From Campbell’s section through Sara’s section

Summary: Campbell

Campbell, while on the phone with his mother, wonders how much people are beholden to their parents. Campbell stops for coffee and gives his waiter a new sarcastic explanation of his service dog, Judge. He returns to his office and finds Anna there. Sara calls while Anna is in the room with Campbell. Sara tells Campbell that Anna has changed her mind, but Anna tells Campbell she has not. Campbell recalls a memory of his father. They competed in a sailing competition, and Campbell ended up embarrassing and disappointing his father. Campbell goes to the courthouse where he meets Sara, who decides to act as counsel for herself and Brian. Sara and Campbell speak with Judge DeSalvo, the judge for the case. They argue about what Anna really wants until Judge DeSalvo decides he needs to speak with Anna.

Summary: Anna

Anna wonders what her funeral would be like. She doesn’t think many people would come, unlike Kate’s funeral, which would be crowded. At the courthouse, Anna speaks with Judge DeSalvo alone. They discuss the trial, and Anna tries to remain composed. But she recalls a time when she and Kate pulled a prank on a nurse at the hospital and starts to cry. She tells Judge DeSalvo she can’t give a kidney to her sister. He assures her no hospital would take a kidney from an unwilling donor, but she says being a donor has never been her choice. She says she never wanted to stop the lawsuit and only told her mother she would because she loves her. Judge DeSalvo decides to appoint Anna a guardian ad litem who can decide what is best for her. The hearing, he says, will take place the following week.

Anna goes home with her parents, even though Campbell wants to speak with her. Brian pleads with Sara to calm down, but Sara shouts that Anna practically signed Kate’s death sentence. Kate runs upstairs. Anna leaves the house to go to a laundromat, a place she feels safe. She tries to picture a future without Kate but can’t. They are as connected, she thinks, as Siamese twins.

Summary: Jesse

Jesse thinks about when he was a child and would light bath soap on fire to show Anna. He reflects that Anna is the only proof he has that he belongs in the family. While driving down the highway, he imagines crashing his car because he would be worth more dead and used as parts. He meets a homeless man named Dan. Jesse has a deal with Dan where he brings Dan food if Dan will watch Jesse’s things, including stolen acid and sawdust. Jesse goes to an abandoned warehouse and sets a fire. He admits he has done it before. He watches the fire from far away until he sees his father arrive. Jesse goes home to find Sara frantic. Kate is vomiting blood. Jesse drives Kate to the ER.

At the hospital, Dr. Chance tells Sara and Jesse that Kate is in the end stages of kidney failure. Sara asks if a transplant is possible, and Dr. Chance tells her that the odds are not good. Sara asks if they would do the transplant if a donor were available. Jesse offers his kidney, but Dr. Chance tells him it must be an exact match. Jesse wonders why he thought he might suddenly be worth something and why he thought he could save his sister when he can’t save himself. Kate tries to tell Jesse something, but all he can understand is “tell Anna.”

Summary: Sara

The time is 1990–1991 and Sara is pregnant with Anna. Sara knows everything about the baby, from the sex to the specific combination of genes that will allow Anna to be a donor for Kate. She admits that she has thought of Anna only in terms of what she will be able to do for Kate. Sara reveals that three months after chemo, Kate went into molecular relapse. Sara recalls the television interview she and Brian did. They explain why they went to a geneticist and deny wanting a “designer baby.” They only wanted a child who would save Kate’s life. Sara goes into labor on New Year’s Eve. Anna is born, and the doctors take her umbilical cord to harvest the cord blood. Kate begins a pre-transplant regimen of radiation and chemotherapy, which makes her violently ill. The doctors put her in isolation, then give her Anna’s cord blood.


