My Sister's Keeper Read online

  "Was it one needle stick, like the other procedures?"

  "No," Sara says quietly. "It was about fifteen."

  "Into the bone?"

  "Yes."

  "What were the side effects for Anna this time around?"

  "She had some pain, and was given some analgesics."

  "So this time, Anna had to be hospitalized overnight . . . and she needed medication herself?"

  Sara takes a minute to compose herself. "I was told that donating marrow isn't considered a particularly invasive procedure for a donor. Maybe I was just waiting to hear those words; maybe I needed to hear them at that time. And maybe I was not thinking as much of Anna as I should have been, because I was so focused on Kate. But I know beyond a doubt that--like everyone else in our family--Anna wanted nothing more than for her sister to be cured."

  "Well, sure," I reply, "so that you'd stop sticking needles in her."

  "Enough, Mr. Alexander," Judge DeSalvo interjects.

  "Wait," Sara interrupts. "I have something to say." She turns to me. "You think you can lay it all out in words, black-and-white, as if it's that easy. But you only represent one of my daughters, Mr. Alexander, and only in this courtroom. I represent both of them equally, everywhere, every place. I love both of them equally, everywhere, every place."

  "But you admitted that you've always considered Kate's health, not Anna's, in making these choices," I point out. "So how can you claim to love both of them equally? How can you say that you haven't been favoring one child in your decisions?"

  "Aren't you asking me to do that very thing?" Sara asks. "Only this time, to favor the other child?"

  ANNA

  WHEN YOU ARE A KID you have your own language, and unlike French or Spanish or whatever you start learning in fourth grade, this one you're born with, and eventually lose. Everyone under the age of seven is fluent in Ifspeak; go hang around with someone under three feet tall and you'll see. What if a giant funnelweb spider crawled out of that hole over your head and bit you on the neck? What if the only antidote for venom was locked up in a vault on the top of a mountain? What if you lived through the bite, but could only move your eyelids and blink out an alphabet? It doesn't really matter how far you go; the point is that it's a world of possibility. Kids think with their brains cracked wide open; becoming an adult, I've decided, is only a slow sewing shut.

  *

  During the first recess, Campbell takes me to a conference room for privacy and buys me a Coke that isn't cold. "So," he says. "What do you think so far?"

  Being in the courtroom is weird. It's like I've turned into a ghost--I can watch what's going on, but even if I felt like speaking no one would be able to hear me. Add to that the very bizarre way I have to listen to everyone talk about my life as if they can't see me sitting right there, and you've landed in my surreal little corner of earth.

  Campbell pops open his 7 UP and sits down across from me. He pours a little into a paper cup for Judge, and then takes a good long drink. "Comments?" he says. "Questions? Unadulterated praise for my skillful litigation?"

  I shrug. "It's not like I expected."

  "What do you mean?"

  "I guess I figured when it started, I'd know for sure that I was doing the right thing. But when my mom was up there, and you were asking her all those questions . . . " I glance up at him. "That part about it not being simple. She's right."

  What if I was the one who was sick? What if Kate had been asked to do what I've done? What if one of these days, some marrow or blood or whatever actually worked, and that was the end? What if I could look back on all this one day and feel good about what I did, instead of feeling guilty? What if the judge doesn't think I'm right?

  What if he does?

  I can't answer a single one of these, which is how I know that whether I'm ready or not, I'm growing up.

  "Anna." Campbell gets up and comes around to my side of the table. "Now is not the time to start changing your mind."

  "I'm not changing my mind." I roll the can between my palms. "I think I'm just saying that even if we win, we don't."

  *

  When I was twelve I started baby-sitting for twins who live down the street. They're only six, and they don't like the dark, so I usually wind up sitting between them on a stool that's shaped like the stubby foot of an elephant, toenails and all. It never fails to amaze me how quickly a kid can shut off an energy switch--they'll be climbing the curtains and bam, five minutes later, they're conked out. Was I ever like that? I can't remember, and it makes me feel ancient.

  Every now and then one of the twins will fall asleep before the other one. "Anna," his brother will say, "how many years till I can drive?"

  "Ten," I tell him.

  "How many years till you can drive?"

  "Three."

  Then the talk will split off like the spokes of a spiderweb--what kind of car will I buy; what will I be when I grow up; does it suck to get homework every night in middle school. It's totally a ploy to stay up a little bit later. Sometimes I fall for it, mostly I just make him go to sleep. See, I get a round hollow spot in my belly knowing I could tell him what's coming, but also knowing it would come out sounding like a warning.

  *

  The second witness Campbell calls is Dr. Bergen, the head of the medical ethics committee at Providence Hospital. He has salt-and-pepper hair and a face dented in like a potato. He is smaller than you'd expect, too, given the fact that it takes him just short of a millennium to recite his credentials.

  "Dr. Bergen," Campbell starts, "what's an ethics committee?"

  "A diverse group of doctors, RNs, clergy, ethicists, and scientists, who are assigned to review individual cases to protect patients' rights. In Western Bioethics, there are six principles we try to follow." He ticks them off on his fingers. "Autonomy, or the idea that any patient over age eighteen has the right to refuse treatment; veracity, which is basically informed consent; fidelity--that is, a health-care provider fulfilling his duties; beneficence, or doing what's in the best interests of the patient; nonmaleficence--when you can no longer do good, you shouldn't do harm . . . like performing major surgery on a terminal patient who's 102 years old; and finally, justice--that no patient should be discriminated against in receiving treatment."

  "What does an ethics committee do?"

  "Generally, we're called to convene when there's a discrepancy about patient care. For example, if a physician feels it's in the patient's best interests to go on with extraordinary measures, and the family doesn't--or vice versa."

  "So you don't see every case that passes through a hospital?"

  "No. Only when there are complaints, or if the attending physician asks for a consultation. We review the situation and make recommendations."

  "Not decisions?"

  "No," Dr. Bergen says.

  "What if the patient complaining is a minor?" Campbell asks.

  "Consent isn't necessary until age thirteen. We rely on parents to make informed choices for their children until that point."

  "What if they can't?"

  He blinks. "You mean if they're not physically present?"

  "No. I mean if there's another agenda they're adhering to, that in some way keeps them from making choices in the best interests of that child?"

  My mother stands up. "Objection," she says. "He's speculating."

  "Sustained," Judge DeSalvo replies.

  Without missing a beat, Campbell turns back to his witness. "Do parents control their children's health-care decisions until age eighteen?"

  Well, I could answer that. Parents control everything, unless you're like Jesse and you do enough to upset them that they'd rather ignore you than pretend you actually exist.

  "Legally," Dr. Bergen says. "However, once a child reaches adolescence, although they can't give formal consent, they have to agree to any hospital procedure--even if their parents have already signed off on it."

  This rule, if you ask me, is like the law against jaywalking. Everyone k