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My Sister's Keeper by Jodi Picoult | Summary and Analysis

Paper Type: Free Essay Subject: English Literature
Wordcount: 5575 words Published: 14th Dec 2017

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Anna Transplant Kidney


Anna Fitzgerald

Anna is a 13-year-old girl from a middle-class family in Rhode Island. Her father, Brian, is a firefighter, and her mother, Sara, is a housewife who used to be a lawyer. Her two older siblings are Jesse and Kate. Jesse is an adult who has had a troubled past and lives in an apartment at the family house. Kate is 16 and has recuperated from leukemia, but the treatments have hurt her kidneys, and she needs a kidney transplant. Anna is a natural choice for the donor because she was conceived to help Kate medically and has made donations to her throughout her life. Anna seeks help from a lawyer, Campbell Alexander, to gain control over her body so she can stop being a donor to Kate. Anna is more mature than her age and often ponders deep questions about her sister’s illness and her role in it. Anna struggles with her decisions, and even though she has her outbursts, she is very close to her sister, and at the hearing, she admits that it was Kate who made her decide to instigate the suit.

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What seemed to be a selfish act of a child was really the love of a sister. Although Kate’s illness has prevented her from having a normal life, Anna is close to Kate and the rest of her family. She is on the opposite side from her mother in the case, but they are still a close mother and daughter. Her father tries to look after her as well as Kate, and she bonds with Jesse because they both feel like they don’t fit in. Anna’s business relationship with Campbell grows into a more personal one. She is with him in the wreck that ultimately kills her. She does donate the kidney while dying and at Campbell’s request. At the hearing, she stood up for herself and her sister and ended up saving her sister’s life, anyway. Anna, who had always felt invisible in her family, ends up being a heroine.

Campbell Alexander

Campbell is the lawyer Anna Fitzgerald asks to represent her in her lawsuit against her parents. He seems cold and calculating at first by being single-minded about Anna’s case and pandering to the media. He has a guide dog, but he will not explain the animal’s purpose. He makes jokes when people ask him about it. His softer side is revealed through Julia, Anna’s guardian ad litem, and the flashbacks to their teen romance. He is the product of a wealthy background with parents who are shallow. His epilepsy and, therefore, the reason for the dog, is revealed in court. Although he wins the case, he feels for both sides and when faced with deciding to donate Anna’s organs, he makes sure Kate is the kidney recipient. He left Julia all those years ago because he did not want her to have to deal with his condition, but Julia chooses to stay with him. He marries her.

Sara Fitzgerald

Sara is a lawyer turned housewife. As Brian’s wife and Kate, Jesse, and Anna’s mother, she does everything she can to keep her family together. She is close to her sister, Suzanne, who is a career woman. She wants Suzanne to be her rescuer, and she wants Anna to be Kate’s rescuer. She is totally focused on Kate’s illness and wants to try every treatment possible. She either ignores Jesse or gets angry with him. It is her idea to get pregnant with Anna and for Anna to make donations. She is shocked when Anna sues her and Brian. Her temper and devotion to Kate make her a worthy adversary to Campbell in the courtroom. At first, Sara can not understand why Anna is doing this and estranges herself from Brian, but after all the facts are revealed at the hearing, she understands the conflicts involved and how Anna is her own person who can make her own choices and that Kate can make her own choices, too. She and Brian become a stronger couple, and she makes peace with Anna before her death. She was shattered by Anna’s death and hoped for her return. Through her family, she healed.

Brian Fitzgerald

Brian is a dependable husband to Sara and father to Kate, Jesse, and Anna. He is a firefighter who loves his job. His hobby is astronomy, and he makes astronomical references that can relate to his own life. When Anna sues him and his wife, he is surprised but wants to support Anna. He moves her into the fire station so she can have some distance from the home situation. This puts a strain on Brian and Sara’s marriage, and they just talk about the medical issues. His decision to testify for Anna at the hearing does not help matters. At the hearing, however, he changes his mind and wants Anna to donate. Brian is really conflicted on the matter. He is not only a rescue worker; he likes to rescue everyone around him, and in this case, he cannot. Even though his sister-in-law Suzanne can help the family financially, he wants to be the provider. He is the only one who learns Jesse is the arsonist and sets him on the right path. He grows closer to his wife as they learn how the medical issues have overshadowed their marriage. He develops a drinking problem after Anna’s death but conquers it.

