My Sister’s Keeper
FRIDAY SARA
by Picoult, JodieThe chapter opens with a harrowing scene as Brian and the narrator rush their daughter Sara to the emergency room after a bike accident. Sara sustains a significant scalp laceration, requiring eighty-two stitches. The parents’ calm demeanor hints at their familiarity with medical crises, a theme that recurs throughout the chapter. The family’s dynamics are briefly highlighted as Sara’s siblings react to her injury, with one remarking on the relative comfort of waiting in the hospital lobby, foreshadowing the family’s frequent encounters with medical emergencies.
The narrative shifts to another critical health crisis involving Kate, the narrator’s nine-year-old daughter, who experiences severe rectal bleeding—a symptom of her relapsed acute promyelocytic leukemia (APL). The mother’s internal monologue reveals her anguish as she tends to Kate, questioning whether her daughter will live long enough to experience milestones like menstruation. Dr. Chance, their physician, delivers the grim news that a bone marrow transplant is now necessary, despite its high risks, as Kate’s survival without it is impossible.
The family’s struggle extends to their insurance company, which initially denies coverage for the life-saving transplant. The narrator’s frustration mounts as she navigates bureaucratic hurdles, disconnected calls, and dismissive representatives who prioritize cost over her daughter’s life. A tense exchange with a supervisor reveals the insurance company’s unwillingness to fully cover the transplant, offering only partial funding for a less effective treatment. The narrator’s impassioned argument underscores the inhumanity of valuing profit over a child’s survival.
The chapter concludes with the painful preparation for Anna, another daughter, to donate bone marrow for Kate’s transplant. Anna’s fear and resentment during the growth factor shots highlight the emotional toll on the family. The narrator’s confrontation with the insurance company escalates, culminating in her outburst about the moral failure of prioritizing protocols over human life. The chapter paints a vivid picture of a family grappling with medical, emotional, and systemic battles in their fight to save Kate.
FAQs
1. What medical emergency occurs with Kate in this chapter, and what does it signify about her condition?
Answer:
Kate experiences rectal bleeding in the bathroom, which is revealed to be a symptom of her acute promyelocytic leukemia (APL) relapse. This hemorrhage serves as a “calling card” for APL, indicating that her cancer has returned despite previous treatments. The mother recognizes this as a clinical relapse, confirmed later by Dr. Chance, who explains that without a bone marrow transplant (BMT), Kate will die. The scene underscores the severity of her condition and the urgency of intervention, as even routine bodily functions become life-threatening manifestations of her disease.2. Analyze the ethical dilemma presented by the bone marrow transplant option. Why is this decision so difficult for Kate’s parents?
Answer:
The bone marrow transplant presents a harrowing choice: a 50% chance of cure versus a 50% chance of death from the procedure itself. Dr. Chance explains the high risks of chemotherapy, radiation, and post-transplant complications, making the decision agonizing for Kate’s parents. Brian voices their shared fear—why risk losing Kate to treatment when the alternative is certain death? This dilemma highlights the brutal calculus of terminal illness, where parents must weigh uncertain survival against guaranteed decline. The metaphor of the Bozo punching bag (resilient yet repeatedly struck) mirrors their emotional exhaustion in facing recurrent crises.3. How does the insurance company’s response to the transplant request reflect systemic issues in healthcare?
Answer:
The insurance company initially denies coverage, claiming the transplant isn’t in Kate’s “best interests,” prioritizing cost over medical necessity. They offer partial coverage for a less effective treatment (donor lymphocyte infusion) that doctors know won’t cure APL. The mother’s frustration—accusing the insurer of valuing “the bottom line” over human life—exposes how bureaucratic processes delay critical care. The requirement for “special reviews” and disconnected calls illustrate systemic inefficiencies, while the supervisor’s suggestion to try cheaper options first (despite medical futility) critiques profit-driven healthcare that undermines physician expertise and patient survival.4. Compare Anna’s and Kate’s medical experiences in this chapter. How do their respective struggles affect the family dynamics?
Answer:
Anna’s bike accident (requiring 82 stitches) is acute but routine, met with sibling teasing and parental reassurance. In contrast, Kate’s relapse is a chronic crisis, marked by invasive treatments and existential dread. Anna’s resentment over growth-factor shots (“she hates you”) contrasts with Kate’s silent suffering, revealing how illness strains sibling relationships. The mother’s grief—wondering if Kate will live to menstruate—juxtaposes mundane milestones with mortality. Brian’s attempt to normalize Anna’s injury (“brave as a firefighter”) versus his terror over Kate’s prognosis shows the family’s fractured resilience in facing simultaneous trauma.5. Evaluate the mother’s phone confrontation with the insurance supervisor. What rhetorical strategies does she use to advocate for Kate?
Answer:
The mother employs logical appeals (citing medical specifics about APL’s resistance to repeated treatments), emotional appeals (“a human being”), and ethical appeals (accusing the board of ignoring expert advice). She dismantles the insurer’s justification by questioning their doctors’ qualifications and highlighting the DLI’s futility. Her shift from calm to furious—”Do you automatons even know what that is?“—reveals desperation. By framing the denial as a death sentence and contrasting clinical jargon with Kate’s humanity, she exposes the insurer’s moral failure. Yet her anger also underscores systemic powerlessness, as corporate protocols override parental advocacy.
Quotes
1. “No MATTER HOW MANY TIMES you drive to the emergency room, it never becomes routine.”
This opening line sets the tone for the chapter, immediately conveying the emotional weight and trauma of repeated medical emergencies in the family. It establishes the constant state of crisis that defines their lives.
2. “Because if you don’t,” Dr. Chance explains, “she will die.”
This blunt statement from the doctor presents the impossible choice facing the parents - risk a dangerous bone marrow transplant with 50% survival odds, or face certain death for their daughter. It’s the pivotal moment where the medical reality crystallizes.
3. “I feel heat rush to my face. ‘Is dying?’”
This terse, angry response to the insurance company’s refusal captures the mother’s outrage at bureaucratic indifference to life-and-death decisions. The rhetorical question lays bare the absurdity of the insurer’s position.
4. “We aren’t talking about a car, where we can try a used part first and if it doesn’t work, get a new one shipped in. We’re talking about a human being.”
This powerful analogy highlights the mother’s frustration with the insurance company treating medical decisions like mechanical repairs. It underscores the fundamental disconnect between healthcare bureaucracy and human lives at stake.
5. “I wonder if it hurts as much as having your six-year-old stare you in the eye and say she hates you.”
This poignant reflection reveals the emotional toll of the medical procedures on both children and parents, comparing physical pain to the deeper wound of a child’s rejection during difficult treatments.