My Sister's Keeper (novel)

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My Sister's Keeper
First edition
AuthorJodi Picoult
CountryUnited States
Publication date
April 6, 2004
Media typePrint (Hardcover & Paperback)
Pages432 pp
813/.54 22
LC ClassPS3566.I372 M9 2003

My Sister's Keeper is a 2004 novel written by Jodi Picoult. It tells the story of thirteen-year-old Anna Fitzgerald, who sues her parents for medical emancipation when she discovers she was supposed to donate a kidney to her elder sister Kate, who is gradually dying from acute leukemia.[1]


The story takes place in the fictional town of Upper Darby, Rhode Island in 2004. Anna Fitzgerald's older sister, Kate, suffers from acute promyelocytic leukemia, a blood and bone marrow cancer. Anna was born as a savior sister specifically so she could save Kate's life. At first it is successful, but the cancer continues to relapse throughout Kate's life.

Anna is usually willing to donate whatever Kate needs, but when she turns 13, she is told that she will have to donate one of her kidneys due to Kate's kidney failure. The surgery required for both Kate and Anna would be major; it is not guaranteed to work, as the stress of the operation may kill Kate anyway, and the loss of a kidney could have a serious impact on Anna's life. Anna petitions for medical emancipation with the help of lawyer Campbell Alexander, so she will be able to make her own decisions regarding her medical treatment and the donation of her kidney.

This is done on the advice of Julia Romano, the court-appointed guardian ad litem whose job it is to decide what would be best for Anna. Julia was once romantically involved with Campbell when they went to high school together, but Campbell broke her heart when he left her. Unbeknownst to Julia, Campbell left her because he discovered he had epilepsy and thought she deserved better.

Meanwhile, Anna's older brother, Jesse, who has spent most of his life being ignored in favor of ill Kate or donor Anna, spends most of his time setting fire to abandoned buildings with homemade explosives and using illegal drugs. He is a self-confessed juvenile delinquent, which leads to their father Brian eventually confronting Jesse for his behavior.

During the trial, it is revealed that Kate originally asked Anna to sue for emancipation because Kate did not want Anna to have to donate her kidney now that Kate has been ready to die, but their mom Sara cannot seem to understand that (she later comes to terms when Anna tells her), and because Kate believes she will die anyway. The judge rules in Anna's favor, and grants Campbell a medical power of attorney. However, as Campbell drives her home after the trial, their car is hit by a pick-up. The on-call firefighter (who also happens to be Brian, Anna's father) who arrives at the scene, retrieves an unconscious and severely injured Anna from the wreckage of the crushed car.

She goes into cardiac arrest and is revived. Both she and Campbell are rushed to the hospital. At the hospital, the doctor informs Sara and Brian that Anna is brain-dead and asks them if they have considered organ donation. An injured Campbell steps in and declares that he has the power of attorney and that "there is a girl upstairs who needs that kidney." Kate is prepared for surgery, and Anna's kidney is successfully transplanted. Anna's life-support machines are then shut off by her family. Kate survives the surgery and remains in remission. Jesse has reformed and graduates from the police academy, despite his criminal record.


  • Kate Fitzgerald, a frail teenage girl who was diagnosed with acute leukemia at a young age. She is the older sister of Anna, and the middle child out of all three Fitzgerald siblings. She sometimes finds all the attention on her stifling. One of the few times she experiences being a typical teenaged girl is when she dates, and has her first kiss with, a boy named Taylor, whom she meets at the hospital while undergoing chemotherapy. Taylor also has cancer, and Kate has some of her happiest times with him, as he's one of the only people with whom she's been able to fully relate, and to speak her deepest, true, feelings about being sick, with. Kate also supports the feelings of her younger sister, Anna, and is thankful for the bodily donations Anna has been made to give her throughout her lifetime. Near the end of the novel, she is the one revealed to have asked Anna to sue for medical emancipation because she was fed up with her mother's behavior and wanted to die for years.
  • Anna Fitzgerald, a girl who was scientifically engineered in order to be a "savior sibling" to her elder sister, and who therefore repeatedly has to donate blood, marrow, and eventually an organ, to her. She is thirteen years old at the time the novel takes place, and seeks to be medically emancipated from her parents, so that she does not have to donate anything to Kate, namely a kidney, against her will, and would thereon have the rights to her own body. She is the main protagonist of the novel.
  • Jesse Fitzgerald, the oldest child, who is dyslexic. Throughout most of the novel, he is a delinquent teenager, but, in young adulthood, after coming to terms with his inner emotions, he goes on to become a police officer, and is no longer rebellious, or desperate for attention, as he was in his teen years.
  • Sara Fitzgerald, the overprotective and domineering "helicopter mom" of Kate, Anna, and Jesse. She tries her hardest to keep her oldest, ill, daughter alive and well, and refuses to accept the idea that she is dying. Before the novel's end, Sara finally listens to Anna about Kate and comes to terms with her choice to die, expressing remorse for her behavior. She is the one who feels insurmountable guilt over Anna's death.
  • Brian Fitzgerald, Sara's husband, who understands Anna's decision to not donate her kidney, but also feels compassion for his wife. He becomes torn between his daughter(s), and his wife, during Anna's emancipation trial, but ends up siding with his wife during his testimony in court, regardless of his conflicting feelings. He also shows concern for his son, and is the one to confront him about his troubling behavior.
  • Julia Romano, the court-appointed, guardian ad litem, whose job it is to decide what is best for Anna. She also often advises Anna regarding medical emancipation. She and Anna's lawyer, Campbell Alexander, dated in young adulthood, before he broke her heart.
  • Campbell Alexander, a lawyer who defends Anna as she tries to become medically emancipated from her parents. He believes that she should have control over her own body, and eventually obtains medical power of attorney over her, when she wins her case. He personally uses a service dog, which others find "mysterious", because he does not tell anyone why; It is later uncovered that he suffers from epilepsy, and that this diagnosis is the reason he broke up with Julia, as he did not believe she "deserved" an unwell mate, that she'd have to look after.
  • Suzanne, Jesse, Kate and Anna's wealthy aunt, Brian's sister-in-law and Sara's older sister of 10 years whose relationship with her is strained due to her overzealousness in keeping Kate alive. While coming to Sara's aid occasionally due to her wealth, she is more supportive of Anna in suing for medical emancipation.
  • Judge DeSalvo, the presiding judge over Anna's case in suing for medical emancipation

