This reading group guide includes an introduction, discussion
questions, ideas for enhancing your book club, and a Q&A with
author Jodi Picoult. The suggested questions are intended to help
your reading group find new and interesting angles and topics for
your discussion. We hope that these ideas will enrich your
conversation and increase your enjoyment of the book.
Introduction
Another heart-wrenching, controversial novel by Jodi Picoult,
Handle with Care introduces Willow, a smart and charming
five-year-old who was born with a brittle bone disease called
osteogenesis imperfecta. Over her lifetime, Willow will have
hundreds of broken bones. Her mother, Charlotte, will do anything
to give Willow the best life possible -- even if she has to say
under oath that Willow never should have been born. In pursuing a
wrongful birth suit against her obstetrician (and best friend for
nearly a decade), Charlotte is willing to put everything on the
line in hopes of gaining the financial means necessary to take care
of her daughter. Picoult constructs an emotionally complex novel,
weaving tender and poignant moments into a difficult story of
suffering and sacrifice. Charged with thought-provoking questions
about medical ethics, morality, parenting, and honesty, Handle with
Care asks just how far we would go to care for the ones we
love.
Questions for Discussion
1. Charlotte and Sean are faced with a very difficult decision
when presented with the option of suing for wrongful birth. How did
you feel about the lawsuit? The matter is complicated in many
aspects, but especially because of Charlotte''s close friendship
with Piper, her ob-gyn. How might the O''Keefes have considered and
entered into the lawsuit if they had not had a personal
relationship with Piper? Would your own reaction to it have
changed?
2. During the filming of a day in Willow''s life, Charlotte
purposely asks Willow''s physical therapist to try some exercises
that she knows Willow isn''t ready for yet, and Willow begins to
cry in pain. Charlotte rushes to her daughter''s side, blaming the
physical therapist, and when she asks if they got that on film,
Marin -- Charlotte''s lawyer -- is angry at Charlotte for
exploiting her daughter. Do you agree with Marin that Charlotte
exploits Willow? Charlotte believes she is doing everything out of
love for Willow, to win the case that will get her the care she
needs, but does this take it too far? Where can we draw the
line?
3. Breaking is a theme in Handle with Care: bones break, hearts
break, friendships break, families break. Consider examples from
the book and discuss why you think certain breaks can or cannot be
mended. Is there anything in the book that represents the
unbreakable?
4. The author inserts recipes throughout the book that highlight
certain baking techniques, such as tempering, blind baking, and
weeping. How do these recipes provide further insight into the
story and into Charlotte''s character in particular?
5. Throughout the story, the question is raised of what it means
to be a mother. For Charlotte, it means doing anything in her power
to provide the best life for Willow, but at the same time, her
other daughter''s suffering goes unnoticed as she develops bulimia
and begins cutting herself. For Marin, the question of what it
means to be a mother addresses the issues of her adoption. Is a
mother someone who gives birth to you and gives you away, or the
woman who raises you? Discuss the different ideas about mothering
that the author presents in this book. At what moments do certain
characters fail or succeed at being a mother?
6. The term wrongful birth suggests that some people never
should have been born. If abortion had been legal when Marin was
conceived, she likely would not have been born. Willow''s severe
disability, had Charlotte known about it early enough, could have
been cause for abortion. How do we determine what kind of life is
worth living? Who has the right to say whether a pregnancy should
be brought to term?
7. Discuss the roles that honesty and deception play in this
novel. How do the characters lie to themselves? To each other? Is
it sometimes better not to know the truth?
8. Charlotte is confident that the potential end of her lawsuit
will justify the means, but Sean can''t handle the idea that the
means may leave Willow thinking she is unloved or unwanted.
Clearly, they both love their daughter, but express it in
drastically different ways. What do each of their approaches say
about love? Do Charlotte''s actions speak louder than Sean''s
words?
9. What message does the trial verdict send? Do you agree with
the jury''s decision?
10. How do you think Amelia''s testimony affects the outcome of
the case?
11. We follow Marin through the search for her birth mother, and
what she eventually finds out about the circumstances surrounding
her conception are truly devastating to her. Why do you think she
thanks her birth mother for this information? Discuss Marin''s
reaction to what she learns.
12. Why do you think the O''Keefes never cash their $8 million
check? How do you feel about what they end up doing with it?
13. How do you feel about the ending? Why do you think the
author chose to write it this way?
Enhance Your Book Club
Try baking some of Charlotte''s recipes for your book club
meeting. Discuss the different baking techniques you used; were you
able to relate to Charlotte''s experience of making these
treats?
Learn more about osteogenesis imperfect by visiting
www.oif.org.
Visit www.jodipicoult.com to view book trailers, see what
Jodi''s up to, and find out about upcoming signings and
appearances.
