I USED TO PRETEND that I was just passing through this family on my way to my real one. It isn't too much of a stretch, really—there's Kate, the spitting image of my dad; and Jesse, the spitting image of my mom; and then there's me, a collection of recessive genes that came out of left field. In the hospital cafeteria, eating rubberized French fries and red Jell-O, I'd glance around from table to table, thinking my bona fide parents might be just a tray away. They'd sob with sheer joy to find me, and whisk me off to our castle in Monaco or Romania and give me a maid that smelled like fresh sheets, and my own Bernese mountain dog, and a private phone line. The thing is, the first person I'd have called to crow over my new fortune would be Kate.

Kate's dialysis sessions run three times a week, for two hours at a time. She has a Mahhukar catheter, which looks just like her central line used to look and protrudes from the same spot on her chest. This gets hooked up to a machine that does the work her kidneys aren't doing. Kate's blood (well, it's my blood if you want to get technical about it) leaves her body through one needle, gets cleaned, and then goes into her body again through a second needle. She says it doesn't hurt. Mostly, it's just boring. Kate usually brings a book or her CD player and headphones. Sometimes we play games. "Go out into the hall and tell me about the first gorgeous guy you find," Kate'll instruct, or, "Sneak up on the janitor who surfs the Net and see whose naked pictures he's downloading." When she is tied to the bed, I am her eyes and her ears.

Today, she is reading Allure magazine. I wonder if she even knows that every V-necked model she comes across she touches at the breastbone, in the same place where she has a catheter and they don't. "Well," my mother announces out of the blue, "this is interesting." She waves a pamphlet she's taken from the bulletin board outside Kate's room: You and Your New Kidney. "Did you know that they don't take out the old kidney? They just transplant the new one into you and hook it up."

"That creeps me out," Kate says. "Imagine the coroner who cuts you open and sees you've got three instead of two."

"I think the point of a transplant is so that the coroner won't be cutting you open anytime soon," my mother replies. This fictional kidney she's discussing resides right now in my own body.

I've read that pamphlet, too.

Kidney donation is considered relatively safe surgery, but if you ask me, the writer must have been comparing it to something like a heart-lung transplant, or some brain tumor removal. In my opinion, safe surgery is the kind where you go into the doctor's office and you're awake the whole time and the procedure is finished in five minutes—like when you have a wart removed or a cavity drilled. On the other hand, when you donate a kidney, you spend the night before the operation fasting and taking laxatives. You're given anesthesia, the risks of which can include stroke, heart attack, and lung problems. The four-hour surgery isn't a walk in the park, either—you have a I in 3,000 chance of dying on the operating table. If you don't, you are hospitalized for four to seven days, although it takes four to six weeks to fully recover. And that doesn't even include the long-term effects: an increased chance of high blood pressure, a risk of complications with pregnancy, a recommendation to refrain from activities where your lone remaining kidney might be damaged.

Then again, when you get a wart removed or a cavity drilled, the only person who benefits in the long run is yourself.

There is a knock on the door, and a familiar face peeks in. Vern Stackhouse is a sheriff, and therefore a member of the same public servant community as my father. He used to come over to our house every now and then to say hi or leave off Christmas presents for us; more recently, he's saved Jesse's butt by bringing him home from a scrape, rather than letting the justice system deal with him. When you're part of the family with the dying daughter, people cut you slack.

Vern's face is like a souffle, caving in at the most unexpected places. He doesn't seem to know whether it's all right for him to enter the room. "Uh," he says. "Hi, Sara."

"Vern!" My mother gets to her feet. "What are you doing at the hospital? Everything all right?"

"Oh yeah, fine. I'm just here on business."

"Serving papers, I suppose."

"Um-hmm." Vern shuffles his feet and stuffs his hand inside his jacket, like Napoleon. "I'm real sorry about this, Sara," he says, and then he holds out a document.

Just like Kate, all the blood leaves my body. I couldn't move if I wanted to.

"What the… Vern, am I being sued?" My mother's voice is far too quiet.

"Look, I don't read them. I just serve them. And your name, it was right there on my list. If, uh, there's anything I…" He doesn't even finish his sentence. With his hat in his hands, he ducks back out the door.

"Mom?" Kate asks. "What's going on?"

"I have no idea." She unfolds the papers. I'm close enough to read them over her shoulder. THE STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS, it says right across the top, official as can be. FAMILY COURT FOR PROVIDENCE COUNTY. IN RE: ANNA FITZGERALD, A.K.A. JANE DOE.

PETITION FOR MEDICAL EMANCIPATION.

Oh shit, I think. My cheeks are on fire; my heart starts to pound. I feel like I did the time the principal sent home a disciplinary notice because I drew a sketch of Mrs. Toohey and her colossal butt in the margin of my math textbook. No, actually, scratch that—it's a million times worse.

That she gets to make all future medical decisions.

That she not be forced to submit to medical treatment which is not in her best interests or for her benefit.

That she not be required to undergo any more treatment for the benefit of her sister, Kate.

My mother lifts her face to mine. "Anna," she whispers, "what the hell is this?"

It feels like a fist in my gut, now that it's here and happening. I shake my head. What can I possibly tell her?

"Anna!" She takes a step toward me.

Behind her, Kate cries out. "Mom, ow, Mom… something hurts, get the nurse!"

My mother turns halfway. Kate is curled onto her side, her hair spilling over her face. I think that through the fall of it, she's looking at me, but I cannot be sure. "Mommy," she moans, "please."

For a moment, my mother is caught between us, a soap bubble. She looks from Kate to me and back again.

My sister's in pain, and I'm relieved. What does that say about me?

The last thing I see as I run out of the room is my mother pushing the nurse's call button over and over, as if it's the trigger to a bomb.

I can't hide in the cafeteria, or the lobby, or anywhere else that they will expect me to go. So I take the stairs to the sixth floor, the maternity ward. In the lounge, there is only one phone, and it is being used. "Six pounds eleven ounces," the man says, smiling so hard I think his face might splinter. "She's perfect."

Did my parents do this when I came along? Did my father send out smoke signals; did he count my fingers and toes, sure he'd come up with the finest number in the universe? Did my mother kiss the top of my head and refuse to let the nurse take me away to be cleaned up? Or did they simply hand me away, since the real prize had been clamped between my belly and the placenta?

The new father finally hangs up the phone, laughing at absolutely nothing. "Congratulations," I say, when what I really want to tell him is to pick up that baby of his and hold her tight, to set the moon on the edge of her crib and to hang her name up in stars so that she never, ever does to him what I have done to my parents.