Jesse Fitzgerald

Jesse is the oldest child in the Fitzgerald family. After his sister is diagnosed with leukemia as a toddler, he is still a child himself and often has to give up events for Kate. After Anna’s birth, he feels useless because he is the sibling that cannot help. He acts out in school and is on a downward spiral into drugs, alcohol, stealing, and arson as he grows up. He tries to project the rebel image around his family, Julia, and Campbell, but his actions show his softer side. He donates platelets to Kate anonymously. He helps Anna out by taking her to the lawyer’s office and when visiting Kate. Brian finds out Jesse is the arsonist, and Jesse has a breakthrough. He plays with fire because he can control it. Fire is a theme in the book, and Jesse shows the negative side of fire. He becomes a police officer and wins an award. He transforms himself from a destroyer to a rescuer.

Julia Romano

Julia is the guardian ad litem assigned to represent Anna in the hearing. She has to make a report about which side she supports. She was a rebel as a teenager from a large, poor family and has turned into a responsible adult. She is close to her twin sister. Close sisterly relationships permeate the book, including Anna and Kate’s and Sara and Suzanne’s. She had a romance with Anna’s lawyer, Campbell Alexander, as a teenager despite their class differences. She was hurt when Campbell abandoned her. As she works with him on Anna’s case, she is attracted to him even though she tries to resist it. She is good with Anna and Kate because she talks to them like they are real teenagers. At the hearing, she is unable to pick a side. She finally learns why Campbell left her after he has a seizure at the hearing. When she finds out he has epilepsy, she refuses to abandon him. They get married.

Kate Fitzgerald

Kate is diagnosed with leukemia as a toddler. When her brother, Jesse, does not match her for bone marrow donation, their mother Sara has the idea to get pregnant with a baby who is a genetic match for Kate. Anna is born, and she donates to Kate on several occasions. Kate struggles with being a normal teenager and having cancer because her appearance is affected, and her first boyfriend had cancer and died. At 16, Kate is cancer free, but the treatments have affected her kidneys, and she needs a kidney transplant. It is assumed Anna will be the donor, but she files a lawsuit to gain control over her body so she can stop donating. Anna reveals at the hearing that Kate was suicidal and urged her not to donate a kidney. Kate wanted her sister to be free of obligations to her. The judge rules for Anna, but after Anna dies in a wreck, Kate gets Anna’s kidney. She recovers and becomes a dance teacher. She had told Julia she wanted to be a ballerina because she could have control over her body.

Duracell Dan

He is the homeless man Jesse bribes to keep his arson materials. He is with Jesse at one of his fires and tells Jesse a homeless man is in the burning building. This forces Jesse to save the man.

Suzanne Crofton

Suzanne is Sara’s older sister. She is a single, career woman who lives a different life than Sara. She is a support during Kate’s illness and even tries to help financially.

Vern Stackhouse

Vern is a sheriff and friend of the Fitzgerald family. He serves Sara with papers related to Anna’s lawsuit. He is around during the hearing and provides assistance to the family and Campbell.

Isobel Romano

Isobel is Julia’s identical twin sister and roommate. She had a bad breakup and cautions Julia against Campbell. Toward the end, Isobel and Campbell seem to come to an understanding.


Providence Hospital

This is where Kate is diagnosed and has her treatments and other stays. Anna is also a patient here as a donor. Her birth and death occur here.

The Fitzgerald House

This is the home of the Fitzgeralds where Brian, Sara, Kate, and Anna live. Jesse lives in an adjoining apartment.

The Fire Station

This is where Brian works and where he and Anna live to give Anna some distance from her mother and the case. The rooftop is a favorite place to watch the stars.

The Locket

Brian gives the locket to Anna as a child after one of her donations. It is a thank you present for helping Kate. Thirteen-year-old Anna sells it at a pawnshop to raise money for attorney fees.

The Courthouse

This is where the hearing is. Campbell and Anna’s secrets are revealed here.

Campbell Alexander’s Office

Anna first meets Campbell here to initiate the lawsuit.

Dr. Chance’s Office

This is the office of the oncologist that diagnoses and treats Kate. The idea for Anna’s conception begins here. It is also where Anna’s donations are suggested.

Duracell Dan’s Hideaway

It is an underpass where a homeless man lives. He stashes the materials Jesse uses for arson.

Jesse’s Apartment

The apartment is part of the Fitzgerald house. From items in the apartment and other clues, Brian figures out that Jesse is the arsonist. This is where he confronts his son.

The Wheeler School

The Wheeler School is the private high school where Campbell and Julia met.

