Content Warning: This review mentions and in some cases goes into depth about eating disorders, self harm and rape. If these topics are upsetting or triggering to you, please stop here and either navigate to another post by the links on the right hand side, or exit the blog via your back button. A new post will be up in 2 week’s time and will replace this post as being the first to read should you wish to return.
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Handle With Care.
Handle with Care was published in 2009 and was written by the famous My Sister’s Keeper Author, Jodi Picoult. This novel, Handle with Care, is hard to describe and it’s only today that I realised why. This novel is meant to be about the difficult life of a young girl, called Willow, who was born with Osteogenesis Imperfecta Type 3 (Brittle Bones Disease), and how her parents are coping with having a disabled daughter (her sister: a disabled, younger sister). What this story is, like what any other story is when it concerns a disabled person, is more about how everyone around this disabled character deals with the disabled person’s existence (in this case Willow), and how their existence impacts on their own lives. This book is not so much about Willow, but those characters in the peripheral of Willow’s life. She is, arguably, both the main character and the most minor character in the book.
The main character, I would say, is her Mother, Charlotte, who tries to show that she cares the most about Willow, by suing the Ob/Gyn for wrongful birth.
And here’s some context as to why I read this book:
I hadn’t read Jodi Picoult before and I didn’t know all that much about My Sister’s Keeper. I knew the film was “a weepy”, and I tend to avoid those, so I didn’t know it was a book nor did I know the author’s name. But this book, Handle with Care, was recommended to me by my the mum of my friend, Laura.
My friend Laura, for those who don’t know, had Osteogenesis Imperfecta Type 3. Actually, according to her specialist, she had one of the most severest cases of it he’d ever seen. Unfortunately, after a serious bout of sickness related to her condition, she passed away back in October 2005, aged 20. It was with personal interest in mind that her Mum read the book, and then recommended it to me some years later. In her words, “Just so much of it’s like Laura”.
So, with high expectations but the understanding that any knowledge I had of OI, and the treatment of it, was second hand and might very well be outdated by now, I started reading. And for a good two thirds of it, I couldn’t put it down.
The story itself is pretty easy to follow, despite story switching POV between multiple characters, and random recipes and misplaced narrative throughout the book. Charlotte had her first daughter Amelia, then she married Sean O’Keefe and had her second daughter, Willow. Charlotte was best friends with Ob/Gyn Piper Reese, who became her and Sean’s go to doctor when they had trouble conceiving, and when their friendship somehow survived through all of that awkwardness and then some, she took on the natal care of Charlotte.
By the time Willow is five, which is when the novel really starts, where the real introduction to Willow happens, the O’keefe’s have mounting medical bills, money problems, a frustrated pre-teen daughter, and a super intelligent, intuitive younger disabled daughter who is being held back by her mobility problems and America’s general lack of understanding of severe disability.
I’m going to take this moment to say that I didn’t realise wheelchair services were so bad in America. Unless Picoult has used some artistic licence, I didn’t know that children had to wait so long between fittings for a suitable wheelchair. We’re not much better in the UK, especially now in the age of the post code lottery, but at least the wheelchairs are free, they tend to try and get things right, they’ve always provided children with chairs you can sort of adjust around their growth, and charities do always help where they can. Leaving a child of five to sit uncomfortable in a chair they got fitted in when they were a toddler, especially if it can be dangerous to their health and safety, would have been unheard of (until about 2010, when the wheelchair services all had their fundings cut. But that’s a post for another day!)
Back to the Book. This is when it starts to get a bit complicated, but I’m going to try and simplify it as much as possible. The O’keefe’s go to Disneyworld and Willow suffers from a bad fall (as is the unfortunate nature of Brittle Bones Disease) and both her thigh bones end up broken. The doctors at the local hospital check it over, but because the medical letter that explains Willow’s condition was accidentally left at home, they mis-read all of Willow’s breaks as abuse, and both Sean and Charlotte end up being arrested. Amelia ends up in guardian home for the night, under child protective custody, and poor Willow ends up in hospital, alone, in a spica cast.
Curiosity drove me forward in reading, but even at this early stage I was sitting there wondering how realistic this would be.
