"When I was little, the great mystery to me wasn't how babies were made, but why." Unlike her friends and classmates, who were interested in the mechanics of baby making, "I paid attention to different details. Like why some mothers only had one child, while others seemed to multiply before your eyes … Now that I am thirteen, these distinctions are only more complicated [for me] … I was born for a very specific purpose … I was born because a scientist managed to hook up my mother's eggs and my father's sperm to create a specific combination of precious genetic material … In my first memory, I am three years old and I am trying to kill my sister. As we got older [and I was told why I was 'created'], I didn't seem to exist except in relation to her. It made me wonder, though, what would have happened if Kate had been healthy."

So begins the story of a family. The kind of family we used to call "nuclear" until that became a dirty word. Sara, a stay-at-home mom, and Brian Fitzgerald, a firefighter, seemingly had it all. They had two children: a son, Jessie, and a younger daughter, Kate. They were stable, educated parents, active with their children and in the community. But in the real world, does this kind of happiness and accomplishment really have a chance to survive? That old cliché about "a little rain must fall into each life" hits this family like a tsunami.

When Kate is two she develops what looks like "a line of small blue jewels" down her spine, and her mother knows immediately that she is not seeing normal bruises. They go to the doctor, he takes blood, and everybody waits for the results; of course, they're not good. The family doctor wants the tests repeated in the hospital, in the hematology/oncology department. There, after a series of painful and invasive procedures, they learn that Kate suffers from "APL … a subgroup of myeloid leukemia. The rate of survival … is twenty to thirty percent, if treatment starts immediately."

The treatments keep Kate alive for about five years until her body explodes with runaway cancer cells. She desperately needs a bone marrow transplant or she will die. Sara Fitzgerald vows that she will do anything, absolutely anything, to keep Kate alive. And her determination leads her to conceive the idea of having another child, one who will be genetically engineered as a perfect match for whatever Kate needs to survive.

Approximately nine months later, Anna is born. When she asks, her mother is perfectly truthful and tries to reassure her of her special place in their family. Even as a very little girl Anna doesn't buy that line. She says, "See unlike the rest of the free world, I didn't get here by accident. And if your parents have you for a specific reason, then that reason better exist. Because once it's gone, so are you." But Anna is a rebel, and while she unquestionably loves her sister with all of her heart, she begins to wonder if that means she has to go so far as to donate one of her kidneys to keep Kate alive. She has lived all of her thirteen years with questions like this that went unasked and unanswered. She resents never having been asked if she wanted to endure painful procedures and extended hospitalizations when she was healthy. Now, with the prospect of major surgery that will deprive her of a major organ, she decides that she must do something --- she hires a lawyer to help sue her parents so she can have medical control over her own body.

MY SISTER'S KEEPER by Jodi Picoult is the amazing, gut-wrenching, sad, funny, insightful, moving and thought-provoking story of this American family. This new novel is by far her best achievement and a leap forward in her literary oeuvre. Readers are asked to think about all of the technological wizardry in the world --- of the ways in which these technologies are used or, unfortunately, abused, and how the results of redirecting fate sometimes feels like the dizzying sensations experienced in threading one's way through the mirrors of a funhouse.

In a graceful portrait, masterfully written in high-pitched prose, Picoult raises the ethical, moral, constitutional, personal and mostly unanswerable questions about how anyone can make a life-or-death decision about a terminally ill loved one for whom extreme measures must be taken to play for more time. Where does the patient's right to stay alive infringe upon the life of someone else (in this case, a sister)?

One of Ms. Picoult's gifts is her sense of humor. Even in the face of the tragedy that befalls her characters in this highly emotional novel, she manages to imbue the book with lighter, delightful moments. No one can question the absolute love this family feels for one another; at the same time, however, they work at cross-purposes. Readers will smile, they will cry, they will be outraged and they will cheer … what they won't be able to do is put the book down. It is definitely a cover-to-cover read.