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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
Kate is eight years old and trying to decide on an outfit for her birthday party. As she once again changes her dress, Sara notices a bruise on her thigh and asks about it, but Kate brushes it off as from a bump. She has been in remission for five years, a fact that Sara still finds difficult to believe; she frequently still feels anxiety around Kate’s health. Kate puts on a sundress and heads downstairs. At her party, she opens her presents, including a goldfish that Sara and Brian got her. Kate has always wanted a pet, but the Fitzgeralds couldn’t handle a dog or cat, so they got her this instead. Kate, overjoyed, names the fish Hercules.
As with many other eras of Kate’s life, the seeming normalcy that the Fitzgeralds are enjoying is undercut with the knowledge that it will come to an end. In particular, the bruise on Kate’s thigh parallels the bruise on her shoulder blades before her diagnosis, foreshadowing a return of her illness. However, Kate’s new fish Hercules also signifies a new life, providing juxtaposition with the shadow of illness still looming over the family.
Themes
During a routine bone marrow aspiration, the Fitzgeralds discover that Kate is in molecular remission, meaning that, although she is not symptomatic, her cancer will return sooner or later. Dr. Chance recommends putting her on ALL-TRANS Retinoic Acid (ATRA), a medication that might put Kate into remission—but might also cause her to develop a resistance to it. When Sara gets home, Jesse reminds her that she promised to take him to get new cleats after the orthodontist. Sara cancels both, and in response to Jesse’s anger and disappointment, lectures him about being self-centered. Jesse tells her that her world revolves around Kate and runs to his room. When Sara goes to apologize, she finds that he’s pulled off his braces so that Sara never has to take him anywhere again.
The heartbreak of Kate’s relapse causes Sara to lash out at Jesse, which has been common behavior from both Sara and Brian since Kate’s diagnosis. However, in the earlier examples of this, Jesse was still quite young and therefore didn’t retaliate. Here, he is old enough to understand the injustice of Sara’s behavior and lashes out accordingly. In this way, this scene shows how Jesse changed from a fairly upbeat young boy to the angry, isolated teenager he is in the present.
Themes
Two weeks after Kate starts ATRA, Jesse talks to her and Anna about the lifespan of different animals. He tells them that a giant tortoise can live to be 177 and an Arctic clam can live to 220. Kate asks him how long a goldfish can live, and Jesse answers that they can live up to seven years with good care. He watches her take her medication and tells her that, if she was Hercules, she’d already be dead.
Although the Fitzgeralds often focus on how Kate will die young, Jesse reframes Kate’s lifespan by comparing it to a goldfish and pointing out that, by that metric, Kate is long-lived. In this scene, then, Jesse’s optimistic streak comes through momentarily despite his growing anger.
Themes
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Sara and Brian go to an appointment with Dr. Chance. The photos in his office have been the same since Kate’s diagnosis, making Sara feel like nothing has changed since she first came here. He tells them that the ATRA worked for a month, but then Kate’s relapse continued. Sara asks about a bone marrow transmission, but Dr. Chance suggests starting with a donation of white blood cells. He warns them that this will not stop Kate’s relapse, but it will buy them some time. Sara asks how long it will take to get the lymphocytes to the hospital. Dr. Chance answers that it depends on how soon they can get Anna there.
This consultation with Dr. Chance is significant in that it marks the first time he raises the idea of once again using Anna as a donor; initially, they intended to only use Anna’s cord blood, which was not an invasive procedure. Also of concern is the way Dr. Chance talks about Anna; in answering Sara’s question about how long it will take to get lymphocytes, he essentially equates Anna to these lymphocytes, thus dehumanizing her.
Themes
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In the hospital elevator, Sara says that she can bring Anna in tomorrow, but Brian confesses that he doesn’t think that they should have Anna donate blood. Sara protests that they had Anna so that she could be a donor for Kate, but Brian points out it was only supposed to be her cord blood, which Anna was too young to remember donating. Sara responds that both she and Brian would give up anything for Kate, and there’s no reason to think Anna would feel any differently. Brian reluctantly agrees with her.
Sara and Brian’s argument makes explicit the discord that’s been suggested between them before this point: while Sara is fully on-board with using Anna as a donor, Brian has more reservations. However, in this moment, Brian quickly folds against Sara’s protests—leading the Fitzgeralds to the situation they’re in in the present, where Anna has been forced into donations over and over again.
Themes
The next day, Sara and Brian bring an oblivious Anna into the hospital. Sara has told her that Kate isn’t feeling well, so the doctors need to take something from Anna for her to feel better. But Sara has given Anna no more information about the procedure. While waiting for the hematologist, Anna cheerfully talks to Brian about dinosaurs. However, as soon as the hematologist comes in and takes out a syringe, Anna begins to panic. Brian, unable to hold her down, yells at Sara for not telling her what to expect. The hematologist comes back with nurses, who work together to soothe Anna. Sara recalls the day that Kate was diagnosed and thinks of how Anna is just like her sister.
