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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.)
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…
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