Julia’s Apartment

Julia lives here with her twin sister, Isobel. This is where she and her sister talk about Campbell.

Campbell’s Apartment

Campbell’s apartment is very sterile and high tech. It seems to reflect his personality. Julia reveals she does not like it, and he agrees.

Shakespeare’s Cat

Julia goes to the gay bar Shakespeare’s Cat to forget Campbell.

Hercules the Goldfish

A pet Kate got for her birthday. Sara saves him from near death a couple of times.



Fire is a common theme in the book, and it ties much of the plot together. The passages that preface each section concern fire. Brian is a firefighter. Jesse sets fires. Kate’s illness can be compared to a fire because it is out of control and destroys everything in its path. Anna compares her initiating the lawsuit to fire. Brian says a fire should be allowed to burn unchecked. He is referring to Kate’s illness in that they should let it run its course without interference. He uses fire to make points in conversations with his coworkers. Brain connects fire to the story of Pandora ‘s Box and hope. Hope is what he has left as Kate’s father. He is trying to put out the home fires, which include Kate’s illness, Anna’s lawsuit, Sara’s stubbornness, and Jesse’s troubles. Julia puts out the fire Brian starts in the kitchen; and in her role as guardian ad litem, she tries to put out fires. She also rescues Campbell.

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People that put out fires are rescuers. Characters in the book fill the rescuer roles. Brian is a rescuer on the job and in his family. Anna is Kate’s medical rescuer. Campbell points out at the hearing that people are not obligated to rescue by sharing a story of a homeless woman who let people die in a fire. Suzanne is Sara’s rescuer. Jesse goes from arsonist to rescuer. At the hearing, it is revealed that Kate wanted to be Anna’s rescuer for once.

At the end of the book, it rains, and this puts out the fires of the characters burning throughout the book. Jesse’s inner fire is put out with Brian’s help, and he redeems himself. Kate’s fire is stopped, and she becomes healthy because of the kidney transplant. Campbell and Julia’s fire is contained because they reunite. Sara and Brian’s fire from Kate’s illness and Anna’s lawsuit and death is also contained, and they become a stronger couple.


Brian’s hobby is used to make points throughout the book. Some of the passages preceding the sections make astronomical references. Anna’s real name comes from a constellation named Andromeda, whose story is she is punished because of her mother, but she is rescued. The constellation resembles arms tied together. This can be applied to Anna’s story because her mother is pressuring her to donate, but with the hearing and the wreck, Anna is rescued. Brian’s talking about watching supernovas dies is comparable to the family and others watching Kate die. The story of Orpheus illustrates how death is inevitable. Sara continues the theme by comparing Kate’s sick face to the moons Brian likes, moons that are “still, remote, cold.”(118) Anna refers to the pleasant memory of catching stars after learning she can stay at the fire station. The punctuation of meteor showers during Brian and Anna’s conversation symbolizes what is hard for them to say. Anna compares astronomy maps to trying to find direction in her own life. Anna talks about astronomy to Campbell during the hearing. She talks about how stars are there even if one cannot see them. This applies to how oblivious parents, especially Anna and Campbell’s, can be to their children.

Brian feels he lives on a different planet because of the situations of Anna and Jesse. He talks about cultures looking between the stars and realizes he has been looking at the wrong things. While rescuing Campbell from his seizure, he thinks about how astronomy of the past makes astronomy today inaccurate and says it is because the earth’s axis shakes. This tells the reader the life-shaking events of the book such as Kate’s illness and Campbell’s condition affects the perceptions of the people involved. After Anna’s death, Brian thinks about how the brightness of a star can overshadow another star, and when the other star is seen, it is too late. This applies to how Kate overshadowed Anna, and when Anna finally asserts herself, she dies. After Anna’s death, Kate reveals that her father said he could see Anna reincarnated in the stars.


The characters in the book play different roles. Anna is in the donor role for her sister when she would rather be in the role of a teenager who has friends and plays hockey. The lawsuit is Anna’s way of resisting her lifelong role. Throughout the book, she imagines herself in outlandish adventure roles, and after winning the hearing, Campbell thinks she will have fantastic roles in 10 years. Anna concludes that that the role she wants most is to be Kate’s sister.

In the hearing, it is revealed that Anna does not mind playing the donor role, but Kate is tired of being the recipient. By getting Anna not to donate a kidney, Kate can be Anna’s savior, and they would have reversed roles for once.