Sara’s neglect in warning Anna about the procedure she’s going to undergo reflects her broader disregard for Anna’s bodily autonomy and the trauma it might cause her to undergo many invasive medical procedures. Furthermore, as Sara herself points out, Anna’s reaction parallels Kate’s panic when she had to get her blood drawn, suggesting that the suffering Anna undergoes as a donor is not entirely different from what Kate undergoes as a cancer patient.
Themes
One day, while vacuuming the girls’ room, Sara accidentally knocks over Hercules’s bowl. Although it doesn’t break, Hercules lands under Kate’s desk. Sara frantically refills his bowl and puts him back in, but he floats to the top of the water. Sara sits at the edge of the bed, dejected, when Anna comes in and asks why Hercules isn’t moving. Just as Sara is about to confess, Hercules begins to swim again. Sara reassures Anna that the fish is fine.
Hercules’s near-death experience signifies Sara’s attempt to maintain an illusion of control around her children. Although Hercules nearly dies and Sara is on the verge of confessing her mistake, she is able to save face when he swims again. Thus, she puts on a façade of control, even though she had no control over Hercules’s survival.
Themes
Kate ends up needing more lymphocytes, meaning that Anna must donate more. Her second appointment falls in the middle of a birthday party for Anna’s friend from gymnastics, so Sara only lets her go to the first part of the party before coming to pick her up. The girl’s mother comes up to Sara and expresses her envy that Anna gets to go “somewhere no one else ever gets to go,” prompting confusion from Sara. Eventually, through the course of the conversation, Sara realizes that Anna has told this woman that she is going to space. When Sara angrily asks Anna why she lied, Anna asks why she had to leave the party. Sara tells her to stop acting like a five-year-old, then remembers that Anna is indeed five years old.
This scene shows how Anna’s role as a donor isolates her from her peers in a very real way. Due to her donation, she misses a meaningful social event with her peers—an event that the narrative in the present has established is a common pattern. However, this scene also serves as the first signs that Anna does not want the procedures imposed on her, with her small rebellion manifesting as her outlandish lies to her friend’s mother.
Themes
On another day, Brian is telling Sara about a particularly terrible fire he fought while she reads an advice column, in which a woman complains about her mother-in-law cleaning out her refrigerator. Sara feels disdain about this being the woman’s biggest problem and expresses her frustration about it to Brian. At first, the two of them laugh about it, but they suddenly stop finding the humor in it. Sara says it’s not fair, and Brian agrees. A month later, they bring Anna back in for a third lymphocyte donation. Smiling up at Sara, she tells her: “In case I forget to tell you after, it wasn’t as bad as I thought it was going to be.”
The frivolous nature of the woman’s complaint in the advice column once again serves to distance the Fitzgeralds from the more mundane, normal lives of others, where a mother-in-law’s nagging can feel like a serious problem. The frivolity of the complaint is further emphasized when juxtaposed with the difficulty of bringing Anna, a young child, in for a third lymphocyte donation, only to discover that she has become accustomed to the pain.
Themes
One day, Suzanne shows up and whisks Sara away to the Ritz Carlton so that she can relax. They hang out in the room and drink. Sara wants to call home, but Suzanne tells her that she doesn’t have to be a martyr all the time. Sara mishears her, saying that she always has to be a mother; when Suzanne corrects her, Sara asks if there’s really a difference. Suzanne tells Sara to stop being such a drama queen and accuses her of living just to wait for Kate’s death. Sara tries to protest but begins to cry instead. Suzanne comforts her and reminds her that relaxing every once in a while isn’t going to make Kate die any faster. She turns on Jerry Springer, and the two of them laugh together. Sara thinks back to how, when they were kids, she always walked behind Suzanne, wanting to follow her.
Suzanne once again serves as an important source of support for Sara, but this time, she serves as emotional support by pulling Sara’s responsibilities. In chastising Sara, she puts words to many of Sara’s major character flaws: mainly, that she has come to form her entire identity over staving off Kate’s death. Suzanne is able to pull Sara away from this flaw, if only for a night, by essentially forcing her to relax. This act of generosity emphasizes how important Suzanne is as Sara’s older sister and caretaker.
Themes
After three days of heavy rain, the Fitzgerald kids are playing outside. While doing laundry, Sara discovers that Hercules is lethargic and gasping in his bowl. She calls Petco asking for advice, then three vets. None of them have any advice. Finally, she rings the oceanography department at URI and gets in touch with a Dr. Orestes, who suggests that the rain might have brought runoff into the house tap water and that using bottled water could help. Sara follows his advice, and Hercules quickly perks up. Kate comes in and admires Hercules, none the wiser. Sara touches her hair and worries that she’s just used up her miracle.
Sara’s determination to save Hercules is a clear example of her not wanting Kate to lose her pet, but it also represents her greater quest to keep death out of her household. Many of the people she calls are baffled that she wants to save a goldfish, but her determination allows her to find a solution that, while unlikely, actually manages to be correct. As a result, it is understandable that Sara worries she’s wasted her chance for such a low-probability cure to an illness.
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