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My Sisters Keeper is a poignant, uplifting, emotional, sad, triumphant, passionate, heartwrenching and extremely powerful story about the Fitzgeralds, a family united in their love for each other but divided on exactly where the boundaries of family obligations, love and sacrifice should end. But it is, ultimately, a story of two sisters, the unbreakable bond they share and how totally entwined they have been all their lives until a crucial decision threatens to tear them apart and ends up changing all the lives forever.Curled Up With a Good Book

The Fitzgeralds - Brian, a firefighter and avid amateur astronomer, and Sara, a stay-at-home mother and ex-lawyer - have the perfect suburban family, but life changes irreversibly when Kate, now sixteen, is diagnosed at age two with leukemia. She develops what looks like "a line of small blue jewels" down her spine, and her mother knows immediately that she is not seeing normal bruises. The family doctor wants the tests repeated in the hospital hematology/oncology department. There, after a series of painful and invasive procedures, they learn that Kate suffers from "APL … a subgroup of myeloid leukemia. The rate of survival … is twenty to thirty percent, if treatment starts immediately." The treatments keep the disease at bay for about five years, until Kate's body explodes with runaway cancer cells. She desperately needs a bone marrow transplant or she will die. Her determined mother, on the advice of the doctor, persuades her husband to try for the "perfectly engineered baby."

Their other child, Jesse, is not a match, but now at thirteen, Anna has always been aware that she was "born for a specific purpose…a scientist managed to hook up [her] mother's eggs" and her father's sperm "to create a specific combination of precious genetic material," so that could she could be a bone marrow match for her sister Kate. When Kate needs leukocytes or stem cells or bone marrow "to fool her body into thinking it's healthy," Anna has obediently stepped in. Everytime Kate is hospitalized so is she, which means Anna can never go away to soccer camp or even to college.

Until now, Anna has never questioned her role in life. But she says that "lately I have been having nightmares, where I'm cut into so many pieces that there isn't enough of me to be put back together." The strain has been heavy on them all, especially Anna who says so bluntly - "I was never really a kid. To be honest, neither were Kate and Jesse…" And it is hard because they "practically set a place for Death at the dinner table." It does different things to them. Jesse is the wild kid who does drugs and plays with matches, gets arrested for stealing a judge's car and is generally hopeless. But he is acting out is because he feels he is worthless, unable to help Kate. He calls himself "a lost cause."

After the countless surgeries, transfusions and shots, Anna is now required to give a kidney, which her mother Sara, so intent on saving Kate, doesn't think is a big deal. Kidney donation us considered a relatively safe surgery. But the pamphlet that Anna reads explains that "when you donate a kidney, you spend the night before the operation fasting and taking laxatives. You're given anesthesia, the risks of which can include stroke, heart attack and lung problems. The four-hour surgery isn't a walk in the park either --- you have a 1 in 3,000 chance of dying on the operating table, if you don't, you are hospitalized for four to seven days, although it takes four to six weeks to recover…"

She has had enough. She loves her sister fiercely but she can't go through with the kidney donation, so she sues her parents for the right to make her own medical decisions.

When you reach the end of the book after following Anna through her journey, you realize that there are no easy or even right answers. There isn't one person who can be judged for what they think is moral or ethical, or even justifiable. Sometimes you don't know what the right thing is but as a mother, as a doctor and even as a sibling, you do what you think is right for you and for everyone else.

Picoult has done an amazing job of presenting the dilemma. She takes this conflicting issue and handles it with compassion, sensitivity and an infinite amount of grace. For the first time in her career, she draws on her own experience with her son Jake, who thankfully was never in a life-threatening situation. It may be cliched to say that this is "a must read," but it's true. Read this book and you will never again consider stem cell research and other news topics indifferently.

Jodi Picoult received a BA in creative writing from Princeton and a master's degree in education from Harvard. The recipient of the 2003 New England Book Award for her entire body of work, she is the author of ten previous novels, including Perfect Match and SALEM FALLS. She lives in New Hampshire with her husband and three children. Visit her website at here for Sonia Chopra's' interview with My Sister's Keeper author Jodi Picoult

Originally published on Curled Up With A Good Book at © Sonia Chopra, 2004

Also by Jodi Picoult:

Change of Heart

5 Questions with

Jodi Picoult

Interviewer Sonia Chopra: The topic of this book was a heavy one. I know that you research your books heavily and also drew in your own circumstances about your son Jake . Was it emotionally hard to write? Did you cry a lot?

