Handle with Care: A Novel


When Willow is born with severe osteogenesis imperfecta, her parents are devastated—she will suffer hundreds of broken bones as she grows, a lifetime of pain. In this provocative story from the #1 New York Times bestselling author, “Picoult writes with unassuming brilliance” (Stephen King).

Every expectant parent will tell you that they don’t want a perfect baby, just a healthy one. Charlotte and Sean O’Keefe would have asked for a healthy baby, too, if they’d been given the ...

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Handle with Care

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When Willow is born with severe osteogenesis imperfecta, her parents are devastated—she will suffer hundreds of broken bones as she grows, a lifetime of pain. In this provocative story from the #1 New York Times bestselling author, “Picoult writes with unassuming brilliance” (Stephen King).

Every expectant parent will tell you that they don’t want a perfect baby, just a healthy one. Charlotte and Sean O’Keefe would have asked for a healthy baby, too, if they’d been given the choice. Instead, their lives are made up of sleepless nights, mounting bills, the pitying stares of “luckier” parents, and maybe worst of all, the what-ifs. What if their child had been born healthy? But it’s all worth it because Willow is, funny as it seems, perfect. She’s smart as a whip, on her way to being as pretty as her mother, kind, brave, and for a five-year-old an unexpectedly deep source of wisdom. Willow is Willow, in sickness and in health.

Everything changes, though, after a series of events forces Charlotte and her husband to confront the most serious what-ifs of all. What if Charlotte had known earlier of Willow’s illness? What if things could have been different? What if their beloved Willow had never been born? To do Willow justice, Charlotte must ask herself these questions and one more. What constitutes a valuable life?

Emotionally riveting and profoundly moving, Handle with Care is an unforgettable novel about the fragility of life and the lengths we will go to protect it.

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Editorial Reviews

From Barnes & Noble
In each of bestselling novels, Jodi Picoult pins her main characters on the prongs of a moral dilemma. In the case of Handle with Care, Charlotte and Sean O'Keefe have "two perfect daughters," but one of them, Willow, suffers from brittle bone disease, a genetic malady that requires expensive medical treatments and constant personal care. Overwhelmed by the costs, both financial and emotional, the couple decides to sue her obstetrician for wrongful birth. Though their decision to litigate is purely practical, it forces them to answer searing questions about who they are and what their children can be.
Perri Klass
It's well written, it's conscientiously researched and, most important, it presents a character who is a child instead of a disability personified…Handle With Care is a great read, with strong characters, an exciting lawsuit to pull you along and really good use of the medical context. Picoult does a terrific job of evoking [osteogenesis imperfecta] and its peculiarities—from the likelihood that parents might be accused of child abuse (because of fractures that don't quite "make sense") to the incessant push and pull of wanting a child to experience kindergarten friendships, Disney World and ice skating, while worrying constantly that another fragile bone will break.
—The Washington Post
Publishers Weekly

Perennial bestseller Picoult (Change of Heart) delivers another engrossing family drama, spiced with her trademark blend of medicine, law and love. Charlotte and Sean O'Keefe's daughter, Willow, was born with brittle bone disease, a condition that requires Charlotte to act as full-time caregiver and has strained their emotional and financial limits. Willow's teenaged half-sister, Amelia, suffers as well, overshadowed by Willow's needs and lost in her own adolescent turmoil. When Charlotte decides to sue for wrongful birth in order to obtain a settlement to ensure Willow's future, the already strained family begins to implode. Not only is the defendant Charlotte's longtime friend, but the case requires Charlotte and Sean to claim that had they known of Willow's condition, they would have terminated the pregnancy, a statement that strikes at the core of their faith and family. Picoult individualizes the alternating voices of the narrators more believably than she has previously, and weaves in subplots to underscore the themes of hope, regret, identity and family, leading up to her signature closing twists. (Mar.)

Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.
Library Journal

Fans of popular author Picoult (My Sister's Keeper) won't be disappointed with her newest novel, which offers a glimpse into the life of a family whose daughter is born with a severe medical condition that could have been prevented, but at what cost? Sean and Charlotte O'Keefe's magical world is turned upside down when daughter Willow is born with brittle bone disease, a disease so severe that Charlotte is forced into the role of caretaker for Willow and emotionally abandoning older daughter Amelia. It's only when Charlotte decides to sue for wrongful death that the family begins to unravel-even if the reason for the lawsuit is for Willow's future. In order to win the lawsuit, Willow's parents have to claim that they would have aborted her if they had known about her condition, a claim that is so abhorrent that it literally fractures the family. Picoult's novels are like Russian nesting dolls, with each plot unveiling a subplot, leading to an ending that readers never see coming. Highly recommended for all public libraries. [See Prepub Alert, LJ11/1/08.]
—Marika Zemke

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Product Details

  • ISBN-13: 9781501106149
  • Publisher: Pocket Books
  • Publication date: 6/30/2015
  • Format: Mass Market Paperback
  • Pages: 672
  • Sales rank: 157,924

Meet the Author

Jodi Picoult

Jodi Picoult received an AB in creative writing from Princeton and a master’s degree in education from Harvard. The recipient of the 2003 New England Book Award for her entire body of work, she is the author of twenty-one novels, including the #1 New York Times bestsellers House Rules, Handle With Care, Change of Heart, and My Sister’s Keeper, for which she received the American Library Association’s Margaret Alexander Edwards Award. She lives in New Hampshire with her husband and three children. Visit her website at JodiPicoult.com.

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    1. Hometown:
      Hanover, New Hampshire
    1. Date of Birth:
      May 19, 1966
    2. Place of Birth:
      Nesconset, Long Island, NY
    1. Education:
      A.B. in Creative Writing, Princeton University; M.A. in Education, Harvard University
    2. Website:

Read an Excerpt

Handle with Care

  • February 2007

My whole life, I’ve never been on a vacation. I’ve never even left New Hampshire, unless you count the time that I went with you and Mom to Nebraska—and even you have to admit that sitting in a hospital room for three days watching really old Tom and Jerry cartoons while you got tested at Shriners was nothing like going to a beach or to the Grand Canyon. So you can imagine how excited I was when I found out that our family was planning to go to Disney World. We would go during February school vacation. We’d stay at a hotel that had a monorail running right through the middle of it.

Mom began to make a list of the rides we would go on. It’s a Small World, Dumbo the Flying Elephant, Peter Pan’s Flight.

“Those are for babies,” I complained.

“Those are the ones that are safe,” she said.

“Space Mountain,” I suggested.

“Pirates of the Caribbean,” she answered.

“Great,” I yelled. “I get to go on the first vacation of my life, and I won’t even have any fun.” Then I stormed off to our room, and even though I wasn’t downstairs anymore, I could pretty much imagine what our parents were saying: There Amelia goes, being difficult again.

It’s funny, when things like this happen (which is, like, always), Mom isn’t the one who tries to iron out the mess. She’s too busy making sure you’re all right, so the task falls to Dad. Ah, see, there’s something else that I’m jealous about: he’s your real dad, but he’s only my stepfather. I don’t know my real dad; he and my mother split up before I was even born, and she swears that his absence is the best gift he could ever have given me. But Sean adopted me, and he acts like he loves me just as much as he loves you—even though there’s this black, jagged splinter in my mind that constantly reminds me this couldn’t possibly be true.

“Meel,” he said when he came into my room (he’s the only one I’d ever let call me that in a million years; it makes me think of the worms that get into flour and ruin it, but not when Dad says it), “I know you’re ready for the big rides. But we’re trying to make sure that Willow has a good time, too.”

Because when Willow’s having a good time, we’re all having a good time. He didn’t have to say it, but I heard it all the same.

“We just want to be a family on vacation,” he said.

I hesitated. “The teacup ride,” I heard myself say.

Dad said he’d go to bat for me, and even though Mom was dead set against it—what if you smacked up against the thick plaster wall of the teacup?—he convinced her that we could whirl around in circles with you wedged between us so that you wouldn’t get hurt. Then he grinned at me, so proud of himself for having negotiated this deal that I didn’t have the heart to tell him I really couldn’t care less about the teacup ride.

The reason it had popped into my head was because, a few years ago, I’d seen a commercial for Disney World on TV. It showed Tinker Bell floating like a mosquito through the Magic Kingdom over the heads of the cheery visitors. There was one family that had two daughters, the same age as you and me, and they were on the Mad Hatter’s teacup ride. I couldn’t take my eyes off them—the older daughter even had brown hair, like I do; and if you squinted, the father looked a lot like Dad. The family seemed so happy it made my stomach hurt to watch it. I knew that the people on the commercial probably weren’t even a real family—that the mom and dad were probably two single actors, that they had most likely met their fake daughters that very morning as they arrived on set to shoot the commercial—but I wanted them to be one. I wanted to believe they were laughing, smiling, even as they were spinning out of control.