Jesse point out to Anna before she begins the lawsuit that the siblings have their own roles in the family–he as the troublemaker, Kate as the martyr, and Anna as the peacemaker. Jesse changes roles by the end of the book. At first, he does not see himself as a rescuer because he cannot rescue Kate. After he has a breakthrough with his father, he goes from arsonist to police officer or savior.

Sara and Brian’s roles go beyond being parents. Sara wants to play the savior role for Kate, but she has to get Anna to play that role. She demonstrates that she expects sisters to help each other as her sister, Suzanne, helps her. Sara has conflicts with the mother/lawyer role. After the lawsuit begins, Sara tries to balance being a mother to Anna and a lawyer on the opposing side of the lawsuit. This is a constant struggle until Sara realizes she is a good mother, and she should not try to save her children from themselves. Brian is the savior and mediator as he tries to save everybody in the family and acts as a buffer between Anna and Sara.

Campbell has the lawyer role as he panders to the media and questions the witnesses at the hearing. He could be seen in a rescuer role as he rescues Anna from donating to Kate. He also has the romantic role with Julia, but this does not come to fruition until the end of the book after his secret is revealed. Julia has a mediator role as Anna’s guardian ad litem and a romantic role with Campbell after she learns the truth. Julia’s role as a sister is shown with her twin, Isobel.

Ethical Dilemmas

At the heart of My Sister’s Keeper is an ethical dilemma: Should thirteen-year-old Anna be forced to give her kidney to her dying sister? Through much of the novel, it seems like Anna does not want to give Kate her kidney because she is tired of being a store of spare parts for Kate. Since she was born, Anna has undergone a number of painful procedures to save Kate’s life. Kate suffers from cancer and conditions related to the illness and its treatment. Her family’s life has been focused on Kate’s illness and its potential recurrence during times of remission, since before Anna was born.

Indeed, Anna was created to be a perfect sibling match for Kate. The Fitzgeralds went to a geneticist who created several embryos with the couple’s sperm and eggs, then figured out which one matched Kate. That embryo was implanted in Sara and became Anna. At the time, there was public controversy over their decision because Anna was seen as a “designer baby.” The ethical debate led to a talk show appearance for the couple, as well as hate mail.

More than anyone else in the family, Sara sees no ethical dilemmas, neither in how Anna was created nor in making Anna suffer to try to keep Kate alive. Sara only responds to the latest crisis and the best solution at hand. When necessary, taking from Anna to give to Kate is no dilemma for her. The result is that Kate has lived longer than her doctor ever expected, but at the cost of a balanced family. The needs of Kate and her illness are put above all else, with Sara diligently guarding those interests at the expense of her husband and other children. Even Julia, the court-appointed guardian of Anna’s interests, cannot make a decision on what should be done.

Anna’s lawsuit brings all these issues and the ethical dilemma to the forefront. With Campbell acting as her lawyer, she seeks the right to decide whether she gives up a kidney. Anna’s true motivation in her quest for medical emancipation is yet another ethical dilemma. As she reveals on the stand during the hearing, the reason that Anna has brought the lawsuit was for Kate’s benefit. Kate cannot tell her mother that she does not want to have the transplant. Kate is aware of the toll her illness has had on everyone and she seems tired of fighting. In fact, she has tried to kill herself before. This situation brings up the ethical dilemma: Should Kate be allowed to die when a measure can be taken to save her life?

None of these ethical dilemmas is allowed to reach its full conclusion in the story. The novel ends with Anna suffering an injury that leads to brain death. As executor of her medical rights, Campbell authorizes the kidney transplant. Kate’s cancer goes into remission, and she has a normal life. But she knows that she is alive because Anna died. She believes that one sister had to die for the other to survive, another ethical conundrum.


One issue that shapes many of the characters and situations in the novel is that of control. Nearly every major character in My Sister’s Keeper is looking for control over some part of their existence in the face of disease. Anna, for example, seems to want to control her body and what is taken from it as evinced by her lawsuit. While it is later revealed that she actually filed the suit at Kate’s behest, Anna is still looking to control the situation to give her sister what she wants. Anna knows she cannot control her mother, her family, or her sister’s illness, but she seeks control of her own destiny.

Kate and Sara would like control of the opposite sides of the same coin. Kate wants to control her existence and the toll she puts on her family. She would like to become a ballerina if she grows up because she believes they have control over their bodies. Sara has spent her life since the diagnosis of Kate’s cancer trying to control the disease as well as Kate’s life. Sara has done everything in her power, including creating Anna, in an attempt to control Kate’s destiny. Sara has controlled all she could to keep Kate alive, without truly examining the consequences to herself and her family.