Jodi Picoult: This was a tough one to research, yes. I spent a lot of time with pedi oncology patients - they were to a fault the most uplifting, happy, wisecracking lot you'll ever meet...but their parents are all smiling so hard and underneath waiting for the other shoe to drop. It's grueling, being with them day after day...and comparing it to my experience with Jake (the answer is, it NEVER compares - thankfully, Jake was never in a lifethreatening situation.) I think, ultimately, that my connection as a parent who had an ill child is what helped me to write Sara as a sympathetic character - you might WANT to hate her, but you can't, because of what she's endured.

All your characters -- Jesse, Kate, Anna, Sara and Brian -- are very real, almost people whom we have known...are they? Or are you just an amazing writer?

I'm an amazing writer. Period. No, just joking. I don't know how they get so real - they're that way when they start talking to me, so I just hold onto the reins and let them speak. They aren't anyone I know, personally. I never create a character based on someone I know because my characters really already have personalities, and that would be superfluous.

Your next book is Vanishing Acts. Is this also a very intense interaction between people, like all your books are?

Yup. It's the story of a 30-year-old woman who has it all - she's been happily raised by a single dad after her mom's death as an infant; she has a 4 y.o. daughter and is on the verge of marrying the dad, an on/off boyfriend; she has a search and rescue dog service...and as she's planning her wedding she starts recalling bits of a life she can't remember living. With a little help from a friend, she does some research...and learns she was abducted by her dad during a custody visit when she was four; that he moved her across country and changed her ID, and that her mom is alive and well in Arizona. The book takes place in AZ, as her dad goes back to stand trial for kidnapping. The woman, of course, has to wonder whether she can now believe her father when he says he HAD to steal her away for her own safety...or if that, like the rest of her life, is a lie. The novel, in my mind, is about who we trust to tell us the story of our lives before we can remember to tell it to ourselves.

Who are your favorite authors? What do you love about being a writer?

Alice Hoffman, hands down. Elizabeth Berg. Chris Bohjalian. JoAnn Mapson. Sue Miller. Anne Tyler. What I love most about being a writer is meeting my fans and hearing how much my books touch them - who wouldn't like that?? - and getting to learn all sorts of cool things when I do my research.

Apart from creating these incredible stories, what other gifts do you receive from being a writer? And what advice would you give to aspiring writers?

The gifts hit you broadside. Like when a depressed teenager tells you that she's not going to commit suicide, because she doesn't want to end up like Emily in The Pact. Or when a woman whose husband died of cancer last year writes after reading My Sister's Keeper and says that I completely nailed grief in those paragraphs, and that it took her away from her own problems. The biggest gift of all is being able to go to work every day and love what I do...not many folks can say that.

The advice I give aspiring writers is to JUST DO IT. Sit down. It's not inspiration, it's hard work - and it's not always easy. There are days you won't want to write; there are days you won't write well -- well, too bad - you just do it and edit the next day. You need self-motivation to succeed in this business, and you also need a thick skin, because you WILL get rejected. But selling a book is like selling a house - you don't need the whole world to love it, just one person...and then he/she does the legwork. If you continue to believe you can make it as a writer, eventually someone will look twice at you and wonder why you believe that so strongly. And sometimes, that second glance is all you need for a starting break.

'My Sister's Keeper' by Jodi Picoult - Book Review Rating 4 Star Rating

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Book Review


Book Keeper

Jodi Picoult

My Sister 'S Keeper

The Bottom Line

My Sister's Keeper is the story of a girl who sues her parents for a right to make her own medical decisions. Anna was conceived after her older sister was diagnosed with leukemia. She is a perfect match for her sister, and spends her life in the hospital donating blood, marrow and whatever else her sister needs to live. As a teenager, she sues so that she will not have to give her sister a kidney. My Sister's Keeper covers the life of this family during the trial. Each chapter is told from a different character's viewpoint. It is one of Picoult's best books

Writing Level StarWriting Level Star

April 02, 2007

Every now and again you read a book that really gets to you. That touches deep to the core and leaves you thinking about it long after you have finished reading it. Well for me this was one of those books. "My Sister's Keeper" is written by Jodi Picoult a best selling American author who isn't afraid to tackle hard issues and whose books are emotional stories about relationships with all their complexities.