Knowledgewise, I was questioning whether it would be really possible for a child with OI type 3 to be put in a spica cast. I was put in a Spica cast following corrective surgeries on my legs when I was five, they’re not the easiest things to live with; And Laura couldn’t have any casts of any type put on her, ever, because they were more of a danger to her than helpful. They were so heavy, they would have caused breaks either side of the cast. And, a Spica cast can go almost all the way up to the chest, just one bump or wrong turn could have meant the spica cast digging the wrong way into a rib. I was left wondering if maybe things had progressed so much that this wasn’t actually a fatal risk anymore. I welcome comments to inform me either way!
Similarly, besides the bouts in her wheelchair, Willow could walk. If medical treatment and medication has come on leaps and bounds since Laura was a child, I’m happy to hear it, but you hardly ever heard of someone with OI Type 3 walking, even into the late 90s. I’m aware a friend of Laura’s could walk with crutchers, but he was a lot bigger than she was so I don’t think he had type 3. What many people with OI decide to do, is to have steel rods inserted into their long bones, so that their legs can bare weight. That was never an option for Laura, her bones wouldn’t have accepted the rods.
And talking of size… It has happened that the less severe forms of OI has been misdiagnosed as severe abuse, and probably does continue to happen. Because you’re looking at someone just a bit outside of the averages of height, weight, proportions and mobility. But with OI type 3, the person is very small. They have certain, unmistakable attributes to their physical appearance. I can understand these factors being overlooked twenty-five years ago, especially in a very young child up to toddler age, but it wouldn’t have taken them more than two seconds to see Willow’s body differed from that of an average child: Her body being a certain shape, the length of legs and arms not being in proportion to her torso or head, the whites of her eyes possibly being a blue-tinted colour, and a voice at a higher pitch than normal you’d find even on an able bodied child. With some conditions, you might not know what it is you’re being faced with, but you certainly know that, skeletally speaking, you’re looking at someone atypical. A child, yes, but an atypical child in physical appearance. Abuse wouldn’t explain low levels bone density or unusual calcium markers in the blood, and I would expect doctors, especially within the last decade, to check into these things before throwing the A word around.
It was one of many occurrences I found that Picoult depended on the sheer ignorance characters and readers alike to carry the plot along. (But hey, how else would the story drive forwards?)
Anyway, in the plot, once everything is sorted out and everyone’s released and free to go home, that leads to the O’keefes trying to sue everyone involved in the events that lead to the mistreatment of the family. The lawyer says that’s a no go, but they should consider sueing the Ob/Gyn for wrongful birth. That is to say, sue the doctor overseeing Charlotte’s pregnancy for not figuring out that Willow had OI in time to give Charlotte the option to abort.
In other more specific words, blame and sue Piper for not giving her the option to abort Willow. Despite the fact that they’re catholics, abortion was never going to be an option as agreed by both Sean and Charlotte, and a late term abortion was in fact offered to and subsequently turned down by Charlotte.
Amelia develops bulimia, the sisterly relationship between the two daughters breaks even further, and eventually Charlotte’s drive to carry through with her plan causes a rift in her and Sean’s marriage.
It’s a very full on story, and the further long I read, the less sympathy I had for Charlotte. She didn’t see what she was doing to her family. Or she did, but she didn’t care. There was one bit where, because Piper’s husband is the small town Dentist, Amelia misses her appointments, because Charlotte refuses to take her, even though she was due to have her braces removed. That’s just cruel.
Willow was intelligent enough to pick up on what was going on, and there’s just no nice way to say “if I’d have aborted you, we wouldn’t be in so much debt” to a young child. There’s also no nice way to say “I do love you, but I didn’t ask for this and someone has to take the blame for that.”
Then there was the convention. Charlotte is confronted by a bunch of mothers who read about the court case in the news. Charlotte is actually angry for being confronted. Charlotte really doesn’t understand how lucky she has it, in comparison to other people. Meanwhile, Amelia’s wandering around the hotel the convention’s held in, pretending to have a lesser form of OI, and she picks up a boyfriend along the way.
