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The narrative of My Sister’s Keeper alternates between
first-person accounts by the novel’s different characters. The bulk of the story takes
place in the present, in a one-and-a-half week stretch of time. Sara Fitzgerald, a
former attorney and current stay-at-home mom, narrates the remainder of the story from
different points in the past but moving gradually toward the present. One final chapter,
the epilogue, occurs in the future. In 1990, doctors diagnose Sara’s two-year-old
daughter, Kate, with a rare and aggressive form of leukemia. The news that their child
might die shocks Sara and her firefighter husband, Brian, but Sara immediately resolves
to begin Kate on treatment. Kate starts chemotherapy, and her oncologist, Dr. Chance,
suggests she might eventually need a bone marrow transplant, preferably from a related
donor. The Fitzgeralds test their four-year-old son, Jesse, but he is not a match. Dr.
Chance mentions that another unborn sibling could be a match, and Sara suggests to Brian
that they have another child.
Sara’s passages, told at different points over the next fourteen years, focus
largely on Kate’s struggles. She describes how scientists help them conceive another
daughter, Anna, who is a perfect genetic match for Kate. Over the course of the next few
years, Anna undergoes several procedures, including frequent blood withdrawals and a
painful bone marrow extraction, to help keep Kate alive. Sara describes in great detail
the pain and suffering Kate endures. Chemotherapy and radiation make her violently ill,
and an emergency trip to the hospital heralds each new relapse. Sara and Brian’s
marriage suffers as a result, to the point where they begin to feel like strangers. In
different ways, both Jesse and Anna act out at Sara because of her single-minded focus
The present action of the story begins on a Monday. Thirteen-year-old Anna goes to
see a lawyer named Campbell Alexander and asks him to represent her. Anna tells Campbell
that she wants to sue her parents for medical emancipation. Kate, her sister, is in the
end stages of kidney failure, and Anna wants to file the lawsuit so she will not have to
donate a kidney to Kate. Campbell, who has a service dog but gives a sarcastic
explanation whenever someone asks why, agrees to represent Anna for free. When she is
served with the papers for the lawsuit, Sara becomes furious with Anna as she cannot
understand Anna’s decision. Brian, however, understands Anna’s point of view to a degree
and recognizes that she would not have brought a lawsuit unless she were genuinely
unhappy. Judge Desalvo, the judge for Anna’s case, decides to appoint a woman named
Julia Romano as Anna’s guardian ad litem, a person whose job is to objectively decide
what is in Anna’s best interests. When Julia goes to see Campbell, it becomes clear they
have a romantic past and have not seen each other in many years. Throughout all of these
events, Jesse has been setting different abandoned buildings on fire. Jesse acts like a
delinquent in other ways as well, such as drinking alcohol excessively, but much of this
behavior stems from anger over his inability to save Kate and his feelings of being
ignored by his parents.
Kate becomes seriously ill and must be hospitalized. Dr. Chance says she will die
within a week. Anna refuses to change her mind about the lawsuit, however. At the
hearing, Sara decides she will represent herself and Brian. Consequently, Brian takes
Anna to stay with him at the fire station to give Anna some distance from her mother. He
believes if they remain in the same house together, Anna may unwillingly cave to her
mother’s wish that she donate her kidney. Meanwhile, through flashbacks Campbell and
Julia alternately recall scenes from their high-school relationship. They both attend a
prep school populated by children from wealthy families. Julia feels and acts like the
outsider, and Campbell falls in love with her despite the reservations of his friends
and parents. Their relationship ends abruptly, however, when Campbell breaks it off
without explanation. In the present, Campbell and Julia initially bicker with each
other, but they end up sleeping together the night before the trial begins.
At the trial, both Sara and Campbell question witnesses, including one of the
doctors familiar with Kate’s medical history, and both are effective at different times.
Reluctantly, Anna takes the stand and admits that she filed the lawsuit because Kate
told her to. At the very moment she makes this announcement, Campbell has an epileptic
seizure and collapses. When his seizure ends, he admits he has been having seizures ever
since a car accident in high school. He broke up with Julia because he didn’t want his
seizures, which limit him greatly, to limit Julia as well. He also explains that the
seizures are the reason he has a service dog, which can tell when another seizure is
coming on. Julia and Campbell reconcile. Back on the stand, Anna explains that Kate
asked Anna not to donate her kidney because she was tired of being sick and waiting to
die. Anna also admits that while she loves her sister, part of her wanted Kate to die,
too, so that she could have more freedom with her life. Judge DeSalvo decides to grant
Anna medical emancipation and gives Campbell medical power of attorney over
On the way to the hospital, Campbell and Anna get into a serious car accident. At
the hospital, the doctors tell the family that Anna has irreversible brain damage.
Campbell tells the doctors to give Anna’s kidney to Kate. Kate narrates the epilogue,
set in 2010. She discusses the grief her family went through after Anna’s death, and the
fact that she blames herself. She knows, however, that she will always carry Anna with