Content Warning: This section of the guide addresses difficult topics such as medical emancipation, painful medical procedures, suicidal ideation, a suicide attempt, and child death.

Kate Fitzgerald (unnamed in the Prologue) looks at her sister, Anna, as she sleeps and remembers a time when she attempted to suffocate Anna with a pillow. As they grew older, Kate felt invisible except when Anna needed her. She reflects that “in the end, though, I did not kill my sister. She did it all on her own” (4).

Anna reflects on all the ways children come into the world. She knows that her parents had her specifically because a scientist told them that she, as an embryo, was an allogeneic donor—an exact genetic match—to her older sister, Kate. Kate was diagnosed with acute promyelocytic leukemia (APL) when she was two. Anna has been donating blood cells and bone marrow to Kate since her birth 13 years ago.

Anna goes to a pawn shop to sell her locket, one her father gave her after she donated bone marrow to her sister when she was 5, and receives 20 dollars, much less than it’s worth. At home, Anna finds her mother, Sara, trying on evening dresses, a hobby she indulges when she can.