Development history[edit]

Publication history[edit]

Picoult, Jodi. My Sister's Keeper. Atria Books: New York, 2004; ISBN 9781416549178/ISBN 141654917X.

Critical reception[edit]

In review for The Washington Post, Katherine Arie described some of the characters as unconvincing, such as Brian, who is "too good to be true", Jesse, "a poster child for self-destructive behavior", and Kate, who is "as weak and wispy on the page as she's supposed to be in life", but ultimately called the book "a thrill to read".[2]

In 2009 the American Library Association (ALA) and the office for Intellectual Freedom named My Sister's Keeper the seventh out of ten most frequently challenged books in the US. Schools and libraries attempted to ban the book for the following reasons: Sexism, Homosexuality, Sexual Explicitly, Offensive Language, Religious Viewpoint, Unsuitability to Age Group, Drugs, Suicide, Violence.[3]


New Line Cinema adapted My Sister's Keeper into a feature film, which was directed by Nick Cassavetes and released on June 26, 2009.[4][5] It starred Cameron Diaz as Sara and Alec Baldwin as Campbell. Kate and Anna were played respectively by Sofia Vassilieva and Abigail Breslin.[5]

The film features an alternate ending and more emphasis on certain subplots while entirely eliminating others. This was against the wishes of Picoult.

Differences between novel and film[edit]

  • The novel's setting is in Rhode Island, while the film's setting is in California.
  • Julia Romano is a central character in the novel and is Anna's guardian ad litem during the trial, while the film has written her out.
  • Aunt Suzanne is also a central character in the novel and while she has come to the family's aid due to her wealth, her relationship with Sara is strained due to her being overzealous in saving Kate's life. In the film, she is replaced with Aunt Kelly who follows a similar role to Suzanne.
  • Campbell and Anna's relationship is more detailed in the novel than in the film.
  • Jesse is a juvenile delinquent in the novel. However, his relationship with his parents improves when Brian finds out why he has been acting out and turning to a life of crime. In the film, Jesse is more neglected by his parents. He is stopped from going into a life of crime by Aunt Kelly, who talks to him.
  • In the novel Sara is a brunette with dark eyes and cares for the well being of all of her children. In the film, she is blonde and more obsessed with saving Kate, neglecting Brian, Anna and Jesse's needs.
  • Kate is a blonde in the novel and is 16, while in the film, she's a brunette and 15.
  • Jesse is a brunette in the novel and is 17, while in the film, he's 18 and a blond like his mom.
  • Anna is 13 and plays hockey in the novel, while in the film, she is 11 and plays soccer.
  • In the novel, Anna dies in a car accident with her usable organs being donated to Kate and she remains in remission for 6 years. In the film, Kate dies instead of her.
  • In the novel's epilogue, Kate explains how her family has been trying to cope with Anna's death and their lives since the trial. In the film, Anna mentions their family goes to Montana every year to honor Kate and that Sara is proud of her for standing up for her own rights.
  • In the novel, it was Judge's barking that got Campbell to ask Anna about her reasons in suing for medical emancipation and it leads to her confession. In the film, it was Jesse who exposed Kate's role in the lawsuit. His exposure angered not only Anna because she was trying to protect their sister, but also Sara for interrupting them.
  • In the novel and before the verdict, Anna tells Sara about Kate's plans to die. While shocked at first, she comes to terms with it and wished Kate had told her sooner. She even mentions that she understood why Anna tried to protect her sister. In the film, Sara is in denial and accuses Jesse of lying to her. When Brian comes to his defense by pointing out her own wrongdoing in not listening to their family as they knew Kate wanted death, Sara feels guilty for ignoring her family and finally accepts responsibility for her actions.
  • In the novel, Campbell had a seizure during the trial, and Brian stepped in to help him. In the film, Campbell left midway of the argument between Sara, Jesse and Brian and had a seizure from not being able to take his medication on time.


  1. ^ Reviewed by Barbara Lipkien Gershenbaum (2005-02-01). "Review, My Sister's Keeper". ReadingGroupGuides. Retrieved 2017-05-10.
  2. ^ Katherine Arie (2004-04-04). "Spare Parts". The Washington Post Company. Retrieved 2010-01-14.
  3. ^ "ALA Website List of top 10 most challenged book bans for 2009". American Library Association. Archived from the original on 2013-07-03. Retrieved 2 October 2011.
  4. ^ "Questions and Answers". Jodi March 2, 2007. Retrieved 2008-01-21.
  5. ^ a b Fleming, Michael (2008-02-12). "Breslin, Vassilieva to star in 'Keeper'". Variety. Retrieved 2008-02-13.

External links[edit]