pick and choose. I loved Anna, and never, ever thought that she was acting out of any sort of selfish, petty, or childish impulse. And even if she had, who could blame her? Not for one day of her life had she been allowed to live a "normal" life, and while I don't fault her parents for the medical decisions they made concerning her (having her continue to donate body parts to her sister), I do fault them for not being more aware of how this lifestyle affected Anna, and doing something about that. I was pissed off about hockey camp. Not to mention pissed off about their older brother, Jesse, being written off completely.
It's not that I can't understand why this would happen; they were so scared all the time about Kate's health, that they (well, in particular their mother, Sara; I loved Brian and thought that he did try to keep things more in "perspective") were unable to see anything else. I honestly can't imagine (and don't want to imagine) being in that situation. But I do hope that, if I had more than one child, I could never neglect any of them so thoroughly because I felt that one of them needed all my attention. In this way, Sara reminded me a lot of the mother in "Deep End of the Ocean," and I didn't like - nor sympathize with - either of them very much. Like I said, I don't blame her for the medical decisions (although expecting a donation of a kidney was a big leap from the earlier stuff), but I do blame her for not really loving Anna - or at least, not loving her in a way that Anna could see, feel and understand. When we heard things in Sara's voice, I honestly never got the feeling that she really did love Anna. She never treated her as though she did, nor ever spoke of Anna in a way that put her first. It was always about Kate. And when Sara said she loved Anna, it always seemed insincere, as it was unaccompanied by actions which showed that love. Well, at least up until the end, of course, when perhaps Sara herself finally realized - too late - just how much she loved Anna for herself, and not just for what she could give to her older sister. Heartbreaking.
As for the ending, well, when I was finished, I immediately went back and re-read that first page. All throughout, I'd kept that first page in mind. That's how we "knew" that Kate was going to die. Anna had told us, right from the start. But oh my GOD no! And I felt like I should have guessed; I should have "gotten" it. The italics, which we never see again (and I was well aware that the font was changing while the story was being told in different voices). And the fact that we never hear things directly from Kate. Why didn't I notice THAT? (That's something else I didn't quite grasp until the very end - just how tragic and horrible Kate's life had been. It was bad enough hearing about her illness through the eyes of others; could we have borne it hearing it from Kate herself? And yet, in the end, she's the one who survives). There's no way I could have guessed. I'm just not clever like that (which is why even easy "mysteries" usually stump me; it has to be pretty obvious for me to twig to "whodunnit"). In any case, it was honestly too horrible for me to have guessed, and if I had guessed, I doubt I'd have finished the book. And once the realization hit, various implications began to sink in. It's not Anna who thought of killing her sister. It was Kate. And we know that Anna always felt as though her life revolved entirely around her sister - her sister was the sun around which all the others were in orbit. But it never once occurred to me that Kate might feel exactly this same way about Anna. In a very real way, Anna was the center, too, only I could never see it that way until the very end. The two of them were intertwined in a way few human beings could ever being, to the benefit - and detriment - of both.
And the ending? Heartbreaking. Utterly. Of course, it was obvious from the first page that there would be no "happy" ending. But to end like that? It was like getting sucker-punched in the gut. Powerful, yes. And surprising, and a huge emotional impact. But it felt gratuitous, at first. Why throw THAT at us, NOW? Hadn't they (hadn't WE?) been through enough already? But the more I thought about it, the less gratuitous it seemed. She could have written a happy ending - Anna donates kidney, Kate gets better, everyone lives happily ever after. But that would have probably seemed like a cop-out, like a huge anti-climax after such an amazingly adept build-up. Oh, I spent a while HATING the author, and I still hurt over the way the book ended, but I have to admit that it was infinitely more powerful - and more memorable - because of it. And in that moment, the focus shifted from all the details that had come before to the one more important point: Always be grateful for what you have RIGHT NOW, because you never know what will happen tomorrow. Yes, definitely more powerful, and I suppose I can't still be angry at Picoult, since I went looking for more books by her at the library this afternoon. (I found one about a murdered infant in an Amish community). If I'm interested in reading more, she must have done some things right.
I still want to cry if I think too much about this book, but in spite of how much it hurt, I am very glad to have read it. It was an amazing work of fiction, well-crafted and powerful, with vibrant, amazing and very, very real characters. I would recommend this, although be warned that it's not an easy or comfortable ride. 5 stars