One of the costs of Sara’s focused assault on Kate’s disease is the loss of closeness with Jesse. Both Brian and Sara have given up on Jesse, who repeatedly acts out. He loves his sisters and has done what he can to keep Kate alive, most notably giving his blood regularly to boost her platelets. But he has also moved into an apartment over the family garage to be separate from, yet still part of, his family. He sets fires to get attention and to feel a sense of control over something. Jesse knows the fires, car theft, and substance abuse are all masks for his pain, but he needs a parent to care about him. Brian reclaims control over his son when he finds evidence that Jesse set fires.

Anna’s lawyer, Campbell, is also obsessed with control. He has suffered from epileptic seizures since the age of eighteen, but he keeps his condition a secret. Whenever someone asks why he has a service dog, he gives an obviously untrue answer. He allowed his condition to end his high school romance with Julia without telling her why. He controlled the situation because he believed she should be free of the burden of caring for someone with his condition.

Familial Bonds

The importance of familial, especially sibling, relationships is another underlying theme of My Sister’s Keeper. Despite all the problems created by Kate’s illness and Sara’s quest to keep Kate alive, the Fitzgeralds remain a family. Though Brian and Sara have their problems, they work together to keep the family together amidst the disruptive force of Kate’s illness. Even Jesse, the delinquent son, still lives at home and is there to help out when Kate is ill or Anna needs his support.

In turn, Anna helps her brother get out of jail when he is arrested for stealing the judge’s vehicle. Anna also does all she can to help her sister. While the pair squabble as sisters do when they share a room, Anna files the lawsuit to give Kate what she wants. All the siblings resent what has happened to them, but respond to the needs of the others in their family when the situation calls for it. After Anna’s unexpected death, the family grieves separately but eventually grows closer again.

Like Kate and Anna, Julia and her twin sister, Izzy, are close. Julia allows her to move in after a painful breakup. Izzy wants to protect her from Campbell. While Campbell’s relationship with his parents is not close at all, it serves as an illuminating contrast to the Fitzgeralds and the Romanos.


Point of View

Each chapter in the book is told from the first person point of view. All the main characters narrate a chapter. They even have their own fonts. Picoult could have made this Kate’s story since it is the central issue, but she allows the characters to share their own stories. Kate has one chapter, and it is the final one. The other characters have more than one chapter each. The reader can see the effects of Kate’s illness on the Fitzgerald family. Everyone in the family despairs about Kate’s illness and Anna’s lawsuit, but they have different perspectives. The reader sees Campbell and Julia’s thoughts on the lawsuit and also their feelings about each other. By viewing Anna’s thoughts, the reader can see she does not take her decision to sue her parents lightly and that she is smart and perceptive. Jesse seems like an unlikable person, but his thoughts and actions show his pain over Kate’s illness and his helplessness.

The reader sees Sara’s desperation to heal Kate at all costs and the epiphany she has during the hearing. The author shows Brian’s conflict over supporting his children when the family is in a divisive crisis. Campbell’s tough side as a lawyer and softer side with Julia are in his chapters. His growing friendship with Anna is shown. Because of the mystery of the guide dog, the reader wonders what Campbell’s medical problem is. Julia is able to see the Fitzgeralds objectively, so the reader gets an unbiased stranger’s view. After the intertwining of the character’s viewpoints, the chapter from Kate’s point of view is surprising and enlightening. Up until her chapter, she was always a character seen by everyone else.


The book is set in Providence, Rhode Island. The medical settings are Kate’s hospital room and Dr. Chance’s office, which are both located in Providence hospital. Although Kate goes through tough times in her hospital room, Anna goes there to visit her sister despite the lawsuit. It is in Dr. Chance’s office that Sara gets the idea of having another child. His suggestions of how Anna can donate to Kate start there. The hospital is where Sara finds out about the lawsuit. The Fitzgerald house, which includes Jesse’s apartment, is another setting. It is in the house where Kate’s leukemia signs begin, and she has other medical problems there. The house is where family arguments such as between Kate and Sara take place. Brian finds materials around the apartment that make him realize Jesse is the arsonist. The homeless man, Duracell Dan’s, place at the underpass is where the rest of Jesse’s materials are kept.

