68 pages • 2 hours read
Jodi PicoultHandle With Care
Fiction | Novel | Adult | Published in 2009A modern alternative to SparkNotes and CliffsNotes, SuperSummary offers high-quality Study Guides with detailed chapter summaries and analysis of major themes, characters, and more.
Prologue-Part 1Chapter Summaries & Analyses
Prologue Summary: “Charlotte, February 14, 2002”
Content Warning: This section of the guide includes depictions of medical procedures and trauma, self-harm, sexual assault, suicide, disordered eating, outdated and offensive mental health beliefs and terminology, police brutality, and the death of a child.
Charlotte O’Keefe goes into labor in the middle of a snowstorm. Her husband, Sean O’Keefe, is a police officer on duty. When she cannot get ahold of Sean, Charlotte calls her best friend and obstetrician, Piper Reece. Charlotte is scheduled for a Caesarean section (C-section) in a few days, primarily because her pregnancy is high-risk. Her daughter, Willow, will be born with OI and could die if delivered vaginally. Realizing that Charlotte needs to get to the hospital, Piper offers to drive her.
Piper, her husband Rob, and Emma, her daughter, arrive at Charlotte’s house. Rob and Emma stay at the house with Amelia, Charlotte’s older daughter. When Piper and Charlotte arrive at the hospital, the high-risk obstetrician, Dr. Gianna Del Sol, is waiting for them. Charlotte is quickly prepped for her C-section, and Sean arrives right before the procedure begins.
As Willow is removed from the womb, one of her arms breaks. The medical personnel try to calm her, but she only stops crying when her mother says her name.
Willow was born with seven broken bones that were fractured in utero. Charlotte doesn’t know how those bones broke but wonders if it happened while she was filling in as a pastry chef at a local restaurant. She dropped a stick of butter and bent down to pick it up to prevent anyone from falling. In the process of bending, she felt a sharp pain in her belly.
After the C-section, