Two people stand in front of you. One must suffer in order for the other to live, but her suffering is your choice. Both individuals are your daughters. What do you do, and how do you justify it to yourself? If you are Sara Fitzgerald, the answer is simple: one child’s suffering is worth the other’s survival. They are, after all, sisters. My Sister’s Keeper, by Jodi Picoult, explores the most difficult decisions a person can ever be forced to make, and the sacrifices a parent must make in order to keep a child alive. Picoult presents the reader with her big idea: individuals need to be treated as a whole, not as a sum of many parts.
The most important parts in this story belong to Anna Fitzgerald, Sara’s thirteen year-old daughter. Anna was conceived in order to save her sister, Kate, from leukemia. This practice of producing children for stem cells, bone marrow and organs has become routine in our society, though it is still taboo at the time this story takes place. Anna’s conception is carried out more as a medical experiment than a desire to raise another child. On page 100, pregnant with Anna and realizing that she hasn’t yet thought of a name, Sara admits, “I have thought of this daughter only in terms of what she will be able to do for the daughter I already have.” This statement dooms Anna to a life of being considered a vessel for replacement parts. While helping her sister with a crossword puzzle on page 251, Anna quips that a four letter word for “vessel” is “Anna”. Even her father, Brian realizes that no one notices when Anna leaves the dinner table early (40). When Anna is not thought of in relation to her sister, she is simply not thought of at all. The most telling illustration of this fact takes place at the beginning of the book, where Anna and her mother are having a typical female bonding experience discussing a dress Sara had just purchased. The sound of Kate crying in her room rips Sara’s attention from Anna and once again, her focus is on Kate. It is not surprising, then, that Sara is horrified when Anna hires a lawyer to claim the rights to her own body. It never occurs to Sara, Brian or Kate’s doctors that Anna might have use for that extra kidney. Anna would have to give up playing hockey for fear of injuring her remaining kidney, and pregnancy could be dangerous. No one considers that Anna is entitled to a life outside of her forced duty to her sister.
Kate Fitzgerald has survived many years with leukemia and has assimilated into a routine of symptoms, tests, and hospitalizations. In her fervor to find a cure for her, Sara reduces Kate to a myriad of symptoms and illnesses and forgets that Kate is a sixteen year-old girl with a girl’s sensibilities. The origin of Kate’s tears on page 11 turns out to be a sad turn of events on her favorite soap opera. Confused, the only thing Sara can think to ask is, “But what hurts?” When Kate’s boyfriend dies from his own strain of leukemia, Sara keeps it to herself for over a month, preferring that her daughter think that she has been unceremoniously dumped. Her reasoning is simple: she didn’t want Kate to use that as an excuse to give up on her treatment (321). Sara’s most significant failure is that she doesn’t take Kate seriously when she protests the idea of a kidney transplant to extend her life. As Kate puts it, “It’s not suicide…if you’re already dying.” (377) Had she taken her daughter seriously and listened to her reasoning, she might have discovered that Anna’s medical emancipation lawsuit resulted because Kate begged her not to participate in the transplant.
The oldest boy in a family often receives a significant amount of attention and is bestowed with the family’s loftiest expectations. Unfortunately for Jesse Fitzgerald, his sister’s illness usurps his place in the family. While Kate is the Illness and Anna the Parts, Jesse is seen as In the Way. If Jesse is unable to contribute to the family by helping to take care of Kate’s needs, then his presence is not required. His father, Brian, is relieved to smell pot on Jesse’s clothes (38), because it means that he’s probably not using a more dangerous drug that might require his parents to deal with him. Not one to give up on getting attention, Jesse supplements his “Eu de Stoned” as Kate refers to his smell, with offensive t-shirts (40). The attention he gets is minimal; after all, he is not sick. On page 65, Jesse is tested to find out if he will be a fitting bone marrow donor for Kate. After a painful stick in his finger, five year-old Jesse runs to his mother, crying. Sara admits, “But it is so, so hard to make myself feel sorry for him.” Jesse does not see Kate as an illness or a patient. To him, Kate is just his sister. Brian gives him the harsh truth of Kate’s more important role in the family when Jesse complains that Kate doesn’t have to finish her dinner. Brian yells a harsh rant at the five year-old, who is frightened and runs for his mother. This is the only sympathy he garners throughout the book, as he astutely compares himself to a willow tree on page 99, “…big, hollow, forgotten by most everyone.” Jesse is desperate to get his parent’s attention; he gets into the habit of setting fires as a means of channeling his firefighter father. In spite of being ignored, he the most concerned with Kate’s survival and Anna’s struggles. One can only imagine how he behaves in school.
Teacher education is a tricky endeavor. Not only do teachers need to know the subject matter, different ways of teaching it and how to manage the classroom all the while, they also need to be able to recognize the different needs of their students. Let’s use the characters of Jesse, Anna, and Kate as examples.
By the time Jesse is in the first grade, he has already fallen into the category of The Forgotten Child. He is not ill, nor is he needed to assist with Kate’s illness, so he serves no purpose at all. At home, he does everything in his power to draw attention to himself. In school, he is most likely to act out and to disrupt the class. Many teachers would become easily frustrated with this behavior and seek to punish him without asking for an explanation. Teachers should be aware that a child who constantly seeks out attention and doesn’t distinguish between positive and negative, is probably looking for something he is not getting at home. Punishment is an easy price to pay for a child who is neither rewarded nor punished by his parents.
Kate’s illness would allow her limited time to attend school. She would out of the classroom constantly to be treated for her illness. Let us assume that Kate did spend a significant amount of time at school, even in a frail condition. Her teachers might be tempted to go easy on her, to make the classroom a comfortable place to be since her illness is wreaking havoc on her body. If she misses an assignment, she could easily ask for an extension. Failing a test might lead to sympathy and even the temptation to raise her grade. After all, in her condition, she’s doing the best she can. A teacher should learn that the sick child wants to be treated like everyone else. Talking in class should lead to the same consequences as the other children. A late homework assignment shouldn’t be tolerated without a note from home explaining the circumstances. And if Kate is capable of understanding the material the same as her classmates, then she should receive the grade she earned, not the grade padded with sympathy points. If the sick child can feel like a normal child during the school day, it would go a long way to boosting her self-esteem and forcing her to consider life beyond her illness and life in light of survival.
The most difficult child to have in the classroom, surprisingly, would be Anna. She would be the People Pleaser. At home, Anna was trained to service her sister’s needs by donating body parts on demand. It didn’t matter to her mother that bone marrow extractions and blood donation took time way from playing hockey or being a normal child. Throughout the book, there was no mention of Anna’s having any friends. In the classroom, Anna would most likely be the student who would go along with anything. She would be content to sit in the back (even if she had trouble seeing the board), not inconvenience the teacher with questions, and to put the needs of her classmates before her own. The teacher might see her as a sweet, polite student, but what the teacher would need to do is to draw Anna out of her shell and to make sure that her needs, whatever they may be, are met to the same extent as the Jesses and Kates in the classroom. After all, Anna won’t complain. As she’s learned at home, who would listen?
The tragic twist to the story takes place when Anna is rendered brain-dead after a car accident and her lawyer makes the difficult decision to bestow her kidneys upon her sister. All of the struggles were for nothing; Anna’s role in the family is complete. It is only after her death that the family realizes that Anna was more than just a donor for her sister; she was an important part of the family. Sara mourns for her lost daughter, and Brian deals with his loss through alcohol. It is only through the loss of the combined parts that Anna’s family realizes her worth as a whole.