Small Great Things
Jodi Picoult’s Small Great Things (2016) explores themes of race, privilege, and justice through the story of Ruth Jefferson, an African American labor and delivery nurse accused of causing the death of a white supremacist couple’s newborn. The novel alternates perspectives between Ruth, the infant’s father Turk Bauer, and Ruth’s public defender Kennedy McQuarrie, revealing systemic racism and personal biases. Inspired by Dr. Martin Luther King Jr.’s quote about doing “small things in a great way,” the narrative examines moral dilemmas and societal structures. The book has been praised for its thought-provoking examination of contemporary racial tensions and is being adapted into a film.
Stage One: Active Labor — Ruth 3
byPicoult, Jodi
The chapter opens with Ruth, a nurse, reflecting on the cyclical nature of her work, where each day brings new births and new stories. However, her routine is disrupted when she receives a call from Carla Luongo, the hospital’s risk management liaison, requesting a meeting. Ruth’s internal tension is palpable as she agrees, masking her anxiety with professionalism. The narrative shifts to her home, where her son Edison observes how her tone changes when speaking to white people, hinting at the underlying racial dynamics that permeate her life and work.
At the meeting with Carla, Ruth is repeatedly questioned about her actions during the tragic incident involving the Bauer baby. Despite Carla’s assurances that the conversation is a formality, Ruth senses an underlying suspicion. She recounts the events meticulously, emphasizing that she followed orders not to touch the baby until directed otherwise. The lawyer’s probing questions—particularly about Ruth’s potential anger or negligence—highlight the hospital’s defensive stance, making Ruth feel like a liability rather than a valued employee.
The tension escalates when Carla brings up an alleged comment Ruth made about sterilizing the baby, a remark Ruth insists was a misunderstood joke. This accusation forces Ruth to confront the racial undertones of the situation, as the parents’ bias and the hospital’s scrutiny converge. Ruth’s hesitation in answering whether she was watching the baby reveals her moral dilemma: admitting she disobeyed orders could cost her job, while claiming she followed them could imply the orders were justified. Her strategic mention of potential discrimination underscores her precarious position.
The chapter closes with Ruth’s quiet defiance, as she subtly threatens legal action against the hospital for discrimination, though she knows the personal and professional risks involved. Carla’s veiled warning about not being a “team player” reinforces the power imbalance. Ruth’s internal conflict—weighing truth against survival—captures the chapter’s central theme of systemic injustice and the impossible choices faced by those caught in its grip.
FAQs
1. How does Ruth’s professional perspective as a nurse influence her view of the events surrounding Davis Bauer’s death?
Answer:
Ruth’s nursing experience shapes her perspective by making her acutely aware of life’s cyclical nature and the routine of medical care. She notes that “life goes on” with new patients constantly replacing old ones, yet Davis Bauer’s case stands out as an exception that forces her to pause and reflect. Her professional detachment is challenged as she relives the moments before the infant’s death repeatedly, indicating how this traumatic event disrupts her usual clinical objectivity. The chapter shows how even experienced medical professionals can be deeply affected by specific cases, despite their training to maintain emotional distance in their work.2. Analyze the significance of Ruth’s interaction with her son Edison regarding her “white voice.” What does this reveal about her character and experiences?
Answer:
This brief exchange reveals Ruth’s experience with code-switching and the racial dynamics she navigates daily. When Edison observes that Ruth’s voice changes when talking to white people, it demonstrates her conscious adaptation to different social contexts—a survival mechanism many minorities develop. This moment underscores the psychological burden of constantly adjusting one’s behavior based on others’ perceptions. It also foreshadows Ruth’s upcoming meeting with Carla Luongo, where she’ll need to carefully manage her tone and responses while discussing the racially charged incident at the hospital.3. What conflicting pressures does Ruth face during her meeting with Carla Luongo, and how do these reflect larger institutional tensions?
Answer:
Ruth faces competing pressures to protect her job while maintaining her integrity. She must navigate Carla’s probing questions about whether she disobeyed orders or acted negligently, knowing that complete honesty could cost her employment. The hospital’s risk management approach (represented by Carla) prioritizes institutional protection over individual circumstances, creating tension between legal liability and human compassion. Ruth’s consideration of playing the “discrimination card” reveals how marginalized employees might use systemic biases as leverage, even when they find such tactics uncomfortable. This interaction highlights how medical institutions balance patient care, legal concerns, and staff relations during crises.4. How does the author use physical details (like Carla’s torn pantyhose) to develop themes and character dynamics in this chapter?
Answer:
The torn pantyhose serves as a subtle but powerful symbol of the imperfect systems and people involved in this situation. Ruth’s focus on this flaw reflects her hyper-awareness of surfaces and appearances—both literal and metaphorical—during this high-stakes conversation. While Carla presents herself as professional and “on Ruth’s side,” this visible imperfection undermines her authority and suggests the fragility of institutional facades. The detail also contrasts with Ruth’s own meticulous self-presentation (shown when she corrects Edison’s manners), emphasizing how both women perform roles while dealing with underlying tensions. This physical imagery reinforces themes of vulnerability hidden beneath professional exteriors.5. Evaluate Ruth’s statement that she “followed orders” by not intervening when the baby gasped. How does this claim relate to broader ethical dilemmas in healthcare?
Answer:
Ruth’s claim presents a complex ethical dilemma about professional responsibility versus compliance. While technically true that she eventually followed the controversial order not to treat the baby, her hesitation suggests moral discomfort with this decision. This moment encapsulates the tension healthcare workers face between institutional protocols and personal ethics—particularly when directives may stem from prejudice. The situation parallels real-world cases where professionals must choose between job security and patient welfare, raising questions about where ultimate accountability lies. Ruth’s careful phrasing (“I followed orders”) reveals her awareness that this justification may not absolve her of guilt in the baby’s death, professionally or personally.
Quotes
1. “When you are a nurse, you know better than most anyone else that life goes on. There are good days and there are bad days. There are patients who stay with you, and those you can’t wait to forget.”
This opening reflection captures Ruth’s professional perspective as a nurse, setting the stage for the moral dilemma she faces. It highlights the cyclical nature of healthcare work while foreshadowing how this particular case will “stay with her” in troubling ways.
2. “But more important, it’s been fourteen nights when I’ve awakened with a start, reliving not that infant’s death but the moments before. Playing them in slow motion and reversing them and erasing the edges of the narrative in my head so that I start to believe what I’ve told myself.”
This reveals Ruth’s psychological turmoil and the unreliable narrator aspect of her recollection. The quote shows how trauma reshapes memory and introduces the central tension between her professional actions and personal guilt.
3. “Edison sits down and piles a heap of cereal into a bowl. ‘Were you talking to someone white?’…‘Your voice changes.’”
This brief exchange with her son exposes Ruth’s code-switching and the racial dynamics underlying the story. The observation about her voice “changing” subtly introduces themes of racial performance and double consciousness.
4. “I can’t tell the lawyer that I disobeyed Marie’s orders, because it could cost me my job. But I can’t tell her that I tried to resuscitate the infant, either, because then those orders suddenly seem legitimate.”
This internal conflict represents the chapter’s climax, revealing Ruth’s impossible position between professional ethics and self-preservation. The quote encapsulates the systemic Catch-22 created by racial bias in medical settings.
5. “Naturally,’ Carla says smoothly, ‘that’s not the kind of team player we’d want on staff.’ In other words: keep threatening to sue and you’re fired.”
The lawyer’s veiled threat demonstrates institutional power dynamics at play. This moment crystallizes how systems protect themselves while individual workers (especially marginalized ones) bear the consequences.