The main character in the story is Anna, a 13 year old girl, a very special 13 year old girl. This is because she was conceived specially for her genetic make-up in order to save her sister Kate who has leukaemia. Initially the only thing she was to give was the blood from the umbilical cord but as the years have gone by and Kate has kept having relapses Anna has had to go through several painful operations and transfusions to provide blood and bone marrow to keep her sister alive.

Anna decides she doesn't want to do this anymore she wants to be a person in her own right and not just the one that people come to when they need something for Kate. So she takes matters into her own hands, approaches a lawyer and takes her parents to court to fight for the right to make decisions about the medical interventions, the rights to her own body.

This decision has far-reaching consequences for her relationship with her parents and her relationship with her sister. But far more importantly her sister's life hangs in the balance if she decides she does not want to undergo any more medical intervention.

The story examines the emotions of main characters and how they react to the situation they are faced. It also examines their past experiences and gives us more of an understanding of what they have been through and why they feel the way they do.

I am not going to go into the characters in a lot of detail as you get to know them all well in the book. However the main characters are Anna and her sister Kate. They also have a brother Jesse who has gone off the rails and their parents don't know what he is up to. Sara and Brian are the parents. Sara spends all her time looking after the children, mainly dealing with Kate's health problems and ferrying her back and forward from the hospital. Brian is a fire-fighter and although feel in control when fighting fires feels out of control at home.

Campbell is the lawyer that Anna hires, a mysterious complex character who has a "service dog" but won't divulge what is wrong with him. Finally Julia is the person appointed by the court to try to work out what they think is in Anna's best interests. She knows Campbell from the past and they appear to have had some history.

As you can probably tell from the short description above this is an emotional book. The author has chosen a very emotive subject but also one which is very topical in today's society with more so called "designer babies" being conceived. For many parents it will strike a chord making them ask to what extremes would they be willing to go to, to save their child. Would they put the health and wellbeing of one child at risk because if they don't the other will die? You can't read this book without asking yourself, what would I do in those circumstances.

I liked the style that the author chose to write this book. The story is told first-hand but the narrator changes with each chapter. This works well giving us a deeper understanding of what the characters are feeling and lets the reader really feel they are getting to know the character and can empathise with them.

It is obvious that Jodi Picoult carried out a lot of research in order to write this novel. In the acknowledgement page at the start of the novel she thanks various people for their help in both the medical terminology and the fire information. The fact she has carried out this research helps the reader to feel that what they are reading about is or could be actually happening, it's very realistic. However I feel that in some places she goes into far too much detail about the medical ins and outs of leukaemia, in these places in the book I don't think the excess detail adds anything to the story its almost as if she is trying a little too hard.

The novel has a gradual build up in tension and anticipation working towards the court case. You start reading this book and you can't put it down. There wasn't anywhere in the book that I felt the story dragged, the pace is good throughout.

I won't give any clues to the ending of the book but will say that my husband came back into the lounge and asked me if I had finished reading the book and I just burst into tears! I cry quite easily but this book certainly did get to me. Towards the end of the book you are trying to guess how it will finish but you just don't know. Jodi Picoult has said that her son read the book himself and at the end she found him crying on the sofa and he stormed up to his room unable to speak to her because he was that angry at her!

I definitely recommend this book to anyone who wants a gripping read about people, emotions and relationships. It's well written and will keep you reading to find out what happens. All I recommend is that you have a box of tissues ready because it's a book that gets you.

Jodi Picoult is a very successful author and has written many novels including The Pact and Salem Falls. She was born in Long Island and now lives in New Hampshire with her husband and 3 children. She writes novels about family and the tangle of relationships. The political and scientific discussions over cloning and DNA were what sparked the inspiration for "My Sisters Keeper" but Jodi Picoult wanted to look at the dilemma from a personal level. As she so perfectly puts it "If you use one of your children to save the life of another, are you being a good mother or a very bad one?"

When I looked at Jodi Picoults website I came across a list of questions suitable for use in book club discussions which I thought were quite interesting. One was something I hadn't noticed before and got me thinking, the question is "Reread the prologue to My Sister's Keeper. Who is the speaker? Is it the same person you thought it was the first time you read it?" If you have read this book go back and read the prologue the bit where the person is reflecting back to their earliest memories and you will see what I mean.

