For the past three months I’ve been reading like a madwoman for the local library’s “Let It Snow” adult reading program. There are all these categories you have to read in order to qualify for the final drawing, and one of them is this year’s “One Book One County” selection: My Sister’s Keeper. As a result of this program, I’ve read a number of books I probably would never have picked up, but this is the only one that’s left me seriously annoyed.

Kate Fitzgerald has leukemia and not a very curable kind of leukemia. Her’s is one of the almost fatal kinds, that first revealed itself when she was two years old. Her parents tried all the available treatments to save her, but none of them worked. The only thing left was getting donor blood products, and the best kind would be from a family member. But no one in the Fitzgerald family was a perfect match. So her parents, Sara and Brian, deliberately created several embryos which were then tested for genetic compatibility. And that’s how they got Anna. She was born nine months later, and, barely a few hours old, she saved her sister’s life once – the cord blood from her umbilical cord did the trick. For a while. Then Kate went out of remission and Anna was called upon again. And again. And again.

Anna is now thirteen, and her sister needs a kidney. All of the treatments Kate has undergone have ravaged her body, and she’s got only one last thing to try. Everyone assumes Anna will pony up like she always has, so it’s an enormous shock when Anna takes matters into her own hands and hires an attorney to sue for medical emancipation from her parents. She doesn’t want to be forced to give up an organ. Her action has a ripple effect in her family when her mother, an attorney, goes to court to try and sway the judge to deny emancipation. And over the course of several hearings it becomes clear that Anna perceives herself as only important in the context of her sister Kate. And there are some good reasons for that. But, of course, these things are never black and white. Welcome to Angst Central.

I hesitate in determining what category of book this is. The Fitzgerald family’s story is told in first person, but in a number of voices. Anna, her brother Jesse, Sara, and Brian all get their say, as do Campbell, Anna’s lawyer, and her guardian ad litem, Julia. So the book’s primary voice isn’t really that of a woman. But the subject matter, the death of a family member, a child, is really the stuff of women’s fiction, not straight fiction. Also, Picoult uses a great deal of poetic metaphor to express her various characters’ feelings and thoughts, so it more or less feels like a woman is telling this tale, no matter the gender of the character talking – the kind of woman who can’t see a leaf fall from a tree without musing about the inevitability of death.

The overall tone of the book, consequently, is quite maudlin. There are books about death that celebrate life. Never Change by Elizabeth Berg comes to mind. This is not that kind of book. Basically the soundtrack playing at Chez Fitzgerald is dirge rendered in bagpipe. Apparently there were years, the years when Kate was in remission, in which there was some semblance of happiness in this family, but those times are never forefront in anyone’s mind. Instead Sara spends her segments of the book musing about death’s many attempts to storm the fortress: the time when Kate’s bruises first appeared, the time when she found Kate covered in blood from head to toe, the time Kate’s first boyfriend, also a leukemia patient, sickened and died after they went to the hospital prom.

And when death steps offstage for brief intermissions, then neglect, with its nasty psychological consequences, comes to the forefront. Anna isn’t the only child who doubts her importance to the family. Jesse has been shunted aside for years because of Kate’s various crises. He’s now a complete juvenile delinquent. He drinks, drugs, steals, and, as a fun side line, burns abandoned structures to the ground. His father, Brian, happens to be the captain of the local fire department with an arsonist as a son. Get it, everyone? Of course you do. Conflict. Angst. Suffering. Fire is a constant metaphor, and Picoult highlights this by including famous fire quotes before every section of the novel.

The underlying authorial assumption here seems to be that this is the kind of inevitable situation anyone with this type of horrible luck would find themselves in. That is, Sara and Brian, make the kinds of decisions any caring parent would make when faced with the possible death of their child. But not everyone would make those same decisions. The book’s main conflict – when to draw the line in terms of medical treatment – is engineered. Genetically engineered, to be precise. In conceiving Anna the way they did, Sara and Brian made the choice to toss ethics aside for the possibility of saving their other daughter. Ultimately they agreed to use Anna as medicine, for the most compelling reasons, certainly, but she wasn’t primarily of importance as an individual. And they continued to use her that way each time Kate needed more donor product.

Interestingly enough, the book I read immediately before this one, Jurassic Park by Michael Crichton, also focused on the subject of genetic engineering. Crichton’s underlying message in that book was that science, in creating solutions, also creates more problems. Scientists have been quick to come up with new treatments, new medicines, and new technology, but ethicists have not kept pace. No one asks themselves if they should do something, merely if they can, and this has terrible consequences. Had Kate died at age three like she would have without the new medical technology, it would have been a tragedy. But her living in constant pain was a tragedy too. Her brother’s nosedive into crime was tragic too, as was her sister’s confusion about her self worth.

Ultimately, the main conflict in My Sister’s Keeper goes unanswered. No one ever really says, “No, we can’t do this. We’ve gone too far. It’s time to stop. What happens, happens.” A surprise twist late in the book gives a sort of resolution to Kate’s problem, but, like the rest of the book, it’s manipulative on the part of the author. As a result I finished the book feeling both manipulated and irritated. For this I spent a weekend reading? Well, at least I have a shot at winning the “Let It Snow” final prize. That’s something, I guess.