Those are the parts I’d say that were written well, even if on the surface I didn’t particularly enjoy the plot. However, intermixed with these parts were really poor writing and plot devices that made me think Picoult’s editor had set a holiday response for their email saying “Whatever you’ve written, I’m sure it’s perfect! We’ll publish it in when I’m back!”
We’ve got the part where, following the removal of Spica Cast, Willow needs to exercise. How does an over protective mother encourage her reception aged daughter, who has a condition where just one fall can kill her, to exercise? She makes her to walk the end of the driveway, by herself, to collect the post (admittedly something she likes doing but still…) where any dubious adult could just come along, sweep her up and run off with her. The route to the mail box at the end of the driveway involves going past a pond that Willow has an attachment to, and not the adult logic of risk assessment. Between any of these points, she could fall and die, if not be abducted by the aforementioned dubious adult.
Holy Brain Fart, Batman!
(I later realised this was a Chekov’s Gun situation, but I’ll get back to that later.)
At one point Sean and Charlotte talk about Willow’s future, and I cringed at the ignorance. It’s very realistic for parents to suddenly realise what the future holds for a disabled offspring, but it’s very undermining to the plot when you have a character (in this case Sean) who are portraying themselves as masters of their daughter’s care, victims in the eyes of the law, prepared to do all that is needed to make sure their daughter’s life is lived as equally as possible… being disparaging about any aids she may need in the future. If it’s meant to add depth to the character, it doesn’t. It wreaks of short sightedness and narrowmindedness.
Then we’ve got the “let’s throw this in/blink if you miss it” rape. Yeah. Rape. Sean and Charlotte have a break in their relationship, and then from the point of view of Sean, they have awful sex that Charlotte didn’t want, where Sean’s main goal is making her hurt as much as her actions have hurt him. Deliberate hurtful sex without enthusiastic consent? That sounds like rape to me.
Then there’s the part where Willow selfs harms because she’s seen Amelia do it to herself. I’d say that this was the point where it felt like Picoult was dragging it passed the point where she should have ended the book. This didn’t just feel like a red herring, it felt tired. It felt like a way to allow the author to point to the book and say “No, see! It really IS about Willow!”, instead of having Willow be this sort of phantom main character that the story is meant to be about, but really isn’t.
There is also a conversation after Willow is hospitalised for self harming between Piper and Sean, because Piper is the only reasonable person in this book. She (rightfully) suspects that Amelia is self harming and suffering from bulimia, and thinks (knows) that’s where Willow “learnt” how to hurt herself. What does Charlotte do when Sean mentions that his information come from Piper? She has a go at him for talking to Piper, talking to the “enemy”. She’s got one daughter in the hospital, and another daughter suffering from serious emotional distress that has manifested into self harm and an eating disorder. But all she cares about is the case.
There’s the whole side plot involving the lawyer, Marin, who doesn’t like the case, because she was an unwanted child herself. I’m not sure what she really added to the story, but things got very contrived when one of the jurors turned out to be her birth mother. What are the actual chances?!
And then, the main big problem I had with the book. The ending.
Willow, once again, is a child who could die from a sneeze (No exaggeration, sneezes can break ribs, ribs can pierce lungs), and yet she is allowed to go outside, by herself, to look for Amelia. It’s cold, slippery winter weather. There’s that pond that she can’t resist going near, which her mother knows. And Yet! The over protective parent allows her to go, by herself, despite ALL of these dangers. Despite the long arsed court case that she’d just won, by saying how much she looks after her severely disabled daughter.
And what happens? Willow goes to the pond, the ice breaks suddenly, and she falls through into the freezing cold water and dies.
The epilogue involves a brief update on everyone. Sean and Charlotte are back together, Amelia’s in therapy, Charlotte placed the cheque she got from winning the case in the coffin with Willow, and Piper moves away and is never heard of again.
I was left so disappointed by the whole ending. Not because of the understandable “After all that!?” feeling I was left with, but because… I suppose, because there were more realistic ways for a person with OI to die, and Picoult chose that one!?