Campbell and Julia’s flashbacks are at the Wheeler School, which is a private high school in Rhode Island where they met. The class differences between Campbell and Julia and the other students’ reactions to their relationship occur at the school. Campbell’s apartment is part of the story because it is described as being modern and up-to-date but not warm like Campbell at first. Julia tells Campbell after they reconcile that she does not like his apartment. Julia’s apartment is where she and her sister discuss Campbell. Julia goes to a bar called Shakespeare’s Cat to try to escape Campbell.

The fire station is a setting where Brian works, and he and Anna live to get away from the lawsuit at home. The fire station is a rescue place in different ways. Not only does it house the firefighters, but it also gives Brian an escape from the house and medical drama. On the rooftop, he can practice his astronomy hobby. Anna escapes there to get away from the pressures of her mother and the lawsuit.

The courthouse is where the hearing is held. Campbell’s secret is revealed there, and the truth behind the lawsuit is also revealed there.

Some settings serve as places that save the characters. The hospital obviously saves Kate’s life. The fire station saves Brian and Anna. The courthouse saves the Fitzgerald family and Campbell and Julia’s relationship.

Language and Meaning

At the beginning of each section, the language of passages from famous works refer to the book’s situations and themes. Anna’s first memory story’s language sets the tone for the rest of the book.

The language in the main part of the book is simple, but medical terms are used often. They are well explained. Sara, Kate, and Anna have as much medical knowledge about Kate’s condition as anyone else. Sara uses medical language to try to save Kate. Kate uses it, along with the language of a frustrated teenager, who is concerned about appearance and dating. Anna also mixes it with her own concerns about her life outside Kate. Legal language is used in the petition and in the hearing. The medical language helps Kate, but the legal language helps Anna. Sara analyzes words as she ponders situations. For example, she talks about how there is no word for a parent whose child dies. (703) Anna tries to figure out language, too. Brian and Anna use the language of astronomy and legends in an attempt to figure the world out. Brian uses his firefighter language to demonstrate situations.

There is a combination of characters’ thoughts and dialogue. Because of his medical knowledge as a rescue worker, Brian’s thoughts let the reader know what is wrong with Campbell. Julia’s language with the Fitzgeralds is that of the mediator, which is part of her role as guardian ad litem even though she is not as conciliatory toward Campbell. The characters’ thoughts allow the readers to understand them; their dialogue does not sufficiently describe the characters. For example, Anna’s thoughts reveal her maturity beyond her 13 years. Jesse projects a tough-guy image to everyone with crude language, but his thoughts reveal his softer feelings about his family. Campbell is similar in that he acts like the tough lawyer, but his flashbacks to Julia and his present-day thoughts unveil his romantic side.

Getting ready for the last day of the trial, Campbell, Brian, Jesse, Anna, and Sara note that it is raining at the beginnings of their chapters. These words quench the fires that have been raging in the book.


The chapters are not numbered. They are titled by the character’s names. There is a prologue with a quote and then a short story by Anna. The sections are started by a day of the week and a passage. Sara’s chapters are flashbacks titled by years until her chapter called Present Day where she joins the present. She begins with Kate’s diagnosis and goes through the milestones of Kate’s illness. Campbell and Julia’s chapters are in the present, but they have flashbacks to their time together in high school. There is an epilogue by Kate set in a time in the future.

The plot zigzags back and forth between the present and the past; it depends on the speaker. The book chronicles the events of the Fitzgerald family out of order mainly after Kate’s diagnosis: Anna’s birth; Anna’s donations; Anna, Kate, and Jesse’s childhoods; and the hearing and its aftermath. Campbell and Julia’s professional and personal stories and sections of the past about their teen relationship are mixed in.

Multiple Points of View

One striking feature of My Sister’s Keeper is the way Picoult uses multiple first-person narrators to tell the story. A first-person point of view tells the story from one character’s perspective in his or her own voice. Each section in the novel is made up of parts designated by the name of the character whose voice and perspective is being revealed. Picoult emphasizes the differences in these voices through the use of different fonts for different characters.

The use of multiple voices allows readers the ability to understand the situations from different standpoints. The way Sara sees Kate’s cancer and Anna’s lawsuit is quite different from Anna’s viewpoint, Jesse’s position, and Campbell’s and Julia’s judgment. The result is a rounded, dramatic narrative.


Several characters use flashbacks and flash-forwards as part of their narratives. Flashbacks look back in time, while flash-forwards describe future events. The only major character in the book who does not get a voice in the main chapters is Kate. She speaks only in the prologue and epilogue, eight years after the novel’s end. In the prologue, she talks about how she imagined killing her sister and that she only existed i


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