• • •

Pick ten strangers and stick them in a room, and ask them which one of us they feel sorrier for—you or me—and we all know who they’ll choose. It’s kind of hard to look past your casts; and the fact that you’re the size of a two-year-old, even though you’re five; and the funny twitch of your hips when you’re healthy enough to walk. I’m not saying that you’ve had it easy. It’s just that I have it worse, because every time I think my life sucks, I look at you and hate myself even more for thinking my life sucks in the first place.

Here’s a snapshot of what it’s like to be me:

Amelia, don’t jump on the bed, you’ll hurt Willow.

Amelia, how many times have I told you not to leave your socks on the floor, because Willow could trip over them?

Amelia, turn off the TV (although I’ve only watched a half hour, and you’ve been staring at it like a zombie for five hours straight).

I know how selfish this makes me sound, but then again, knowing something’s true doesn’t keep you from feeling it. And I may only be twelve, but believe me, that’s long enough to know that our family isn’t the same as other families, and never will be. Case in point: What family packs a whole extra suitcase full of Ace bandages and waterproof casts, just in case? What mom spends days researching the hospitals in Orlando?

It was the day we were leaving, and as Dad loaded up the car, you and I sat at the kitchen table, playing Rock Paper Scissors. “Shoot,” I said, and we both threw scissors. I should have known better; you always threw scissors. “Shoot,” I said again, and this time I threw rock. “Rock breaks scissors,” I said, bumping my fist on top of your hand.

“Careful,” Mom said, even though she was facing in the opposite direction.

“I win.”

“You always win.”

I laughed at you. “That’s because you always throw scissors.”

“Leonardo da Vinci invented the scissors,” you said. You were, in general, full of information no one else knew or cared about, because you read all the time, or surfed the Net, or listened to shows on the History Channel that put me to sleep. It freaked people out, to come across a five-year-old who knew that toilets flush in the key of E-flat or that the oldest word in the English language is town, but Mom said that lots of kids with OI were early readers with advanced verbal skills. I figured it was like a muscle: your brain got used more than the rest of your body, which was always breaking down; no wonder you sounded like a little Einstein.

“Do I have everything?” Mom asked, but she was talking to herself. For the bazillionth time she ran through a checklist. “The letter,” she said, and then she turned to me. “Amelia, we need the doctor’s note.”

It was a letter from Dr. Rosenblad, saying the obvious: that you had OI, that you were treated by him at Children’s Hospital—in case of emergency, which was actually pretty amusing since your breaks were one emergency after another. It was in the glove compartment of the van, next to the registration and the owner’s manual from Toyota, plus a torn map of Massachusetts, a Jiffy Lube receipt, and a piece of gum that had lost its wrapper and grown furry. I’d done the inventory once when my mother was paying for gas.

“If it’s in the van, why can’t you just get it when we drive to the airport?”

“Because I’ll forget,” Mom said as Dad walked in.

“We’re locked and loaded,” he said. “What do you say, Willow? Should we go visit Mickey?”

You gave him a huge grin, as if Mickey Mouse was real and not just some teenage girl wearing a big plastic head for her summer job. “Mickey Mouse’s birthday is November eighteenth,” you announced as he helped you crawl down from the chair. “Amelia beat me at Rock Paper Scissors.”

“That’s because you always throw scissors,” Dad said.

Mom frowned over her list one last time. “Sean, did you pack the Motrin?”

“Two bottles.”

“And the camera?”

“Shoot, I took it out and left it on the dresser upstairs—” He turned to me. “Sweetie, can you grab it while I put Willow in the car?”

I nodded and ran upstairs. When I came down, camera in hand, Mom was standing alone in the kitchen turning in a slow circle, as if she didn’t know what to do without Willow by her side. She shut off the lights and locked the front door, and I bounded over to the van. I handed the camera to Dad and buckled myself in beside your car seat, and let myself admit that, as dorky as it was to be twelve years old and excited about Disney World, I was. I was thinking about sunshine and Disney songs and monorails, and not at all about the letter from Dr. Rosenblad.

Which means that everything that happened was my fault.

• • •

We didn’t even make it to the stupid teacups. By the time our flight landed and we got to the hotel, it was late afternoon. We drove to the theme park and had just walked onto Main Street, U.S.A.—Cinderella’s Castle in full view—when the perfect storm hit. You said you were hungry, and we turned into an old-time ice-cream parlor. Dad stood in line holding your hand while Mom brought napkins over to the table where I was sitting. “Look,” I said, pointing out Goofy pumping the hand of a screaming toddler. At exactly the same moment that Mom let one napkin flutter to the ground and Dad let go of your hand to take out his wallet, you hurried to the window to see what I wanted to show you, and you slipped on the tiny paper square.