At the end of the book she includes the first chapter of The Pact another of her novels. So I am off to read that next.

ISBN 0-340-83546-X Pages - 407

Plot Summary of My Sister's Keeper

"Anna was born with one purpose in mind - to be a donor for her older sister Kate, who was diagnosed with terminal leukemia at age 2. Now, at 13, Anna sues her parents for the rights to her own body - at the risk of losing her sister. The ensuing battle, both within the family and within the courtroom, shakes the concept of family to the very core, and calls into question the term "good parenting.""

, Resident Scholar

"Anna Fitzgerald was genetically designed, conceived, and born to be the perfect genetic match for her sister, Kate. Kate suffers from a rare form of childhood leukemia and will die without blood and bone marrow transfusions from Anna. At 13, when her sister now needs a kidney, Anna has had enough. She hires an attorney and sues her parents for the rights to her own body. As her case works its way through the byzantine legal system, things at home fall apart for Anna and her family. Anna recalls both the loving memories of her sister as well as holidays, parties, and activities sacrificed so she could be hospitalized to donate. Their father, a firefighter and part time stargazer, is torn between the competing needs of his children. Their mother, an attorney who retired when she had children, struggles to hold the family together and keep Kate alive at all costs."

Jennifer Martin-Romme, Resident Scholar

"Anna Fitzgerald was definitely not a mistake. She was especially designed from her parents genes to provide a match for her elder sister Kate's rare blood type. Kate has Leukemia, and when Anna was young she donated bone marrow to help with the treatment. Soon however, it was more marrow, blood, stem cells and now, when she is thirteen her parents want her kidney.

The book jumps straight into the story where Anna begins to fight against her parents control, and adamantly against giving Kate her kidney she convinces a lawyer to take her case against her parents - she is suing them for the rights to her own body.

The plot follows Anna's family's struggle, not only within the legal system but the emotional trials they all must now face; her parents struggle to understand Anna's motives, as Anna seems also to do at times. At thirteen years old Anna rebels against her parents in one of the most heart wrenching ways possible for both parties, and in particular her alienation of her mother causes all sorts of difficulties within the family. A well-rounded story, more emphasis is placed on the family side of Anna's battle with the underlying influence of Jesse, the girls' older brother who has been slightly neglected, and perhaps due to the strain of having two frequently hospitalised sisters has become delinquient and isolated.

Interestingly, Kate does not seem to voice much opinion about Anna's choice to deny her sister a life-saving organ, which adds to the intrigue of the legal battle. Anna's relationship with her lawyer is at times one-sided, as she begins to increasingly rely upon him, and he gets frustrated as he begins to feel like a babysitter. He does however recognize the influence of her controlling mother, and puts her under the care of a legal guardian, which naturally strains family relationships further.

Anna's case finally reaches the court, but her battle is far from over. More emotional manipulation and typical insecurities follow, as she stands up for herself in a world of adults. "

Jessica Charlton, Resident Scholar

Anna, who has already been through numerous surgeries and blood transfusions, invests in the services of lawyer Campbell Alexander. She questions her place in the world and decides to sue her parents for medical emancipation for the right to make her own decisions about her body. Decisions that are quite literally a matter of life and death for the sister she loves.

My Sister's Keeper Review

My Sister's Keeper is a gripping story about Anna's fight to make her own decisions about her body. Fighting for medical emancipation causes a great deal of friction within the family. Her mother, an ex-lawyer who quit to take care of Kate is angry, her father a firefighter is torn, and her brother who feels left out, rebels by being destructive and falling into the role of the black sheep.

Anna reminisces about family holidays and the good times that she had with her sister but also looks back on the sacrifices she has made over the years, like missing out on parties and camps because her mother didn't want Anna to be too far away in case 'Kate needs her'.

Anna's first sacrifice was at birth, when she gave up her umbilical cord. Though that was a painless contribution she would never miss, giving up a kidney is something else entirely. Potential side effects include difficulty becoming pregnant and a lifetime of non-contact sports so as not to put the remaining kidney at risk. These are things that Anna considers, however, there is much more to the decision than that.

Written from varying viewpoints, Picoult creates deep and likeable characters that the reader will feel for and understand, while she weaves an emotional and thought provoking story. Interestingly, Kate doesn't appear to have much of an opinion, which adds intrigue. My Sister's Keeper is a masterfully written story with a surprising ending. Highly recommended.