Anna’s behavior in the section reveals both her need for attention and the severity of the internal conflict she feels regarding her decision to stop serving as Kate’s donor. She compares the turnout at her hypothetical funeral to the turnout she imagines at Kate’s funeral, for instance, and feels jealous that more people would likely go to Kate’s. These thoughts, beyond foreshadowing Anna’s death at the end of the novel, show that Anna craves attention. From what the reader knows at this point about Anna’s role in her family, the reason she wants attention appears to be that her parents generally neglect Anna and focus all their energy on Kate. The implication seems to be that Anna’s lawsuit is a cry for attention more than anything else. As Anna begins receiving more attention, specifically from Sara, she appears to be more willing to drop the lawsuit, apparent when she seems to agree with her mother about stopping the suit. She tells Campbell, however, that she wants to continue, suggesting that her motivation goes deeper than a simple desire to be noticed.

Sara’s pregnancy with Anna introduces the novel’s secondary ethical debate (the primary debate being about Anna’s rights over her own body versus her moral obligation to give Kate a kidney). With the aid of scientists, Sara and Brian screen Sara’s embryos and select the embryo that matches Kate’s genes. Then the scientists implant the embryo with the desired traits in Sara through in vitro fertilization. When Sara and Brian discuss the issue in a television interview, we learn that they have been receiving hate mail because people think they want a “designer baby,” typically meaning a child whose physical traits the parents select. Brian defends their decision, saying they didn’t choose the embryo based on height or IQ, just the traits that would keep Kate alive. In essence, however, Sara and Brian use the same process as they would in creating a “designer baby,” even if their intent differs.

Perhaps more importantly, the way Sara treats her pregnancy raises its own set of ethical questions. Sara admits that she only thinks of Anna in terms of how Anna may benefit Kate. When Sara gives birth, her first words are to tell the doctors to be careful with the umbilical cord, not to ask about her newborn baby. These actions reveal that Sara thinks of Anna more as a treatment for Kate than as an individual human. Though Sara does come to regard Anna as a person, she never stops thinking of Anna as a donor for Kate. To her, that role is part of Anna’s identity, which is why she cannot understand Anna’s decision not to give Kate a kidney. Paradoxically, Sara accuses Anna of effectively signing Kate’s death sentence by deciding not to donate her kidney, but Anna has that power specifically because her parents conceived her as a way to save Kate’s life.

The reader also gains more insight into Jesse’s character in this section. Jesse’s thoughts about whether he would be worth more dead and sold for parts (while he speeds down the highway) reveal both his self-destructive tendencies and his desire to sacrifice himself for someone else’s benefit. Though Jesse never names Kate as the person he wants to sacrifice himself for, his feelings about his inability to save Kate obviously inform his line of thinking. Despite his angry exterior, Jesse obviously cares a great deal about Kate. He doesn’t hesitate to take Kate to the hospital himself as she begins vomiting blood, and when Dr. Chance suggests that a new kidney might save Kate, Jesse offers his own. Jesse becomes angry when Dr. Chance tells him his genes don’t match Kate’s closely enough for him to be the donor, causing Jesse to wonder why he thought he might be worth something and why he thought he could save Kate when he can’t save himself. Clearly his feelings of powerlessness over Kate’s cancer have hurt his sense of self-worth, fueling his self-destructive tendency to take out his feelings of guilt and anger on himself.

Jesse began playing with fire at a young age, evident in his recollection of setting Jean Naté Bath Splash alight. He would show Anna the fire, expecting her to run away, but instead it fascinated her just as it did him. After noting that reaction, Jesse says Anna is the only proof he has that he belongs in the family. Apparently, even from a young age Jesse felt like an outsider, and he associates that feeling with his fascination with fire. As he aged, Jesse developed from a child playing with matches into a serial arsonist, indicating that his feelings were not only never resolved, but in fact have only grown stronger over the years. Not surprisingly, Jesse’s feelings and his obsession with fire have paralleled Kate’s cancer, which has similarly become only more severe and life-threatening over time. Moreover, Jesse’s relationship with fire clearly stems from his relationship with his parents, specifically with Brian, his father and a career firefighter. Jesse could have found any number of outlets for his self-destructive behavior, but the fact that he sets fires when his father works putting them out indicates that Jesse has used fire both as a way to gain his father’s attention and as a replacement for his father’s attention.