A Conversation with Jodi Picoult
Q: What led you to OI as the topic for this book? Did the
idea of a wrongful birth suit come first or second? Talk about the
research required for writing this novel.
A: The seed for Handle with Care began with an
article I read about wrongful birth -- a mother in New York sued
her ob-gyn after her son was born with severe chromosomal
abnormalities and won a multi-million-dollar settlement. It was
clear from the article that she loved this child dearly -- but that
in order to give him a better lifestyle, she needed to tell the
world she would have aborted the fetus if given the chance. That
moral conundrum got me thinking: what if her child had not been
profoundly mentally disabled, but just physically disabled? What if
her child could hear her in court, saying that she wished he''d
never been born?
That led me to osteogenesis imperfecta. Also known as
brittle bone disorder, it is a genetic bone disease characterized
by fragile bones that break easily. It''s caused by a mutation on a
gene that affects the body''s production of collagen in bones. It
affects between twenty-five thousand and fifty thousand Americans
-- the range is large, because mild cases of OI often go
undiagnosed. There are eight types of OI, ranging from lethal at
birth to mild with few symptoms. A person with severe OI might
experience hundreds of fractures and have a reduced life span.
Other symptoms include short stature (people with severe OI are
approximately three feet tall), hearing loss, curvature of the
spine, respiratory failure, and loose joints and muscles.
Physically, it''s a very difficult condition -- but mentally,
people who have OI are one hundred percent normal. Many kids with
OI are even brighter than their able-bodied friends, because they
do so much reading after a break, when they can''t run
around.
For research, I tried to walk a brief way in the shoes
of a parent whose child has OI, by visiting multiple families with
kids who were afflicted by the disorder. The first girl I met with
OI, Rachel, had Type I -- a milder form -- but had suffered nearly
fifty breaks in her eight years because her parents wanted her to
live as normal a life as possible. Rather than having her walk on
her knees or restrict her activities, they allowed her to do what
she wanted... knowing that it would lead to broken bones. I
remember asking Rachel what it felt like when that happened. "It
feels like lightning under my skin," she said, and I realized then
that the pain these kids feel is just what you or I would feel if
we broke a bone -- it just happens much more frequently for them.
From Rachel, I moved on to meetings with kids who had Type III OI
-- the most severe type you can get that isn''t lethal at birth. I
remember the flash in five-year-old Hope''s eyes when the waitress
at the restaurant mistook her for a toddler, due to her size; the
pain in Jonathan''s mom''s voice when she talked about how she used
to think about just leaving him and running away, because she was
so afraid she''d be the one to cause another break. During my visit
with Matthew, his mom asked me to take him out of his car seat --
and I panicked. What if I was the one who snapped a bone this time?
This, I realized, was what these parents went through on a daily
basis.
The kids I met who had OI were all sweet, bright,
engaging, adorable -- and much more than the sum of their
disabilities. This was best illustrated in the case of a young
woman who became my technical advisor for Handle with
Care. Kara Sheridan is a Paralympian who swam in Athens for
Team USA in 2004. She is currently a Ph.D. student in clinical
psychology and is busy planning her wedding. She also has Type III
OI. When I asked her what she wished people would know about OI,
she said it''s a challenging and painful condition, but it doesn''t
mandate a tragic life. The moments she''s cherished the most have
come about because of her condition, and are just as important a
part of OI as the medical difficulties. She also pointed out that
no child has OI alone -- it affects families, friends, and loved
ones by default.
Many people shy away from a child in a wheelchair -- but
when you spend time with kids who have OI, you are not struck by
how different they are from able-bodied children, you''re struck by
how similar they are. They giggle, they flirt, they tease their
brothers. They tell knock-knock jokes and whine about long car
rides and hate broccoli. But they also know about things regular
kids don''t: splints and braces and pamidronate infusions and
spinal rodding. And when you watch them interacting with their
parents, you realize that these mothers and fathers are just like
the rest of us: willing to do whatever it takes to give their child
the best life possible.
Even if that means lying to a judge and
jury.
And suddenly, it''s a lot harder to tell whether that''s
blatantly wrong... or impossibly right.
Q: The characters in your books are always layered and
complex, as are the issues that plague them. How do you create a
character like Charlotte whom readers can love and hate at the same
time?
A: Well, for me, it''s a lot harder to create a flat
character who''s either all villain or all hero. Most of us are a
combination, aren''t we? Charlotte''s the best kind of character --
one who is doing something that looks unpalatable, but is doing it
for all the right reasons. In this way she reminds me a bit of Nina
Frost from Perfect Match. You want to hate her -- but can
you really say that if it were you, you wouldn''t at least think
about doing the same thing she does? Charlotte''s tragic flaw, in
my opinion, is that she is so single-minded in her pursuit of
making Willow''s life easier that she neglects the rest of her
support system -- her friends and her family.
