Anna and Sara sit with Kate at the hospital during her dialysis session. Sara talks about kidney donation while Anna thinks about all of the risks associated with the procedure. Vern Stackhouse, a sheriff, comes to Kate’s room. He awkwardly serves Sara papers for the lawsuit Anna has filed for medical emancipation. Sara responds angrily, but before she can talk to Anna about the lawsuit, Kate cries out in pain. Sara goes to Kate’s bedside while Anna runs out of the hospital room. Jesse drives to the hospital to pick Anna up, and they go home.
When Sara and Kate arrive home, Kate runs to her room, and Sara demands to know what Anna is doing. Anna refuses to drop the lawsuit, and despite Brian’s protests, Sara grows even angrier until she slaps Anna. Later, Kate talks to Anna. Kate says that even if she has to lose Anna as a sister she can’t bear the thought of losing her as a friend. Anna doesn’t respond, but in her thoughts admits she couldn’t stand to lose Kate either. Sara and Brian walk into Anna’s and Kate’s room at night. Anna overhears her father saying that maybe Anna’s actions aren’t crazy. He leaves, and Sara sits on Anna’s bed. Anna thinks Sara hates her, but Sara insists she could never hate her. Sara holds Anna and assures her they can fix everything by talking to the judge. Anna only nods.
In 1990, Sara and Brian see an oncologist named Dr. Chance, who will be in charge of Kate’s treatments. Sara calls her older sister, Zanne, whom she has fallen out of touch with, and later Zanne arrives to help the family out. Sara and Brian feel overwhelmed with the list of details and questions facing them about Kate’s cancer and treatment. Since Kate’s form of cancer often resists treatment, the doctors admit they can only do so much. Sara asks what it will be like if Kate dies and wonders how she would survive it. Kate starts chemotherapy and gets extremely sick. The doctors test Jesse to see if he is a genetic match for Kate, since she might need bone marrow if she relapses, but he is not. Dr. Chance tells Sara that if she and Brian have more children, one sibling could be a match. After chemo, Kate develops an infection and has to be rushed to the hospital. While at the hospital, Sara tells Brian she is thinking of having another child. Brian thinks Sara wants to be able to replace Kate if she dies, but Sara assures him she wants to have another child to see if the child would be a genetic match for Kate.
Sara’s angry reaction to Anna’s lawsuit reflects the single-mindedness of her character, which we have seen previously, whereas the other members of the family react in more complex ways. While Sara immediately berates Anna for her choice, Brian insists that his daughter be allowed to explain. As in the previous section, he seems to see—or at least wants to see—all the members of the family. Kate also reacts with concern for Anna. When she talks to Anna, she expresses sadness, not anger. Anna, meanwhile, behaves in contradictory ways. She won’t back down, but she also wants desperately to let her mother fix things. She may be rebelling against her mother’s wishes, but she is not yet strong enough or mature enough to be entirely independent. The reader sees that, despite the very bold step she has taken by filing her lawsuit, Anna is still just a child.
Sara’s description of Kate’s struggle exhibits an almost graphic level of detail. Sara relays all the realities of Kate’s disease, from the names and dosages of Kate’s medicine to the way Kate’s central line looks underneath her chest to the horrific side effects of chemotherapy. These details help to make the story realistic by giving the reader concrete information. But perhaps more importantly, this barrage of information creates for the reader a sense of the overwhelming situation Sara and Brian faced with Kate’s cancer. None of these details were trivial to Sara and Brian because they directly affected Kate’s health and her chances of survival. In providing these specifics, the reader gets an idea of the struggle the Fitzgerald family faced just in arriving at the present point in which the story takes place.
Even without hearing Jesse’s voice directly, we learn much about his character in this section. For instance, he supports Anna in a way that no one else does, without judgment or commentary. A great deal of what the reader knows about Jesse at this point concerns his delinquency, but his behavior toward Anna points to a different aspect of his personality. The details in Sara’s narration about the early days of Kate’s cancer also reveal important information about Jesse. As two-year-old Kate began her struggle, Sara and Brian hoped that Jesse would be a genetic match for Kate, which would allow him to act as her donor and prolong, or potentially save, her life. Jesse, however, was not a match. Sara and Brian, who had already begun shifting their attention to Kate and away from Jesse, paid him even less attention after that, as they began searching for other treatments for Kate. Ever since, Jesse has felt neglected by his parents and guilty for not being able to save Kate. These feelings lie at the heart of his behavior in the present.
1. “See, unlike the rest of the free world, I didn’t get here by accident. And if your parents have you for a reason then that reason better exist. Because once it’s gone, so are you.”
Anna’s statement, which appears in her narration on the first Monday, refers to the way Anna’s parents conceived her. When Anna says she “didn’t get here by accident,” she means that her parents deliberately selected her, or rather the embryo that would become her, for a specific reason. They needed a genetic match to act as Kate’s donor in order to keep Kate alive, and the doctors told them that the best way to find such a match was essentially to create one. As a result, Anna was born. Anna, however, feels that her only purpose, in the eyes of her parents’ anyway, is to serve as Kate’s donor. She says that if your reason for existing disappears, so will you. In other words, if something were to happen and Kate were to die, Anna suggests her parents would no longer need or want her.
These feelings motivate a great deal of Anna’s actions throughout the novel. Although Anna may have filed the lawsuit at Kate’s behest, Anna still admits that having Kate die would be one of the best things that could happen to her. If that were to occur, Anna’s life would no longer depend on Kate’s, allowing Anna to live independently for the first time. Situations such as Sara forcing Anna to leave her friend’s birthday party early so she could take Anna to the hospital would no longer occur. Kate even says if she were to die Anna would be able to do all the things she ever wanted, such as going to hockey camp.
2. “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.
3. “‘She is dying Sara. She will die, either tonight or tomorrow or maybe a year from now if we’re really lucky. You heard what Dr. Chance said. Arsenic’s not a cure. It just postpones what’s coming.’
My eyes fill with tears. ‘But I love her,’ I say, because that is reason enough.”
Sara and Brian have this exchange in Sara’s narration during The Weekend chapter, and it takes place in 2001, when Kate relapses and goes into system failure. The quote illustrates the different views Brian and Sara take of Kate’s cancer. Brian recognizes that Kate’s leukemia is fatal and that, even if they provide treatment, that treatment may only prolong Kate’s life without curing her. Sara, on the other hand, cannot accept the possibility that Kate may die. On the contrary, she feels determined to fight endlessly to keep Kate alive. This mindset motivates Sara to try any treatment on Kate, even those that require Anna as a donor, so long as it may aid Kate’s survival.
This quotation additionally brings up the ethical question of quality of life versus sanctity of life. In this moment, Brian and Sara each represent a different side. Brian knows that the treatments Kate has endured for her leukemia, such as radiation and chemotherapy, have harsh side effects. Though these treatments may extend Kate’s life, they cause her a great deal of suffering. In Brian’s view, the quality of Kate’s life may have deteriorated so much that the better option appears to be to allow Kate to die. Sara’s main priority, however, is keeping Kate alive. Sara obviously does not want Kate to suffer, but she feels the positive aspects of Kate’s survival, primarily her continuing to be present in the family, outweigh the negative aspects, such as the side effects of the treatments she must undergo.
4. “Maybe it’s because Jesse isn’t all that different from me, choosing fire as his medium, needing to know that he could command at least one uncontrollable thing.”
Brian has this thought in the section he narrates on the second Monday in the novel, when he confronts Jesse about Jesse’s acts of arson. Both Brian and Jesse recognize the same traits in fire that they see in Kate’s cancer. To them, both represent destructive and uncontrollable forces. As a result, both regard fire as a substitute for Kate’s cancer (although neither Brian nor Jesse says so explicitly, Brian’s career as a firefighter appears to have been the catalyst for Jesse’s preoccupation with fire, or at least informs it to a large degree). Brian realizes that he and Jesse view fire in the same way, and although Brian disagrees with Jesse’s actions, he feels that he understands them. Consequently, when Brian discovers that Jesse has been setting the fires all over the city, he tells Jesse he knows about the arson but does not punish him.
Despite the fact that Brian and Jesse both regard fire in this way, their relationships to fire differ drastically. Brian, as a firefighter, regularly works to put fires out and often saves people who have become trapped in burning buildings. Similarly, Brian steadily battles Kate’s cancer and does what he can to keep her alive. Although he knows he cannot control the fires he fights anymore than he can control Kate’s cancer, he recognizes that he can do things to control at least the outcomes of these situations. Jesse, on the other hand, feels that he has no power at all against Kate’s cancer. Specifically, he feels that because he is not a genetic match for Kate and cannot serve as a donor, he can do nothing to help Kate. He can only watch idly as Kate dies. The guilt and futility that Jesse feels as a result turn into a destructive—and often self-destructive—rage, which Jesse expresses by setting fires.
5. “‘The answer is that there is no good answer. So as parents, as doctors, as judges, and as a society, we fumble through and make decisions that allow us to sleep at night—because morals are more important than ethics, and love is more important than law.’”
This quote, spoken by Judge DeSalvo, appears in Campbell’s section during the novel’s second Thursday, shortly before the Judge gives his decision. The quote raises a recurring theme in the novel: that no clear distinction always exists between right and wrong. As Judge DeSalvo also says, Anna’s quality of life is inextricably tied to Kate’s sanctity of life. In other words, the more Anna must act as Kate’s donor, the more Anna’s quality of life deteriorates. She has to suffer through painful procedures like bone-marrow extraction and has to give up things she wants, such as hockey camp. But without Anna making these sacrifices to serve as Kate’s donor, Kate would die. The situation raises serious questions: does keeping Kate alive justify causing Anna to suffer, and at what level of Anna’s suffering does that tradeoff become invalid?
The court is supposed to hear all the facts and testimonies of those involved and determine what, in this situation, is ethically and legally correct. But throughout the trial, we hear multiple characters testify that they don’t know the right answer. Just before he breaks down in tears, Brian acknowledges that he doesn’t have a clear answer. Julia, who the court appointed as Anna’s guardian ad litem specifically to determine what is best for Anna, admits that she cannot reach a definitive conclusion. Sara, in her closing argument, tells the court she doesn’t know what is moral or legal, just that she knows it’s right to do everything to keep Kate alive. Finally, Judge DeSalvo, in his ruling, admits that no good solution exists, and that ultimately people make imperfect decisions based not on ethics or law but on personal morals and the love we feel for the people we care about.