My Sister's Keeper is a book that bleeds with earnest intentions. The characters are well-drawn, the plot is briskly paced, the situation is moving, the theme is both relevant and engrossing. Unfortunately, the theme is also about as subtle as an anvil falling on a coyote's head. The book was liberally littered with flashing neon arrows saying "This Way to the Message!" Every passage ended with an epigrammatic observation on loss, relationships, life and death, and sacrifices both willing and unwilling. Every scene not tied directly to the plot was thematically so obviously related to it that not a single word in the novel's entire 423 pages could be enjoyed unrelated to the Big fluorescent yellow Point: There Are No Good Answers When Your Child is Very Sick, But Gee, No One Should Be Turned into a Living Organ Donor Against their Will, Either.

Which, hey, is a good point. But when it can be written out as a single sentence, why expand it into a novel?

I'm sure this sounds unbalanced. It's not a bad book. The momentum was good, I read it straight through to the end, I cried in all the right places, I empathized for the characters--none of whom had an easy choice to make. The writing itself was skillful and moving. But it would have been about a thousand times better if she had stopped with the gigantic signposts saying, This Way! I can handle a bit of subtlety. I like it when I realize, on about page 100, that the author is using a great deal of religious symbolism, and then putting the book down so I can spend twenty minutes thinking about why. This is infinitely more enjoyable than, "Yes! I get it! God! Heaven! Death! Enough already! I'm not stupid!"

The ending has drawn some negative criticism; whether or not you find it disappointing will depend on whether you saw the foregoing several hundred pages as primarily about the parents' response to their daughter's illness and their belief that the future was ordained, or primarily about the youngest daughter's struggle to control her own body and destiny. If the former, the ending will make some sense. If the latter, it will be an enormous let-down.