We all watched it in slow motion, the way your legs simply gave out from underneath you, so that you sat down hard on your bottom. You looked up at us, and the whites of your eyes flashed blue, the way they always do when you break.

It was almost like the people at Disney World had been expecting this to happen. No sooner had Mom told the man scooping ice cream that you’d broken your leg than two men from their medical facility came with a stretcher. With Mom giving orders, the way she always does around doctors, they managed to get you onto it. You weren’t crying, but then, you hardly ever did when you broke something. Once, I had fractured my pinkie playing tetherball at school and I couldn’t stop freaking out when it turned bright red and blew up like a balloon, but you didn’t even cry the time you broke your arm right through the skin.

“Doesn’t it hurt?” I whispered, as they lifted up the stretcher so that it suddenly grew wheels.

You were biting your lower lip, and you nodded.

There was an ambulance waiting for us when we got to the Disney World gate. I took one last look at Main Street, U.S.A., at the top of the metal cone that housed Space Mountain, at the kids who were running in instead of going out, and then I crawled into the car that someone had arranged so Dad and I could follow you and Mom to the hospital.

It was weird, going to an emergency room that wasn’t our usual one. Everyone at our local hospital knew you, and the doctors all listened to what Mom told them. Here, though, nobody was paying any attention to her. They said this could be not one but two femur fractures, and that might mean internal bleeding. Mom went into the examination room with you for the X-ray, which left Dad and me sitting on green plastic chairs in a waiting room. “I’m sorry, Meel,” he said, and I just shrugged. “Maybe it’ll be an easy one, and we can go back to the park tomorrow.” There had been a man in a black suit at Disney World who told my father that we would be comped, whatever that meant, if we wanted to return another day.

It was Saturday night, and the people coming into the emergency room were much more interesting than the TV program that was playing. There were two kids who looked like they were old enough to be in college, both bleeding from the same spot on their foreheads and laughing every time they looked at each other. There was an old man wearing sequined pants and holding the right side of his stomach, and a girl who spoke only Spanish and was carrying screaming twin babies.

Suddenly, Mom burst out of the double doors to the right, with a nurse running after her and another woman in a skinny pin-striped skirt and red high heels. “The letter,” she cried. “Sean, what did you do with it?”

“What letter?” Dad asked, but I already knew what she was talking about, and just like that, I thought I might throw up.

“Mrs. O’Keefe,” the woman said, “please. Let’s do this somewhere more private.”

She touched Mom’s arm, and—well, the only way I can really describe it is that Mom just folded in half. We were led to a room with a tattered red couch and a little oval table and fake flowers in a vase. There was a picture on the wall of two pandas, and I stared at it while the woman in the skinny skirt—she said her name was Donna Roman, and she was from the Department of Children and Families—talked to our parents. “Dr. Rice contacted us because he has some concerns about the injuries to Willow,” she said. “Bowing in her arm and X-rays indicate that this wasn’t her first break?”

“Willow’s got osteogenesis imperfecta,” Dad said.

“I already told her,” Mom said. “She didn’t listen.”

“Without a physician’s statement, we have to look into this further. It’s just protocol, to protect children—”

“I’d like to protect my child,” Mom said, her voice sharp as a razor. “I’d like you to let me get back in there so I can do just that.”

“Dr. Rice is an expert—”

“If he was an expert, then he’d know I was telling the truth,” Mom shot back.

“From what I understand, Dr. Rice is trying to reach your daughter’s physician,” Donna Roman said. “But since it’s Saturday night, he’s having trouble making contact. So in the meantime, I’d like to get you to sign releases that will allow us to do a full examination on Willow—a full bone scan and neurological exam—and in the meantime, we can talk a little bit.”

“The last thing Willow needs is more testing—“Mom said.

“Look, Ms. Roman,” Dad interrupted. “I’m a police officer. You can’t really believe I’d lie to you?”

“I’ve already spoken to your wife, Mr. O’Keefe, and I’m going to want to speak to you, too . . . but first I’d like to talk to Willow’s sister.”

My mouth opened and closed, but nothing came out of it. Mom was staring at me as if she were trying to do ESP, and I looked down at the floor until I saw those red high heels stop in front of me. “You must be Amelia,” she said, and I nodded. “Why don’t we take a walk?”

