In my first memory, I am three years old and I am trying to kill my sister. (Prologue.1)
Okay, from the very first line of the novel, you know that there is going to be death hanging over everything, like a mobile over a crib… a mobile consisting solely of rotating grim reapers.
"What happens if you don't give your sister a kidney?"
"She'll die." (1.2.20-1.2.21)
Yep, things are serious—we're talking real life-or-death consequences here. Picoult doesn't pull any punches.
Kate is going to die. It took me a long time to be able to say that. We all are going to die, when you get down to it, but it's not supposed to be like this. Kate ought to be the one who has to say good-bye to me. (1.4.87)
Death is hard for anyone to accept, but the hardest might be a parent trying to accept the inevitable death of a child.
Gamma rays, leukemia, parenthood. It is the things you cannot see coming that are strong enough to kill you. (3.4.27)
Add car accidents to this list, because this is what claims Anna in the end. Sara is talking about the unpredictability of illness and death… and that's pretty much how the book ends, too.
"You know, normal people don't sit around thinking about dying."
"Liar. Everyone thinks about dying."(3.7.61-3.7.62)
How many books have you read that have to deal with death? You wouldn't be able to read them all in your lifetime. Yes, we're talking about death right now. Death death death. Yeah, everyone thinks about it, some people just try to deny it.
"Is this… a eulogy?"
By now, Brian is crying, too. "If I don't do it now, I won't be able to when it's really time." (6.4.52-6.4.53)
Brian is preparing for his daughter's death like some dads would prepare for college or a new car. Unfortunately, death will likely come for Kate before either of those other milestones.
"That's why [Kate's] hanging on, you know. She wants your permission to leave." (6.4.113)
Of course Kate's parents don't want her to die, but it's almost like Kate is afraid that she'll get in trouble if she dies, despite her parents' best efforts.
"It's not suicide," [Kate] said, "if you're already dying." (9.5.34)
Well, the M*A*S*H theme taught us that suicide is painless, but dying by kidney failure… not so much. So we're not sure if Kate's analogy holds up—at least not to the logic of 1970s television show theme songs.
Kate's death would be the worst thing that's ever happened to me… and also the best. (9.8.62)
Kate's death would close some doors for her (the final door), but it would open some windows for Anna. A death is really just the end for one person: the person dying. For others, it can be a new beginning.
"It was a good one, Mom, wasn't it?" I bite my lip, feel the heaviness of tears. "It was the best," I answer." (9.8.31)
Here's the big tear-jerker moment of the book (well, one out of about a dozen): Sara finally accepts that Kate is going to die. Kate, being the dying one, has accepted it for a while. It just takes a little longer for mom to get with the program, understandably.