My Sister's Keeper was first published in the United States in 2004 by Attria Books (ISBN 978-1-74237-102-3) and has since been made into a movie starring Cameron Diaz, Abigail Breslin, Alec Baldwin and Joan Cusack. Picoult has written many novels including Second Glance, Salem Falls and Harvesting the Heart. Several of her books have been made into movies in addition to My Sister's Keeper including The Pact, The Tenth Circle and Plain Truth.


My Sister's Keeper

A Short Synopsis

Anna is not sick, but she might as well be. By age thirteen, she has undergone countless surgeries, transfusions, and shots so that her older sister, Kate, can somehow fight the leukemia that has plagued her since childhood. The product of preimplantation genetic diagnosis, Anna was conceived as a bone marrow match for Kate - a life and a role that she has never questioned… until now.

Like most teenagers, Anna is beginning to question who she truly is. But unlike most teenagers, she has always been defined in terms of her sister - and so Anna makes a decision that for most would be unthinkable… a decision that will tear her family apart and have perhaps fatal consequences for the sister she loves. My Sister's Keeper examines what it means to be a good parent, a good sister, a good person. Is it morally correct to do whatever it takes to save a child's life… even if that means infringing upon the rights of another? Is it worth trying to discover who you really are, if that quest makes you like yourself less?

A conversation with Jodi Picoult about My Sister's Keeper

Your novels are incredibly relevant because they deal with topics that are a part of the national dialogue. Stem cell research and "designer babies" are issues that the medical community (and the political community) seem to be torn about. Why did you choose this subject for My Sister's Keeper? Did writing this novel change any of your views in this area?

I came about the idea for this novel through the back door of a previous one, Second Glance. While researching eugenics for that book, I learned that the American Eugenics Society -- the one whose funding dried up in the 1930s when the Nazis began to explore racial hygeine too -- used to be housed in Cold Spring Harbor, NY. Guess who occupies the same space, today? The Human Genome Project… which many consider "today's eugenics". This was just too much of a coincidence for me, and I started to consider the way this massive, cutting edge science we're on the brink of exploding into was similar… and different from… the eugenics programs and sterilization laws in America in the 1930s. Once again, you've got science that is only as ethical as the people who are researching and implementing it -- and once again, in the wake of such intense scientific advancement, what's falling by the wayside are the emotions involved in the case by case scenarios. I heard about a couple in America that successfully conceived a sibling that was a bone marrow match for his older sister, a girl suffering from a rare form of leukemia. His cord blood cells were given to the sister, who is still (several years later) in remission. But I started to wonder… what if she ever, sadly, goes out of remission? Will the boy feel responsible? Will he wonder if the only reason he was born was because his sister was sick? When I started to look more deeply at the family dynamics and how stem cell research might cause an impact, I came up with the story of the Fitzgeralds. I personally am pro stem-cell research - there's too much good it can to do simply dismiss it. However, clearly, it's a slippery slope… and sometimes researchers and political candidates get so bogged down in the ethics behind it and the details of the science that they forget completely we're talking about humans with feelings and emotions and hopes and fears… like Anna and her family. I believe that we're all going to be forced to think about these issues within a few years… so why not first in fiction?

In Jesse, you've done an amazing job of bringing the voice of the "angry young man" alive with irreverent originality. Your ability to transcend gender lines in your writing is seemingly effortless. Is this actually the case, or is writing from a male perspective a difficult thing for you to do?

I have to tell you - writing Jesse is the most fun I've had in a long time. Maybe at heart I've always wanted to be a 17 year old juvenile delinquent… but for whatever reason, it was just an absolute lark to take someone with so much anger and hurt inside him and give him voice. It's always more fun to pretend to be someone you aren't, for whatever reason -- whether that means male, or thirteen, or neurotic, or suicidal, or any of a dozen other first person narrators I've created. Whenever I try on a male voice - like Jesse's or Campbell's or Brian's - it feels like slipping into a big overcoat. It's comfortable there, and easy to get accustomed to wearing… but if I'm not careful, I'll slip and show what I've got on underneath.

On page 190, Jesse observes, while reminiscing on his planned attempt to dig to China, that, "Darkness, you know, is relative." What does this sentiment mean and why did you choose to express it through Jesse, who in some ways is one of the least reflective characters in the novel?