I went from wondering whether a child with OI Type 3 these days could actually walk, to wondering what sort of brain fart do you have to have to let your child, who could fall and die by slipping on ice (as any child could, but this is more so), go out by herself in icy weather?! You can only consider it in character because of the same brain fart earlier on, (Chekov’s brain fart alert!) and although it must have been planned out due to the previous incident of letting Willow out to the end of the drive and going missing by the pond, it just reads as a quick solution to bring about the end of the story.
There are natural complications with OI that a person can die of.
There are the usual risks anyone has in daily life where the risk of dying is increased due to the nature of the condition. For example, one day, Laura, aged 4 or abouts, was spinning happily around in a circle, in her wheelchair, and Almost cracked her head on the edge of a piano. She didn’t, luckily, but the point is, it could have happened and the outcome would have been devastating. An able-bodied child would probably just give themselves a concussion.
It feels, for the lack of a better word, disrespectful.
And then Piper… Piper just moves away!? I think that was another point of contention for me. It was written in a half unbiased, half sympathetic style directed at Charlotte, as if we should all see it her way. It was all very pragmatic towards Piper, a sort of “Well, what can you do? Someone has to answer for this child being disabled” attitude about it. There wasn’t much sympathy at all for a woman who not only did not cause Willow’s disability, by action or inaction, but also did everything right by the whole family, and still had her career ruined for it.
I’ve missed a lot of out, half because I can’t remember it, and half because I couldn’t be bothered going into those bits. There is so much to this story, from so many different points of views, it’s just difficult to go over.
I’ll give credit where credit’s due (although again, I wonder if this was from lack of research on Picoult’s part and not really through a deep understanding of disability), there was one good thing that came through over all. Many people don’t understand that disability can be a spectrum, and that mobility can and does change from day to day for many people. Sometimes there is a conscious choice involved over what “part” of your disability you have to consider most important, and allow the rest of yourself to suffer the fall out. For example, having to walk because a problem with your upper body doesn’t allow you to self propel, and then dealing with the pain in your legs from walking, which is the lesser of two evils in this scenario.
In this book, there is an understanding that when Willow’s health is best, she can walk and only needs her wheelchair for safety and speed. She also has a walker and other aids for bad days and an array of things for the worst days. Many people think that if you’re a wheelchair user, that’s it, you can’t walk. Nobody says to Willow’s parents, “Well, she could walk yesterday”, nobody asks why she doesn’t use walking aids all the time. It’s just understood she uses whatever she needs, whenever she needs to. That’s so unaccepted in today’s society that people have actually become afraid to stand up, lest they get abuse for it.
People who deal with fluctuating conditions are at least experienced in preparing for the worst but knowing that’s not always the case so do what they can on their good days. There needs to be more of that shown across all medias.
Although, preferably with accuracy and research, and not a research fail, which is what I suspect is the case here.
The remaining issue is: Was Willow like Laura?
Well, yes and no. Laura was a lot like Willow when she was that age. But, a lot of disabled children are, just like a lot of able boded children are similar. There’s just this amazing phenomenon where physically disabled children develop brilliant personalities that differ from their able bodied peers, and some are quick witted. In the book, it’s explained that children who can’t learn through physical play find solace in books and television, and they become intelligent because there’s this thirst to do everything and know everything, and if all they can do is read and watch television instead of, I dunno, play football and poke things, then they will quench that thirst with good interesting books and documentaries. And Laura did have a high reading age for her age and was interested in a lot of things. But Laura also did accessible sports, so, you know, same outcome, different processes.
Mostly, they just shared experiences. I may have been the one with the Spica cast, but Laura was the one going to hospital every few months and spending three days tied to an IV pump of pomedrominate (before they switched to tablets for Laura). Laura did have to go on holiday with letters from doctors, to prove she was fit to fly, to prove that her Mum knew what she was doing. Laura had fun getting fitted for a wheelchair in a way that the O’keefe’s were only aware of. She was mistaken more than once for a baby. Even at the age of 18, she had people mistaking her for a toddler, and sometimes her and her mum couldn’t tell if people were speaking down to her because they’d mistaken her for a child, or because of a terrible attitude towards disabled people (again, different process, same outcome). There’s only so many ways you can react to these life situations, and maybe that’s what feels so familiar.
But that stops, the characters all become their own beings… and it stops being an enjoyable read.
I gave this book a 2.5/5