Study Guide

My Sister's Keeper Themes

  • Family

    You've probably heard the term "nuclear family" before. If not, it has nothing to do with radiation, causing your mom to have two heads and your dad to have three eyes. A nuclear family is just the parents and children. Forget grandparents, aunts, uncles, and third cousins twice removed.

    My Sister's Keeper is definitely a book about the nuclear family. We see Aunt Suzanne a few times, but she's not really that important—it's all about the parents and kids here… and one of the kids was genetically engineered. Which is definitely something of the atomic age.

    Questions About Family

    1. What do Anna and Campbell have in common when it comes to their relationships with their own parents?
    2. Is Sara a good mother? Is Brian a good father? Why or why not?
    3. What is Julia's family life like? How is it different from that of the other characters in the novel?
    4. Is Anna obligated to help her sister, no matter what, just because of the family ties between them?

    Chew on This

    You can pick your friends, but you can't pick your family. You've probably heard that before. But Sara does pick her family… at least when it comes to Anna. You'd think that would make Anna feel more wanted, not less.

    Every character in the book has some sort of family problems: The Fitzgeralds' problems are endless, Campbell's dad is a piece of work, Julie fights with her sister, and even Judge DeSalvo has lost a daughter.

  • Suffering


    The word doesn't exactly conjure up images of smiley face balloons, fireworks, and pink hearts. It makes you think of pain and suffering, and some of that pain and suffering is from what it takes to treat cancer, not the cancer itself. Chemotherapy isn't exactly pleasant.

    My Sister's Keeper shows what it's like not just to be a cancer patient, but to be a cancer patient's mother, or father, or brother, or genetically engineered organ donor. Something we might all be able to relate to. (Well, except for the genetically engineered part.) And no matter what role you play, suffering abounds.

    Questions About Suffering

    1. What is the most painful part of the donation process for Anna? The actual pain, or the fact that she doesn't have a choice?
    2. Why does Campbell hide his illness?
    3. Does Sara's overprotective nature lessen Kate's suffering or augment it? (Think about the time she doesn't tell Kate that Taylor's died, for example.)

    Chew on This

    The pain Anna suffers at the hands of her doctors is worse than the pain Kate suffers, because Anna doesn't get any physical benefit from all the injections.

    Relationships cause suffering in this book, too. The fact that Campbell hides his illness causes Julia all sorts of relationship pain that wouldn't happen if he had just been honest years ago.

  • Choices

    If your sister wanted to borrow five dollars, what would you do? What if she wanted to borrow your car? Neither of those are life and death decisions, but they still might be difficult choices (especially if your sister is only sixteen with a learner's permit). Now what if your sister needed an organ? And not the giant one at the church, but a kidney? In a way, that choice might be easier to make than letting your terrible driver of a sister borrow your car. "Of course I'd give her my kidney!" you say—anything to save a loved one's life.

    My Sister's Keeper complicates things because Anna doesn't want to give her kidney to her sister. She's tired of being forced to give her blood and plasma. But for Anna, it's less about wanting to kill her sister, and more about just being given the choice.

    Questions About Choices

    1. Should Anna have the right to choose whether or not to donate her kidney to Kate?
    2. Is Sara making the right choice by wanting Anna to donate her kidney?
    3. Why doesn't anyone ever ask Kate what she wants until the very end?
    4. Why did Campbell decide to leave Julia in college? What do you think of this choice?

    Chew on This

    Anna's whole lawsuit is purportedly about fighting for her right to choose what she does with her body, but the truth is that the lawsuit isn't even her choice—it's Kate's.

    Anna still doesn't get any control over her own body (even if she had lived) because Campbell gets power of attorney over her medical decisions until she's eighteen.

  • Isolation

    It's hard being by yourself. We have no idea how hermit gurus on the tops of mountains do it—not only would it be lonely and cold, but cell service is probably terrible. But at least it's a choice they make… unless they're driven from their villages thanks to seriously bad B.O.

    Some people, however, are isolated against their will. And in My Sister's Keeper, this is definitely the case for the Fitzgerald kids, especially Anna and Jesse. Their parents, particularly their mom, just don't pay any attention to them. Being a teenager is hard enough, but thinking you're invisible can be unbearable. (Unless you're Clay Aiken.)

    Questions About Isolation

    1. Why do Anna and Jesse feel so isolated from their family? Do their parents ever do anything to make them feel included?
    2. Do you think Kate ever feels isolated or lonely? Why or why not?
    3. Why do Brian and Sara decide to separate? What brings them back together?
    4. Is Julia lonely? Why hasn't she had another relationship since Campbell?

    Chew on This

    Julia has an easier time with isolation because she's used to being alone. It doesn't mean she likes it, she just copes with it better.