Well, that's exactly why it has to be Jesse who says it! To Jesse, whatever injustices he thinks he's suffered growing up will always pale to the Great Injustice of his sister being sick. He can't win, plain and simple… so he doesn't bother to try. When you read Jesse, you think you see exactly what you're getting: a kid who's gone rotten to the core. But I'd argue that in his case, you're dealing with an onion… someone whose reality is several layers away from what's on the surface. The question isn't whether Jesse's bad… it's what made him that way in the first place… and whether that's really who he is, or just a facade he uses to protect a softer self from greater disappointment.

How did you choose which quotes would go at the beginning of each section? Milton, Shakespeare, D.H. Lawrence -- are these some of your favorite authors, or did you have other reasons for choosing them?

I suppose I could say that all I ever read are the Masters… and that these quotes just popped out of my memory… but I'd be lying! The bits I used at the beginning of the sections are ones that I searched for, diligently. I was looking for allusions to fire, flashes, stars -- all imagery that might connect a family which is figuratively burning itself out.

Sisterhood, and siblinghood for that matter, is a central concept in this work. Why did you make Isobel and Julia twins? Does this plot point somehow correspond with the co-dependence between Kate and Anna? What did you hope to reveal about sisterhood through this story?

I think there is a relationship between sisters that is unlike other sibling bonds. It's a combination of competition and fierce loyalty, which is certainly evident in both sets of sisters in this book. The reason Izzy and Julia are twins is because they started out as one embryo, before splitting in utero… and as they grew their differences became more pronounced. Kate and Anna, too, have genetic connections… but unlike Izzy and Julia, aren't able to separate from each other to grow into distinct individuals. I wanted to hold up both examples to the reader, so that they could see the difference between two sisters who started out as one and diverged; and two sisters who started out distinct from each other, and somehow became inextricably tangled.

Anyone who has watched a loved one die (and anyone with a heart in their chest) would be moved by the heartfelt, realistic and moving depiction of sickness and death that is presented in this story. Was it difficult to imagine that scenario? How did you generate the realistic details?

It's always hard to imagine a scenario where a family is dealing with intense grief, because naturally, you can't help but think of your own family going through that sort of hell. When researching the book, I spoke to children who had cancer, as well as their parents -- to better capture what it felt like to live day by day, and maintain a positive attitude in spite of the overwhelming specter of what might be just around the corner. To a lesser extent, I also drew on my own experience, as a parent with a child who faced a series of surgeries: when my middle son Jake was 5, he was diagnosed with bilateral cholesteatomas in his ears -- benign tumors that will eventually burrow into your brain and kill you, if you don't manage to catch them. He had ten surgeries in three years, and he's tumor free now. Clearly, I wasn't facing the same urgent fears that the mom of a cancer patient faces… but it's not hard to remember how trying those hospitalizations were. Every single time I walked beside his gurney into the OR, where I would stay with him while he was anesthetized, I'd think, "Okay, just take my ear; if that keeps him from going through this again." That utter desperation and desire to make him healthy again became the heart of Sara's monologues… and is the reason that I cannot hate her for making the decisions she did.

Sara is a complicated character, and readers will probably both criticize and empathize with her. How do you see her role in the story?

Like Nina Frost in Perfect Match, Sara's going to generate a bit of controversy, I think. And yet, I adore Nina… and I really admire Sara too. I think that she's the easy culprit to blame in this nightmare… and yet I would caution the reader not to rush to judgment. As Sara says at the end of the book, it was never a case of choosing one child over the other - it was a case of wanting BOTH. I don't think she meant for Anna to be at the mercy of her sister… I think she was only intent on doing what had to be done to keep that family intact. Now… that said… I don't think she's a perfect mom. She lets Jesse down - although she certainly was focused on more pressing emergencies, it's hard for me to imagine giving up so completely on a child, no matter what. And she's so busy fixating on Kate's shaky future that she loses sight of her family in the here and now -- an oversight, of course, that she will wind up regretting forever at the end of the book.

The point of view of young people is integral in your novels. In fact, more wisdom, humor and compassion often comes from them than anywhere else. What do you think adults could stand to learn from children? What is it about children that allows them to get to the truth of things so easily?

