Kate Fitzgerald is dying of acute promyelocytic leukemia. A kidney transplant is her only hope. Anna’s parents assume without question, that she will offer her kidney. Aware that she was conceived to be a genetic match, and ongoing donor for Kate, Anna wants a chance to live her own life. Though she loves her sister dearly, Anna retains Campbell Alexander, seeking medical emancipation, knowing that without the surgery Kate will die.
Thus begins the saga of seven lives intertwined in ways none could ever have imagined. Anna forces a legal confrontation that compels each character to examine the relationships in their lives. Sara Fitzgerald has focused obsessively on Kate’s medical needs, unwittingly ignoring the needs of other family members. Brian, a firefighter, finds respite from his family’s ills on the job, and in the stars, which become a metaphor for life.
Jesse, eighteen, is the family misfit. Unable to help Kate, he is wracked by guilt. A rebel, he becomes an unlikely healing force. As the court proceedings swirl around Anna, all involved are forced to reckon with the ghosts of their pasts and the paths they have chosen.
Picoult addresses the ethics of the situation only tangentially. The ending is superbly crafted, literally pulling the reader into the text. This is a cosmic tale about relationships and endurance, and the ability of love to change lives forever.