Jodie Picoult - My Sister's Keeper

"Well." The oncologist rubs his forehead. "Then we try to keep her going until research catches up to her."

He is talking about my little girl as if she were some kind of machine: a car with a faulty carburetor, a plane whose landing gear is stuck. Rather than face this, I turn away just in time to see one of the misbegotten leaves on the plant make its suicide plunge to the carpet. Without an explanation I get to my feet and pick up the planter. I walk out of Dr. Chance's office, past the receptionist and the other shell-shocked parents waiting with their sick children. At the first trash receptacle I find, I dump the plant and all its desiccated soil. I stare at the terra-cotta pot in my hand, and I am just thinking about smashing it down on the tile floor when I hear a voice behind me.

"Sara," Dr. Chance says. "You all right?"

I turn around slowly, tears springing to my eyes. "I'm fine. I'm healthy. I'm going to live a long, long life."

Handing him the planter, I apologize. He nods, and offers me a handkerchief from his own pocket.

"I thought it might be Jesse who could save her. I wanted it to be Jesse."

"We all did," Dr. Chance answers. "Listen. Twenty years ago, the survival rate was even smaller. And I've known lots of families where one sibling isn't a match, but another sibling turns out to be just right."

We only have those two, I start to say, and then I realize that Dr. Chance is talking about a family I haven't yet had, of children I never intended. I turn to him, a question on my lips.

"Brian will wonder where we've gone." He starts to walk toward his office, holding up the pot. "What plants," he asks conversationally, "would I be least likely to kill?"

It is so easy to presume that while your own world has ground to an absolute halt, so has everyone else's. But the trash collector has taken our garbage and left the cans in the road, just like always. There is a bill from the oil truck tucked into the front door. Neatly stacked on the counter is a week's worth of mail. Amazingly, life has gone on.

Kate is released from the hospital a full week after her admission for induction chemotherapy. The central line still snaking from her chest bells out her blouse. The nurses give me a pep talk for encouragement, and a long list of instructions to follow: when to and when not to call the emergency room, when we are expected back for more chemotherapy, how to be careful during Kate's period of immunosuppression.

At six the next morning, the door to our bedroom opens. Kate tiptoes toward the bed, although Brian and I have come awake in an instant. "What is it, honey?" Brian asks.

She doesn't speak, just lifts her hand to her head and threads her fingers through her hair. It comes out in a thick clump, drifts down to the carpet like a small blizzard.

"All done," Kate announces a few nights later at dinner. Her plate is still full; she hasn't touched her beans or her meat loaf. She dances off to the living room to play.

"Me too." Jesse pushes back from the table. "Can I be excused?"

Brian spears another mouthful with his fork. "Not until you finish everything green."

"I hate beans."

"They're not too crazy about you, either."

Jesse looks at Kate's plate. "She gets to be finished. That's not fair."

Brian sets his fork down on the side of his plate. "Fair?" he answers, his voice too quiet. "You want to be fair? All right, Jess. The next time Kate has a bone marrow aspiration, we'll let you get one, too. When we flush her central line, we'll make sure you go through something equally as painful. And next time she gets chemo, we'll—"

"Brian!" I interrupt.

He stops as abruptly as he's started, and passes a shaking hand over his eyes. Then his gaze lands on Jesse, who has taken refuge under my arm. "I… I'm sorry, Jess. I don't…" But whatever he is about to say vanishes, as Brian walks out of the kitchen.

For a long moment we sit in silence. Then Jesse turns to me. "Is Daddy sick, too?"

I think hard before I answer. "We're all going to be fine," I reply.

On the one-week anniversary of our return home, we are awakened in the middle of the night by a crash. Brian and I race each other to Kate's room. She lies in bed, shaking so hard that she's knocked a lamp off her nightstand. "She's burning up," I tell Brian, when I lay my hand against her forehead.

I have wondered how I will decide whether or not to call the doctor, should Kate develop any strange symptoms. I look at her now and cannot believe I would ever be so stupid to believe that I wouldn't know, immediately, what Sick looks like. "We're going to the ER," I announce, although Brian is already wrapping Kate's blankets around her and lifting her out of her crib. We bustle her to the car and start the engine and then remember that we cannot leave Jesse home alone.

"You go with her," Brian answers, reading my mind. "I'll stay here." But he doesn't take his eyes off Kate.

Minutes later, we are speeding toward the hospital, Jesse in the backseat next to his sister, asking why we need to get up, when the sun hasn't.

In the ER, Jesse sleeps on a nest of our coats. Brian and I watch the doctors hover over Kate's feverish body, bees over a field of flowers, drawing what they can from her. She is pan-cultured and given a spinal tap to try to isolate the cause of the infection and rule out meningitis. A radiologist brings in a portable X-ray machine to take a film of her chest, to see if this infection lives in her lungs.

Afterward, he places the chest film on the light panel outside the door. Kate's ribs seem as thin as matchsticks, and there is a large gray blot just off center. My knees go weak, and I find myself grabbing on to Brian's arm. "It's a tumor. The cancer's metastasized."

The doctor puts his hand on my shoulder. "Mrs. Fitzgerald," he says, "that's Kate's heart."

Pancytopenia is a fancy word that means there is nothing in Kate's body protecting her against infection. It means, Dr. Chance says, that the chemo worked—that a great majority of white blood cells in Kate's body have been wiped out. It also means that nadir sepsis—a post-chemo infection—is not a likelihood, but a given.

She is dosed with Tylenol to reduce her fever. She has blood, urine and respiratory secretion cultures taken, so that the appropriate antibiotics can be administered. It takes six hours before she is free of the rigors—a round of violent shaking so fierce that she is in danger of shimmying off the bed.

The nurse—a woman who braided Kate's hair in silky corn-rows one afternoon a few weeks back, to make her smile—takes Kate's temperature and then turns to me. "Sara," she says gently, "you can breathe now."

Kate's face looks as tiny and white as those distant moons that Brian likes to spot in his telescope—still, remote, cold. She looks like a corpse… and even worse, this is a relief, compared to watching her suffer.

"Hey." Brian touches the crown of my head. He juggles Jesse in his other arm. It is nearly noon, and we are all still in pajamas; we never thought to take a change of clothes. "I'm gonna take him down to the cafeteria; get some lunch. You want something?"

I shake my head. Scooting my chair closer to Kate's bed, I smooth the covers over her legs. I take her hand, and measure it against my own.

Her eyes slit open. For a moment she struggles, unsure of where she is. "Kate," I whisper. "I'm right here." As she turns her head and focuses on me, I lift her palm to my mouth, press a kiss in its center. "You are so brave," I tell her, and then I smile. "When I grow up, I want to be just like you."

To my surprise, Kate shakes her head hard. Her voice is a feather, a thread. "No Mommy," she says. "You'd be sick."

In my first dream, the IV fluid is dripping too quickly into Kate's central line. The saline pumps her up from the inside out, a balloon to be inflated. I try to pull the infusion, but it's held fast in the central line. As I watch, Kate's features smooth, blur, obliterate, until her face is a white oval that could be anyone at all.