My Sister's Keeper: A Novel Read online

  • • •

  To save Kate’s life, part of her has to die. That’s the purpose of chemotherapy—to wipe out all the leukemic cells. To this end, a central line has been placed beneath Kate’s collarbone, a three-pronged port that will be the entry point for multiple medication administrations, IV fluids, and blood draws. I look at the tubes sprouting from her thin chest and think of science fiction movies.

  She has already had a baseline EKG, to make sure her heart can withstand chemo. She’s had dexamethasone ophthalmic drops, because one of the drugs causes conjunctivitis. She’s had blood drawn from her central line, to test for renal and liver function.

  The nurse hangs the infusion bags on the IV pole and smoothes Kate’s hair. “Will she feel it?” I ask.

  “Nope. Hey, Kate, look here.” She points to the bag of Daunorubicin, covered with a dark bag to protect it from light. Spotting it are brightly colored stickers she’s helped Kate make while we were waiting. I saw one teenager with a Post-it note on his: Jesus saves. Chemo scores.

  This is what starts coursing through her veins: the Daunorubicin, 50 mg in 25 ccs of D5W; Cytarabine, 46 mg in a D5W infusion, a continuous twenty-four-hour IV; Allopurinol, 92 mg IV. Or in other words, poison. I imagine a great battle going on inside her. I picture shining armies, casualties that evaporate through her pores.

  They tell us Kate will most likely get sick within a few days, but it takes only two hours before she starts throwing up. Brian pushes the call button, and a nurse comes into the room. “We’ll get her some Reglan,” she says, and she disappears.

  When Kate isn’t vomiting, she’s crying. I sit on the edge of the bed, holding her half on my lap. The nurses do not have time to nurse. Short-staffed, they administer antiemetics in the IV; they stay for a few moments to see how Kate responds—but inevitably they are called elsewhere to another emergency and the rest falls to us. Brian, who has to leave the room if one of our children gets a stomach virus, is a model of efficiency: wiping her forehead, holding her thin shoulders, dabbing tissues around her mouth. “You can get through this,” he murmurs to her each time she spits up, but he may only be talking to himself.

  And I, too, am surprising myself. With grim resolve I make a ballet out of rinsing the emesis basin and bringing it back. If you focus on sandbagging the beachhead, you can ignore the tsunami that’s approaching.

  Try it any other way, and you’ll go crazy.

  • • •

  Brian brings Jesse to the hospital for his blood test: a simple finger stick. He needs to be restrained by Brian and two male residents; he screams down the hospital. I stand back, and cross my arms, and inadvertently think of Kate, who stopped crying over procedures two days ago.

  Some doctor will look at this sample of blood, and will be able to analyze six proteins, floating invisibly. If these six proteins are the same as Kate’s, then Jesse will be an HLA match—a potential donor for bone marrow for his sister. How bad can the odds be, I think, to match six times over?

  As bad as getting leukemia in the first place.

  The phlebotomist goes off with her blood sample, and Brian and the doctors release Jesse. He bolts off the table into my arms. “Mommy, they stuck me.” He holds up his finger, festooned with a Rugrats Band-Aid. His damp, bright face is hot against my skin.

  I hold him close. I say all the right things. But it is so, so hard to make myself feel sorry for him.

  • • •

  “Unfortunately,” Dr. Chance says, “your son isn’t a match.”

  My eyes focus on the houseplant, which still sits withered and brown on the sill. Someone ought to get rid of that thing. Someone ought to replace it with orchids, with birds-of-paradise, and other unlikely blooms.

  “It’s possible that an unrelated donor will crop up on the national marrow registry.”

  Brian leans forward, stiff and tense. “But you said a transplant from an unrelated donor was dangerous.”

  “Yes, I did,” Dr. Chance says. “But sometimes it’s all we’ve got.”

  I glance up. “What if you can’t find a match in the registry?”

  “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