Usually, their faces appear sheepishly in front of my paper-laden desk, like puppies that know they shouldn’t have chewed the slippers but had to since they were absolutely starving (for food? for attention?). "I’m back, Miss," they invariably say. I usually don’t even have to look up to know which face I will see this time; the name of the current returning student is usually jotted down on a sticky pad next to my computer, awaiting a phone call home or an email to the guidance counselor. And then it comes: the laundry list of responsibilities that have circumvented their every dedicated effort to make it to school for the past two weeks. Work, babysitting, a sick parent: the students I teach often drift into part-time status, not an official category, but one that I deem fitting for kids with chronic attendance problems.

Surprisingly often it is the parents who demand these days away from school; I must be careful when challenging their expectations. "You know," I suggest, "these last two years of high school are the most important. These are where you learn what you need to know to succeed in college. I know your mom wants you to baby-sit your sister’s children while she’s at work, but you need to be here. You’ll be able to help them more later if you have a college degree." Or a high school diploma, I think privately.

I know those parents aren’t selfish. I know they love their grandchildren and are really and truly stuck in a bad situation, but, much like the premise of Jodi Picoult’s novel My Sister’s Keeper, I question the choice they determined to be the best solution to the problem. It must be terrible to have to choose between the best interests of your own children.

Picoult’s novel was a New York Times bestseller not only for her writing style, which pulls readers breathlessly from one well-crafted sentence to the next, but for her provocative theme. When Sara first detects something wrong, her daughter Kate is only two years old, but there they are, "trailing her spine, like a line of small blue jewels, are a string of bruises." For months, she and her husband Brian focus all of there attention on Kate. Picoult beautifully details their anguish: after a bone marrow extraction for her newly diagnosed leukemia, "the tissue paper beneath her cheek is damp. I learn from my own daughter that you don’t have to be awake to cry."

After a long struggle, Brian, Sara, and the aptly-named Dr. Chance realize that without a bone marrow donor, Kate will not live much longer. They and their son, Jesse, are not matches. Dr. Chance is the one who first plants the seed: another sibling could be the perfect match. With a little genetic help, Anna is conceived. The plan is simple at first. Who would object to using the leftover stem cells from Anna’s umbilical cord to save her sister?

Unfortunately, as the reader knows from the first pages of the novel, that first step was a slippery, agonizing slope. As the perfect donor, Anna is called upon again and again to donate blood, marrow, and other life-saving substances. But at thirteen, she seems determined to draw the line at a kidney transplant.

"Lately, I have been having nightmares, where I’m cut into so many pieces that there isn’t enough of me to be put back together." Anna constantly wonders what her life would be like with an identity separate from Kate. To be fair, so does her trouble-making brother. At this point in their lives they’ve been "setting a place for Death at the dinner table" for over a decade. What readers will appreciate most about the novel is that just when one character has completely made them sympathize with her, another one steps in and gives a completely different, equally heart-wrenching account. There are no simple answers, but soon a judge will have to find one.

Anna engages the reluctant services of Campbell Alexander, an aloof lawyer with a few mysteries of his own. Before long, the two have divided the family as a judge weighs the facts (what few facts there are in such a matter) in Anna’s suit for medical emancipation. To complicate matters, the child liaison assigned to the case is an ex-girlfriend of Campbell’s, and their estranged relationship is under the scrutiny of Julia’s lesbian twin sister. Fortunately for the reader, Picoult is talented enough to include Campbell and Julia’s thoughts as individual chapters as well, weaving a path between past and present experiences.

Picoult had her hands full enough with such a weighty topic, but she doesn’t stop there. The book grows more intense as secrets are unveiled by each character. With every revelation, readers will grow more conflicted about the right choices for Anna, Kate, and the family as a whole until the novel reaches its shocking conclusion. Far from a political commentary on stem-cell research, My Sister’s Keeper carefully considers the moral implications of a situation with no one right choice, only choices that hurt different people.

So this one child, standing beside my desk now, is an early Anna, I think. Asked to sacrifice a dream in order to care for someone she loves. I want her to be selfish, to demand the time and quiet for reading, study, and homework, while her parents are just surviving. So many responsibilities for a teenager to consider.