Kids are the consummate radar devices for screening lies. They instinctively know when someone isn't being honest, or truthful, and one of the really hard parts about growing up is learning the value of a white lie… for them, it's artifice that has to be acquired… remember how upset Holden Caulfield got at all the Phonies? Anna sees things the way they are because mentally she's still a kid - in spite of the fact that she's pretty much lost her childhood. The remarkable thing about adolescents, though, that keeps me coming back to them in fiction… is that even when they're on the brink of realizing that growing up means compromising and letting go of those ideals, they still hold fast to hope. They may not want to admit to it (witness Jesse!) but they've got it tucked into their back pockets, just in case. It's why teens make such great and complicated narrators.

The ending of My Sister's Keeper is surprising and terribly sad. Without giving too much away, can you share why you choose to end the novel this way? Was it your plan from the beginning, or did this develop later on, as you were writing?

My Sister's Keeper is the first book one of my own kids has read. Kyle, who's twelve, picked it up and immediately got engrossed in it. The day he finished the book, I found him weeping on the couch. He pushed me away and went up to his room and told me that he really didn't want to see me or talk to me for a while - he was THAT upset. Eventually, when we did sit down to discuss it, he kept asking, "Why? Why did it have to end like that?" The answer I gave him (and you) is this: because this isn't an easy book, and you know from the first page, that there are no easy answers. Medically, this ending was a realistic scenario for the family -- and thematically, it was the only way to hammer home to all the characters what's truly important in life. Do I wish it could have had a happy ending? You bet -- I even gave a 23rd hour call to a oncology nurse to ask if there was some other way to end the book -- but finally, I came to see that if I wanted to be true to the story, this was the right conclusion.

All of your books to date have garnered wonderful press. In what ways, if any, does this change your writing experience?

Um, are you reading the same reviews that I am?!? I'm kidding - well, a little. I've had overwhelmingly good reviews, but I think the bad reviews always stick with you longer, because they sting so much (no matter how many times I tell myself I'm going to ignore them, I read them anyway). I am fortunate to write commercially marketed books that still manage to get review coverage -- too often in this industry books are divided by what's reviewed and literary, or what's advertised and commercial. It's incredibly fun to have a starred review in a magazine -- photographers come out and take fancy pictures of you, and people are forever seeing your face and a description of your novel when they hang out in doctor's and dentist's waiting rooms. But the best thing about good press is that it makes people who might not otherwise have a clue who you are want to go and pick up your book. I never write a book thinking of reviewers (in fact, if I did, I'd probably just hide under my desk and never type another letter!) but I certainly think about whether it will hold the interest of a reader as well as it's holding my own.

Book club discussion questions for My Sister's Keeper

Reread the prologue to My Sister's Keeper. Who is the speaker? Is it the same person you thought it was the first time you read it?

What is the metaphorical relevance of Brian's profession as a fire chief?

Why is Jesse's behavior so aberrant, while until now, Anna has been so compliant?

What might be a possible reason for Brian's fascination with astronomy?

On page 98, Kate is being admitted to the hospital in very serious condition. She mouths to Jesse, "tell Anna," but is unable to finish. What do you think she was trying to say?

On page 122, Julia says, "Even if the law says that no one is responsible for anyone else, helping someone who needs it is the right thing to do." Who understood better how to "help" Kate, Sara or Anna?

Did Anna do the right thing, honoring Kate's wishes?

Do you feel it was unfair of Kate to ask Anna to refuse to donate a kidney, even though this seemed to be the only way for her to avoid the lifesaving transplant?

On page 142, Brian says that when rescuing someone from a fire, that "the safety of the rescuer is of a higher priority than the safety of the victim. Always." How does this apply to his role in his own family?

On page 144, Brian says, "Like anything that's been confined, fire has a natural instinct to escape." How does this truth apply to Kate? to Brian himself?

On page 149, Brian is talking to Julia about astronomy and says, "Dark matter has a gravitational effect on other objects. You can't see it, you can't feel it, but you can watch something being pulled in its direction." How is this symbolic of Kate's illness?

For what reason(s) did Brian offer Anna a place to stay at the firehouse while the legal proceedings were underway?

How does Anna's decision to pursue medical emancipation parallel Campbell's decision to end his relationship with Julia after his accident?

Do you agree with Brian's decision not to turn Jesse in to the authorities for setting the fires?

Do you feel that it's ethical to conceive a child that meets specific genetic requirements?

If not, do you believe that there should be specific exceptions, such as the purpose of saving another person's life, or is this just a "slippery slope?"