Friday, March 13, 2009

ArtsPaper Books: Picoult's 'Handle With Care' is gripping, heartbreaking

Writer Jodi Picoult.

By Aviva L. Brandt

It’s every mother-to-be’s worst nightmare: To find out that the baby she is carrying has a health condition that will cause it to either die at birth or face a life of excruciating pain and disability.

In Handle With Care, her 16th novel, Jodi Picoult (pronounced PEE’-koh) takes her readers inside that nightmare, telling a heartbreaking story of parenting a child with osteogenesis imperfecta, better known as brittle bone disease, a collagen defect that leaves bones so brittle they can break with just a sneeze.

Willow, the child at the heart of the story, suffers seven fractures in utero, plus four more during delivery. By kindergarten, Willow has broken 68 bones, including some from activities as innocuous as coughing or rolling over in bed while sleeping.

Her parents, Sean and Charlotte O’Keefe, are slowly going bankrupt from the expenses involved with having a child with a severe disability. Sure, they have health insurance, but there are so many medical expenses that insurance doesn’t cover – sheepskin to pad Willow’s many casts, extra therapies, travel to see the few experts in the country who are familiar with the rare disease.

Charlotte has to give up her career as a pastry chef after Willow’s birth because of the high level of care required for a child with OI, and Sean’s job as a police officer in a small New Hampshire town just doesn’t stretch to cover all their expenses.

Dr. Piper Reece is Charlotte’s best friend and her obstetrician, but when Charlotte finds out that it may have been possible to diagnose the OI early in her pregnancy, she sues Piper for not recognizing that a “too clear” 18-week ultrasound photo of Willow’s brain was a sign of a serious problem. Charlotte loves Willow as much as any mother loves her child, but the book asks whether, if she had truly understood what OI would mean to her family’s lives (including Willow’s), would she have chosen an abortion instead?

As Charlotte explains: “I wasn’t naïve – I already had a daughter. I knew I’d take care of Willow when she was hurt. I knew I’d have to get up in the middle of the night when she had nightmares. But I didn’t know she was going to be hurt for weeks at a time, for years at a time. I didn’t know I’d be up with her every night. I didn’t know she would never get better.”

Picoult’s novels always revolve more around the relationships involved than the controversial issues upon which she bases her stories. Handle With Care focuses on the spousal relationship between the O’Keefes, which is torn apart when Sean refuses to be part of the lawsuit, and the friendship between Piper and Charlotte, which is irretrievably broken despite Charlotte’s initial belief that Piper would understand she was just trying to do her best for her child.

Picoult also examines the sibling relationship between Willow and her sister Amelia, who is seven years older than Willow and healthy, at least until she develops an eating disorder and starts self-mutilating as she watches her family disintegrate. Then there is the relationship between Charlotte and her lawyer Marin, an adoptee who is repulsed by the idea of a mother wishing her child had never been born and becomes increasingly obsessed with finding her birth mother.

The book is told from multiple points of view, which is jarring until the reader gets used to it. In an interesting yet somewhat perplexing twist, the story is told by each character (Sean, Charlotte, Amelia, Piper and Marin) as if they were speaking or writing to Willow: “Suffice it to say,” a chapter from Charlotte’s point of view says, “that the trip home wasn’t a pleasant one. You had been put into a spica cast – surely one of the biggest torture devices ever created by doctors. It was a half shell of plaster that covered you from knee to ribs.”

But once accustomed to the not-always-linear storytelling method, Picoult’s writing grabs the reader with easy-to-understand explanations of complicated medical conditions and legal situations that even the non-expert can absorb.

Picoult, mother to three children, always makes the children in her books believably real, whether she’s writing about suicidal teenagers in The Pact or a severely physically disabled child in Handle With Care. The adults in her novels aren’t always as three-dimensional as the children, which is probably why it’s the kids in her books that always make me cry.

Picoult’s books are perennial best-sellers, and several have been made into made-for-television movies. A big screen version of My Sister’s Keeper, starring Cameron Diaz, Abigail Breslin and Alec Baldwin, is scheduled to hit movie theaters June 26.

This isn’t Picoult’s best novel – I’d be torn to say whether My Sister’s Keeper or Plain Truth was her best to date – but it’s a well-researched, compelling story that I couldn’t put down once I was a third of the way into it, staying up past 2 a.m. because I needed to find out what happened next. And it’s a book well worth a second, slower read to absorb all the details missed on the initial pass as I raced to find out the end of the story.

The ending is sudden and startling, as well as upsetting, and it’s only at the end of the novel that the reader recognizes the foreshadowing throughout.

HANDLE WITH CARE, by Jodi Picoult, Atria, 496 pp., $27.95.

Aviva L. Brandt is a freelance writer based in Portland, Ore., and mom to a 4-year-old girl, who thankfully is exceedingly healthy. She previously was a writer and editor for The Associated Press and now blogs about chronic illness and parenthood at

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