    Kate has resigned herself to being alone because she spends almost all her time in the hospital hooked up to machines. It's not like anyone really sees beyond her illness anyway…

  • Mortality

    Cancer isn't always a death sentence, but sometimes cancer does, in fact, equal death. That's the grim equation the Fitzgerald family faces in My Sister's Keeper. Their daughter Kate is diagnosed with acute promyelocytic leukemia which sounds serious. And Kate's case is. She has to come to terms with facing her own death, and her parents have to face the death of their child. As this book shows us, death is sometimes more difficult for those who live.

    Questions About Mortality

    1. Why is it easier for Kate to accept her own death than for Sara to accept Kate's?
    2. Do you think Anna would have agreed with the decision made for her after her death?
    3. How would Anna have felt if she withheld her kidney and Kate did die? Use the text to support your answer.
    4. As a firefighter and paramedic, is it easier for Brian to accept death than for Sara? Why or why not?

    Chew on This

    Anna's death is the only way to end the novel because it's the only thing that gets the family to snap out of their selfish ways.

    Anna's death is random, but it's no more random than cancer, or the car accident that gives Campbell epilepsy. Much as death is certain, when it appears almost always feels random.

  • Identity

    Any book with a teenage protagonist is probably going to deal with identity issues. How do you fit in a white school if you're Native American? How do you grow from the Boy Who Lived into an international superstar wizard? And how do you define yourself when your entire existence is devoted to your sick sister?

    Anna in My Sister's Keeper is the last example. (If she's a wizard, she didn't tell us.) She was literally born because her sister, Kate, has cancer. Anna was genetically engineered to donate blood to Kate, but when Kate isn't cured, she has to keep donating plasma, and is eventually expected to donate a kidney. What is she, a walking organ bank? If Anna is her sister's keeper… who will Anna be when her sister is gone?

    Questions About Identity

    1. How would Anna have grown up if she lived? Use the text to support your answer.
    2. Will Kate have a hard time growing up, considering that she, too, has been defined by her illness her whole life? Get textual, yo.
    3. Does Anna's family put too much pressure on her to be the family savior? Why or why not?
    4. How much of Campbell's personality is really him, and how much of it is an act?

    Chew on This

    Campbell puts up his guard to hide his true self (vulnerable, epileptic) from everyone else as much as he does to hide it from himself.

    Kate gets to lead the life that Anna would have wanted her to lead. If Kate had died, Anna probably would have been guilt-ridden for the rest of her life.

  • Rules and Order

    Although there are no rules or order to cancer and car accidents (two defining moments in My Sister's Keeper), there are the rules of the law to abide by. A large part of this book takes place in the courtroom, and it seems like almost every character is either in the legal profession (Sara, Campbell, and Julia), law enforcement (Brian, who is a fire fighter, which is close enough), filing a lawsuit (Anna), or simply breaking the law (Jesse). Yep, all six narrators are involved in this system somehow. If Kate weren't bedridden by cancer, she'd probably be applying to law school or something.

    Questions About Rules and Order

    1. Does Judge DeSalvo make the right decision in awarding medical emancipation to Anna?
    2. How do you think a similar court case would play out in real life?
    3. Why does Sara decide to represent herself instead of hiring an attorney?

    Chew on This

    Sara simply adds to the family drama by representing herself. The case would have been much easier (no restraining order, for example) if she had hired an attorney.

    Jesse turns from law breaker to law enforcement in the end. He always did need some direction in life, and once Anna dies, he decides to focus on saving others instead of destroying himself.

  • Love

    If you look down the list of themes, you're probably overcome with dread about now. They're all pretty painful and depressing: Suffering. Mortality. Isolation. Family. (Well, depending on what kind of family you have.) It's a relief to get to love, isn't it? Picoult isn't a total masochist, and in My Sister's Keeper, she throws us a bone in the form of a love story between Campbell and Julia, along with a lot rumination about the nature of familial love as well. We're glad the heart of this story isn't just another organ that needs to be transplanted.

    Questions About Love

    1. Does Campbell really love Julia? Does Julia really love Campbell? Why? How can you tell?
    2. Why do Brian and Sara fall out of love? What brings them back together? Are they the same again?
    3. Does Sara love Anna as a daughter, or as an organ donor? Use the text to support your claim.
    4. Does Brian love Anna differently than Sara does? Get specific, yo.
    5. Do you agree with Julia that "You don't love someone because they're perfect. […]You love them in spite of the fact that they're not" (9.7.18)?

    Chew on This

    Julia never fell out of love with Campbell, she just needed him to be himself, and remind her why she fell in love in the first place.

    Sara only loves Brian when he agrees with her. Heck, Sara only seems to love most of her family members when they agree with her.