It is clear that people of all ages lack an understanding of a life-changing devastation called Acute Promyelocytic Leukemia. Society should take a more active role in learning the basic knowledge of the bone marrow. In Jodi Picoult’s My Sister’s Keeper Kate Fitzgerald is a sixteen-year-old teenager, needlessly suffering from Acute Promyelocytic Leukemia and had faced extreme challenges over the years. Before Kate’s death, she experienced ongoing treatments, chemotherapy, stem cell transplant, countless surgeries and radiation therapy. Suffering from Acute Promyelocytic Leukemia can be troublesome; along with its extensive impacts on lifestyle, relationships and the physical body of the patient. Nevertheless, there are many ways to prevent and overcome it. One of the greatest impacts that patients with Acute Promyelocytic Leukemia face are immense lifestyle changes. In addition to being sick and dealing with the illness itself, it is difficult to find a motivation to change constant habits and behaviours. In My Sister’s Keeper, Kate Fitzgerald is fearful and anxious due to her cancer. As a result, her sleep schedule is disorganized and she lacks sleep. “I stare at the ceiling wondering what I should do next.” (Picoult 48) Cancer treatment can be exhausting and physically depleting. An adequate amount of sleep as patients undergo treatment is detrimental. (American Cancer Society) In comparison, Acute Promyelocytic Leukemia is affecting Kate’s ability to sleep at night causing her to feel emotional about unnecessary thoughts. Kate has to monitor and take the precaution of her health carefully and closely. She has to take medication routinely to kill cancer cells. Dr. Chance told her that it’s possible “She’ll bleed out after consciousness” (63) It is mandatory for Kate to visit the doctors’ routinely to make sure her cancer hasn’t progressed. Chemotherapy kills fast dividing cells including normal body cells as well as cancer cells. The normal bone marrow is sensitive to chemotherapy and the blood counts may drop, making the patient vulnerable to infection and bleeding. (Blood Cancer Research Fund) Since Acute Promyelocytic Leukemia patients bleed easily, Kate is more prone to lose a sufficient amount of blood possibly leading to death. Kate is different from an ordinary teenager and she mentions her isolation from reality as she says “I’ve always wondered what it would be like to be normal.” (133) Her leukemia burdens her from attending school, work and often public places. She either stays home or is at the doctors most of her time. When a child or teen is diagnosed with cancer, families and parents will face and need to cope with many problems, including the impact of a child’s cancer diagnosis and treatment on regular school routines. A child’s cancer diagnosis and treatment can interrupt regular school routines. (American Cancer Society) Similarly, Acute Promyelocytic Leukemia interferes with Kate’s daily life. Patients who suffer from Acute Promyelocytic Leukemia deal with a vast amount of lifestyle changes. Not only does Acute Promyelocytic Leukemia affect the patient itself; but it also has a significant influence on family connections and desperation. Sara and Brian are willing to harvest a kidney from their own daughter Anna to help Kate live. Disregarding the fact that Anna is only thirteen years young, and she may face health complications from the transplant. The Fitzgerald family expects Anna to donate her kidney leaving her with no other option. Anna feels more objectified, like a mass of organs instead of a daughter, or even a person. “My parents don’t really pay attention to me, except when they need my blood or something.” (64). Brian and Sara are inconsiderate that Anna would grow up with a missing kidney. Families are afraid of facing the death of a loved one, knowing that death is coming soon takes an emotional toll on the person with cancer and their loved ones. (American Cancer Society) The emotional and desperate character trait of Sara and Brian is demonstrated through Anna. Having the thought that Kate could die any minute brings the idea of harvesting a kidney from Anna so both of their daughters could be in their lives. It is clear that Kate and Anna’s parents are unable to face death. When an individual is affected by an illness and death, their family, are naturally affected too. In My Sister’s Keeper, Kate’s leukemia affects every member of her family. When Kate was first born, the Fitzgerald family found out she had leukemia. Unethically, Brian and Sara, the mother and father of the Fitzgerald family decided to genetically engineer Anna. “Most babies are accidents, not me. I was engineered, born to save my sister’s life.” (3) By the age of thirteen, Anna has undergone many blood transfusions, numerous surgeries and multiple bone marrow transplants. As she grew older and became more knowledgeable; she gained consciousness of all the pain and suffering she was experiencing and didn’t want to go through with Kate’s plan and treatment anymore. “It made me wonder, though, what would have happened if Kate had been healthy. Certainly, I would not be part of this family.” (8) Anna’s whole existence happened because Kate was ill. Since she disagreed with what her family wanted, she went to a lawyer to sue her parents for medical emancipation and for rights for her own body. Better Health Channel comments on a similar occurrence, it is proven that conflicts occur when family members have different views or beliefs that clash. Issues of conflict that are not resolved peacefully can lead to arguments and resentment. It