As we left, a police officer who looked like Dad did when he went to work stepped into the doorway. “Split them up,” Donna Roman said, and he nodded. Then she took me to the candy machine at the far end of the hallway. “What would you like? Me, I’m a chocolate fiend, but maybe you’re more of a potato chip girl?”

She was so much nicer to me when my parents weren’t sitting there—I immediately pointed to a Snickers bar, figuring that I’d better take advantage of this while I could. “I guess this isn’t quite what you’d hoped your vacation would be?” she said, and I shook my head. “Has this happened to Willow before?”

“Yeah. She breaks bones a lot.”


For someone who was supposed to be smart, this woman sure didn’t seem it. How do anyone’s bones break? “She falls down, I guess. Or gets hit by something.”

“She gets hit by something?” Donna Roman repeated. “Or do you mean someone?”

There had been one time in nursery school when a kid had run into you on the playground. You were pretty gifted at ducking and weaving, but that day, you hadn’t been fast enough. “Well,” I said, “sometimes that happens, too.”

“Who was with Willow when she got hurt this time, Amelia?”

I thought back to the ice-cream counter, to Dad, holding your hand. “My father.”

Her mouth flattened. She fed coins into another machine, and out popped a bottled water. She twisted the cap. I wanted her to offer it to me, but I was too embarrassed to ask.

“Was he upset?”

I thought of my father’s face as we sped off toward the hospital following the ambulance. Of his fists, balanced on his thighs as we waited for word about Willow’s latest break. “Yeah—really upset.”

“Do you think he did this because he was angry at Willow?”

“Did what?”

Donna Roman knelt down so that she was staring me in the eye. “Amelia,” she said, “you can tell me what really happened. I’ll make sure he doesn’t hurt you.”

Suddenly, I realized what she thought I’d meant. “My dad wasn’t mad at Willow,” I said. “He didn’t hit her. It was an accident!”

“Accidents like that don’t have to happen.”

“No—you don’t understand—it’s because of Willow—”

“Nothing kids do justifies abuse,” Donna Roman muttered under her breath, but I could hear her loud and clear. By now she was walking back toward the room where my parents were, and even though I was yelling, trying to get her to hear me, she wasn’t listening. “Mr. and Mrs. O’Keefe,” she said, “we’re putting your children into protective custody.”

“Why don’t we just go down to the station to talk?” the officer was saying to Dad.

Mom threw her arms around me. “Protective custody? What does that mean?”

With a firm hand—and the help of the police officer—Donna Roman tried to peel her away from me. “We’re just keeping the children safe until we can get this all cleared up. Willow will be here overnight.” She started to steer me out of the room, but I grabbed at the doorframe.

“Amelia?” my mother said, frantic. “What did you say?”

“I tried to tell her the truth!”

“Where are you taking my daughter?”

“Mom!” I shrieked, and I reached for her.

“Come on, sweetheart,” Donna Roman said, and she pulled at my hands until I had to let go, until I was being dragged out of the hospital kicking and screaming. I did this for five minutes, until I went totally numb. Until I understood why you didn’t cry, even though it hurt: there are kinds of pain you couldn’t speak out loud.

• • •

I’d seen and heard the words foster home before, in books that I read and television programs I watched. I figured that they were for orphans and inner-city kids, kids whose parents were drug dealers—not girls like me who lived in nice houses and got plenty of Christmas presents and never went to sleep hungry. As it turned out, though, Mrs. Ward, who ran this temporary foster home, could have been an ordinary mom. I guess she had been one, judging from the photos that plastered every surface like wallpaper. She met us at the door wearing a red bathrobe and slippers that looked like pink pigs. “You must be Amelia,” she said, and she opened the door a little wider.

I was expecting a posse of kids, but it turned out that I was the only one staying with Mrs. Ward. She took me into the kitchen, which smelled like dishwashing detergent and boiled noodles. She set a glass of milk and a stack of Oreo cookies in front of me. “You’re probably starving,” she said, and even though I was, I shook my head. I didn’t want to take anything from her; it felt like giving in.

My bedroom had a dresser, a small bed, and a comforter with cherries printed all over it. There was a television and a remote. My parents would never let me have a television in my room; my mother said it was the Root of All Evil. I told Mrs. Ward that, and she laughed. “Maybe so,” she said, “but then again, sometimes The Simpsons are the best medicine.” She opened a drawer and took out a clean towel and a nightgown that was a couple of sizes too big. I wondered where it had come from. I wondered how long the last girl who’d worn it had slept in this bed.

