Although I am nine months pregnant, although I have had plenty of time to dream, I have not really considered the specifics of this child. I have thought of this daughter only in terms of what she will be able to do for the daughter I already have…Then again, my dreams for her are no less exalted; I plan for her to save her sister’s life.

This quote, spoken by Sara, occurs in Sara’s section on the first Wednesday of the novel, when Sara is pregnant with Anna in 1990-1991. The quote touches on the controversial nature of Anna’s birth. Sara knows that having another child represents Kate’s best hope of survival. She has not considered the child, however, as an individual, and cannot see the child except with regard to how she will benefit Kate. At this point, she measures Anna’s value in terms of how she will help keep Kate alive. This attitude creates the family environment in which the main plot of the novel unfolds. Anna grows up feeling that she has no power over her own life. Her main purpose, as she sees it, lies in providing platelets, bone marrow, and even her kidney to Kate, and as a result Anna feels that Kate’s needs always take precedence over hers.

Sara reinforces these feelings through her behavior. Even after Anna has grown up, Sara frequently overlooks Anna’s feelings, and sometimes even Anna herself. At the beginning of the novel, for instance, Sara does not notice that Anna seems withdrawn or that she leaves the dinner table. Later that night, Sara asks Brian how Kate looked to him at dinner. Brian has to point out to Sara that Kate seemed fine, while Anna, on the other hand, appeared to be upset about something. Sara only seems to think of Anna when she needs Anna to help Kate. Though we learn that it may not be Anna’s primary motivation, Anna files her lawsuit for medical emancipation at least in part as a reaction to this neglect.