is normal to disagree with each other from time to time and occasional conflicts are part of family life. However, ongoing conflicts can be stressful and damaging to relationships. Some people find it difficult to manage their feelings and become intentionally hurtful, aggressive or even violent. (Better Health Channel) Ongoing conflicts such as Anna suing her parents damage her relationship with them. Because of their continuous arguments, their family are distancing away from each other. Sara and Brian fumble through and make decisions that allow them to sleep at night because morals are more important than ethics, and love is more important than law. By focusing on Kate, and only on Kate, not only do Anna and Jesse feel invisible, but it starts to put a strain their parents, Sara and Brian’s marriage. Sara and Brian barely talk about anything other than Kate’s illness.”When the waiter arrives to take our order, we both eagerly, grateful for someone who keeps us from having to recognize the strangers we have become” (235). Dinners are awkward affairs to the point where there is no communication or discussion. Anna doesn’t feel like she belongs to this family anymore as she says “I used to pretend that I was just passing through this family on my way to my real one.” (49) The Fitzgerald family is falling apart and it isn’t the same as it was before Kate was diagnosed with leukemia. Canadian Cancer Society comments on a similar occurrence. Having cancer can make being a parent even more demanding and challenging. The symptoms and side effects of cancer and its treatment can make it hard to care for other family members, while the parents of teens may find things challenging because they have to ask their teens to take on more responsibility at home at a time when teens are trying to break away from and establish more independence from the family. (Canadian Cancer Society) The family members are each in a stage of the Kubler-Ross’ Five stages of dying. Anna is experiencing acceptance, Jesse’s dealing with anger, Sara is in denial, and Brian is coping with depression. Kate’s leukemia has taken a major priority for everyone. Therefore, it is hard for Sara and Brian to take care of all three children equally. Acute Promyelocytic Leukemia has a substantial role in family connections and relationships. Another way that Acute Promyelocytic Leukemia impacts the patient is how it shapes the physical body and well being. In My Sister’s Keeper, Kate experiences weakness and fatigue all the time. “I’m too tired to hold my own body upright” (130) Acute Promyelocytic Leukemia has taken over Kate’s body to the point where she’d rather die than to live in pain every day. According to The Leukemia & Lymphoma Society Of Canada, many patients find cancer-related fatigue to be more distressing and disabling than other cancer-related symptoms such as pain, depression and nausea. The fatigue often begins before cancer is diagnosed, worsens during the course of treatment and may persist for months or even years after treatment ends. (The Leukemia & Lymphoma Society Of Canada) Kate’s lack of energy and adrenaline mirrors cancer- related fatigue symptom. Fatigue can have a major impact on quality of life, with physical consequences. After Kate’s Chemotherapy treatments, she barely ate any food and had no energy in her. Her family had to ‘force’ her into eating so she maintains a diet that includes essential vitamins, minerals and foods. (145) According to Cancer Council Victoria, Acute Promyelocytic Leukemia causes an unstable appetite depending on how you feel or the physical effects of the cancer treatments. Some people lose their appetite, while others eat more. (Cancer Council Victoria) Kate’s appetite change clearly reflects how cancer patients lose their appetite post-treatment. Since Acute Promyelocytic Leukemia causes negative changes in appetite, it also interferes with the patient’s weight. As time passes, Kate’s leukemia advances. Her treatments and drug use resulted in losing all of her hair. “I can’t go out with a bald head, people are gonna stare at me.” (302) Kate expresses her fear that people will stare at her head which indicated her underlying self- consciousness. Which is also shown through her concern of how she is perceived by the public. Cancer treatments, such as surgery, chemotherapy and radiotherapy, can cause changes in your body. Whether these changes are temporary or permanent, they can change your self-esteem and make you feel self-conscious. You may feel less confident about who you are and what you can do. This is a common reaction whether or not your body has changed physically. (Cancer Council Victoria) Kate’s hair loss represented how anticancer drugs can cause hair loss by interfering with the normal growth of hair follicle cells. In addition, it illustrates how cancer transforms the physical appearance of a patient. As a result, Acute Promyelocytic Leukemia has a significant connection to the patient’s physical body and well- being. Suffering from Acute Promyelocytic Leukemia can be burdensome; along with its extensive impacts on lifestyle, family connections and relationships and the physical body of the patient. Leukemia has transformed Kate’s life and body significantly as well as how each family member deals with one another. Chronic illnesses are diagnosed to someone every-day, but they are not the only ones who suffer. The book My Sister’s Keeper acutely portrays the effects of modern biomedical technologies on patients and their loved ones. As a society, we should take further awareness of Acute Promyelocytic Leukemia.