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Themes
Key
LitCharts assigns a color and icon to each theme in My Sister’s Keeper, which you can use to track the themes throughout the work.
Bodily Autonomy
Siblinghood
Parenthood
Control
Illness and Isolation
Summary
Analysis
At the hair salon, Sara discovers that the other two customers are pregnant like her. They discuss different aspects of their pregnancy, such as what names they’re thinking of and what number pregnancy each of them is on. When one of the woman asks Sara if she knows the sex of her baby, Sara thinks about how she knows everything there is to know about her baby. Since her baby, a girl, is a perfect match for Kate, she feels that she’s having a miracle. However, when the woman asks if she’s picked out a name, Sara realizes she hasn’t thought about it; she’s only thought of what the baby can do for Kate. She tells the woman that she and Brian are waiting—which it feels like she’s always doing.
During her pregnancy with Anna, Sara feels empowered to enact control over her family’s fate. While the other women have other aspects of uncertainty to their pregnancy, Sara knows everything about her baby and feels confident that she is giving birth to a miracle. However, there is one notable thing Sara doesn’t know: her baby’s name, which she hasn’t even thought about. This fact highlights how Sara is emotionally detached from Anna due to viewing her as a tool to save Kate.
Themes
A year before her encounter at the hair salon, Sara enjoys a period where Kate is in remission and life returns to a relative normal. However, Sara knows that they’re on borrowed time, and as a result she decided to conceive an embryo that’s a perfect match to Kate just in case. Sure enough, they discover during a bone marrow aspiration that Kate is in relapse, although she has not shown any symptoms yet. On the drive home from the hospital, Jesse asks Sara a variety of innocent questions. The last one he asks is when they pass a cemetery: he points at it and asks if that’s where Kate is going to go. Sara pulls the car over and looks back at him, telling him Kate is staying with them.
Even when the Fitzgeralds enjoy a period of normalcy after Kate’s remission, it is not the same normalcy as before Kate’s diagnosis; after all, Sara knows it will eventually end. When it does, Sara struggles once again with the lack of control that she has over the situation. This is illustrated by her response to Jesse’s question, which parallels Sara’s previous declaration to Brian that she’s not going to let Kate die. Although Sara cannot guarantee Kate’s survival, she refuses to entertain another possibility.
Themes
Sara and Brian go on a national news channel for an interview about their decision to conceive a donor for Kate. Sara explains their situation pragmatically, stating that in vitro fertilization was more time-efficient than having babies over and over until one of them was a match for Kate. The interviewer, Nadya, reveals that the Fitzgeralds have received hate mail and asks if they think they’ve made a “designer baby.” Brian denies this, stating that they don’t want a “superbaby,” just one that can save Kate. Nadya asks Sara what she wants to tell her baby when she grows up; Sara answers that, hopefully, she can tell her to stop bugging her sister.
Sara and Brian’s interview highlights the larger ethical issues of conceiving a child for a specific purpose. Although the two of them insist that their conceiving of Anna is different from people who conceive “designer babies” with ideal characteristics, Nadya’s challenges raise the question of how different their conception of Anna really is. After all, in both cases, they have conceived a child for a specific purpose—and in the Fitzgeralds’ case, Anna likely wouldn’t even exist without Kate’s illness.
Themes
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Sara goes into labor on New Year’s Eve. The nurse tells her that her daughter is a Capricorn, which is good since Capricorns “get the job done.” Although another woman, Emelda, tries to make it to the new year, Sara doesn’t; she gives birth to Anna just before the clock strikes midnight. As soon as the baby is born, Sara frantically checks on the umbilical cord, which the doctor carefully removes for preservation so that the cord blood can be donated to Kate.
Sara’s response to Anna’s birth is striking and unsettling. Rather than having an emotional response to Anna herself, Sara fixates on Anna’s cord blood, which is her first concern immediately after giving birth. This encapsulates how, from the very beginning, Sara has viewed Anna as a source of medical treatment for Kate.
Themes
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The day after Anna is born, Kate begins her preparation for transplant: radiation therapy. Kate is given sedation that makes her stumble about. Sara thinks about how she might look like this when she gets drunk for the first time, then reminds herself that Kate might never reach adolescence. Kate is then brought into the suite for therapy, where the therapist places thick pieces of lead over her chest. Sara watches her through the protective glass wall, thinking of how it’s the things you can’t see coming that kill you: “gamma rays, leukemia, parenthood.”
Kate’s radiation treatment leads Sara to think of the nature of parenthood. Her thought comparing parenthood to invisible killers such as gamma rays and leukemia illustrates the brutal vulnerability of being a parent, especially the parent of a severely sick childhood. Thus, though Sara’s attitude towards Anna can be coldly pragmatic, this scene returns to the core of why she makes the choices that she does.
Themes
Kate suffers severe side effects from her bout of radiation therapy: she has constant diarrhea, and her throat is constantly full of mucus. She becomes severely immunocompromised to the point that she has to be placed in extreme isolation and cannot even read picture books without wearing gloves. Outside of her room, Sara practices giving subcutaneous injections to an orange, since Kate will need shots after her transplant. Brian tries to eat another orange, but Sara stops him, paranoid that someone else has been injecting things into it. Eventually, Dr. Chance shows up and they begin the transplant, which does not even wake Kate up. Everyone watches the cord blood enter Kate’s body, hoping it will work.
Picoult once again spends a great deal of time describing the serious suffering that Kate undergoes through the course of her treatment. These descriptions also serve to make Sara a more sympathetic figure as she attempts to rescue Kate from this suffering—but, at the same time, it highlights how continuing to push for Kate’s survival causes pain not only for Anna, but Kate herself. Even so, Anna’s cord blood provides a glimmer of hope for Dr. Chance and the Fitzgeralds, once again raising the possibility that Sara’s efforts are worth it.
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