“I’m right down the hall if you need me,” Mrs. Ward said. “Is there anything else I can get you?”

My mother.

My father.



“How long,” I managed, the first words I had said out loud in this house, “do I have to be here?”

Mrs. Ward smiled sadly. “I can’t say, Amelia.”

“Are my parents . . . are they in a foster home, too?”

She hesitated. “Something like that.”

“I want to see Willow.”

“First thing tomorrow,” Mrs. Ward said. “We’ll go up to the hospital. How’s that?”

I nodded. I wanted to believe her, so bad. With this promise tucked into my arms like my stuffed moose at home, I could sleep through the night. I could convince myself that everything was bound to get better.

I lay down, and tried to remember the useless bits of information you’d rattle off before we went to sleep, when I was always telling you to just shut up already: Frogs have to close their eyes to swallow. One pencil can draw a line thirty-five miles long. Cleveland, spelled backward, is DNA level C.

I was starting to see why you carried those stupid facts like other kids dragged around security blankets—if I repeated them over and over, it almost made me feel better. I just wasn’t sure if that was because it helped to know something, when the rest of my life seemed to be a big question mark, or because it reminded me of you.

I was still hungry, or empty, I couldn’t tell which. After Mrs. Ward had gone to her own bedroom, I tiptoed out of bed. I turned the light on in the hallway and went down to the kitchen. There, I opened up the refrigerator and let the light and cold fall over my bare feet. I stared at lunch meat, sealed into plastic packages; at a jumble of apples and peaches in a bin; at cartons of orange juice and milk lined up like soldiers. When I thought I heard a creak upstairs, I grabbed whatever I could: a loaf of bread, a Tupperware of cooked spaghetti, a handful of those Oreos. I ran back to my room and closed the door, spread my treasure out on the sheets in front of me.

At first, it was just the Oreos. But then my stomach rumbled and I ate all the spaghetti—with my fingers, because I had no fork. I had a piece of bread and another and then another, and before I knew it only the plastic wrapper was left. What is wrong with me? I thought, catching my reflection in the mirror. Who eats a whole loaf of bread? The outside of me was disgusting enough—boring brown hair that frizzed with crummy weather, eyes too far apart, that crooked front tooth, enough fat to muffin-top my jeans—but the inside of me was even worse. I pictured it as a big black hole, like the kind we learned about in science last year, that sucks everything into its center. A vacuum of nothingness, my teacher had called it.

Everything that had ever been good and kind in me, everything people imagined me to be, had been poisoned by the part of me that had wished, in the darkest crack of the night, that I could have a different family. The real me was a disgusting person who imagined a life where you had never been born. The real me had watched you being loaded into an ambulance and had let myself wish, for a half a second, that I could stay behind at Disney World. The real me was a bottomless soul who could eat a whole loaf of bread in ten minutes and still have room for more.

I hated myself.

I could not tell you what made me go into the bathroom that was attached to my room—wallpaper spotted with pink roses, shaped soaps curled in dishes next to the sink—and stick my finger down my throat. Maybe it was because I could feel the toxic stuff seeping into my bloodstream, and I wanted it out. Maybe it was punishment. Maybe it was because I wanted to control one part of me that had been uncontrollable, so the rest of me would fall into line. Rats can’t throw up, you’d told me once; it popped into my head now. With one hand holding up my hair, I vomited into the toilet until I was flushed and sweating and empty and relieved to learn that, yes, I could do this one thing right, even if it made me feel worse than I had before. With my stomach cinching and bile bitter on the back of my tongue, I felt horrible—but this time there was a physical reason I could point to.

Weak and wobbly, I stumbled back to my borrowed bed and reached for the television remote. My eyes felt like sandpaper and my throat ached, but I could not fall asleep. Instead I flipped through the cable channels, through home decorating shows and cartoons and late-night talk shows and Iron Chef cooking contests. It was on Nick at Nite, twenty-two minutes into The Dick Van Dyke Show, that the old Disney World commercial came on—like a joke, a tease, a warning. It felt like a punch in the gut: there was Tinker Bell, there were the happy people; there was the family that could have been us on the teacup ride.

What if my parents never came back?

What if you didn’t get better?

What if I had to stay here forever?

When I started to sob, I stuffed the corner of the pillow deep into my mouth so Mrs. Ward wouldn’t hear. I hit the mute button on the television remote, and I watched the family at Disney World going round in circles.

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Reading Group Guide

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.


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 mightthe 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.

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