Q: How did you choose the recipes that appear throughout the
book? Do you believe in the significance they hold for Charlotte?
Are you a baker yourself?
A: Before I got married, I was lucky enough to have a
roommate who became one of my best friends. Now Katie works at the
Smithsonian organizing special events -- but prior to that, she
went to culinary school. When I knew that I wanted Charlotte to be
a baker, I turned to her and asked for help. Charlotte, as a baker,
would believe that the sum of the ingredients is so much more than
its parts -- this is true for her when it comes to Willow, too, who
is so much more than a litany of moments when she broke a bone or
had a surgery or was sidelined to recuperate. I do bake (too much,
if you ask my husband, who is constantly cursing me for a pan of
brownies cooling on the stove that he is compelled to eat) -- and
often I have been struck by the metaphorical language of baking. I
wanted Charlotte''s cookbook to be a collection of these terms,
with accompanying recipes. So one day I emailed Katie a list --
words like weeping, hardball, blind baking -- and asked her to
create recipes that might involve each term. I have to admit that
rarely is my fact-checking process so delicious... I got to bake,
and road test, every recipe in the book.
Q: During the course of the trial, Amelia develops an eating
disorder and starts cutting herself. Did you see this as the
natural progression for her character? While conducting your
research, did you find that these types of behaviors in siblings of
disabled children were common?
A: While doing research with a child psychiatrist about
adolescent bulimics, I learned that cutting is very common for
those girls. Apparently, bulimia involves a lot of self-hatred...
and cutting figures into that. Siblings of disabled children
aren''t always like Amelia, thank goodness -- I''d hope that their
families would do a better job of including them than the O''Keefes
do. For Amelia, the difficulty of having a sibling with a
disability is compounded by the fact that she feels she''s failed
her sister (in Disney World, for example) and that there are very
high stakes in the household for being a child who isn''t perfect
(which would be Amelia''s interpretation of her mother''s
lawsuit).
Q: With the multiple narrators you''ve created, is there a
character that you connect with most, or that you feel represents
your own voice?
A: I had great sympathy for all of the characters in
this book -- each of them has a valid point to make, in my opinion.
So I''d have to say that at different times, I sided with each
one!
Q: Your narrators share their stories as though they are
telling them to Willow. Why did you decide to construct the novel
this way?
A: I have always wanted to write a book in the
second-person narrative voice, but it''s tricky and calls for the
right kind of story. Because the whole book revolves around Willow,
I wanted her to feel present and accounted for -- hence the
structure. Plus, given the behavior of these characters, they
deserved to explain themselves directly to Willow. But I also
wanted the reader to feel viscerally what it''s like to be at the
center of this kind of controversy -- and the second person
narration helped foster the sense that the characters are talking
to you.
Q: As the author, do you ever feel as though you''re taking
on the role of the jury? How did you decide what the ruling of the
wrongful birth suit would be?
A: I like to think of my reader in the role of the jury,
actually. It''s my job as writer to present all sides of the story
and then, based on the evidence, leave you to decide what was wrong
and what was right. As for a ruling here, it wasn''t as important
to me as the final twist of the book -- but in order to have that
final twist, I had to first have the jury rule a certain way... and
that''s all I''m going to say before I give it away!
Q: Why did you decide not to share Willow''s perspective
until the end?
A: Because the reader serves as Willow''s "stand-in" in
the book -- since the characters are explaining themselves to
"you," it makes you part of the action, and therefore part of the
judgment of their behavior. And yet I felt the reader, after
hearing everyone''s explanation about the wrongful birth issue,
also deserved to hear directly from Willow to see how everything
had affected her.
Q: You''ve said before that you know how a book will end
before you write the first word. Was this also true for Handle
with Care? Do you ever change your mind about an ending as you
get deeper into the story?
A: I do know the ending before I write a single word,
and I did here too. I will tell you that I think Handle with
Care is the saddest book I''ve written -- and coming from me,
that''s pretty dire! I never wavered on the ending, however,
because there''s a bit of a morality lesson in there as well --
it''s a real "Be careful what you wish for" moment.
Q. What''s your next project?
A: My 2010 book is about a teenage boy with Asperger''s
syndrome. He''s hopeless at reading social cues or expressing
himself well to others, and like many kids with AS, Jacob has a
special focus on one subject -- in his case, forensic analysis.
He''s always showing up at crime scenes, thanks to the police
scanner he keeps in his room, and telling the cops what they need
to do... and he''s usually right. But then one day his tutor is
found dead, and the police come to question him. All of the
hallmark behaviors of Asperger''s -- not looking someone in the
eye, stimulatory tics and twitches, inappropriate affect -- can
look a heck of a lot like guilt to law enforcement personnel -- and
suddenly, Jacob finds himself accused of murder. I wanted to write
a book about how our legal system works well for people who
communicate a certain way -- but lousy for those who
don''t.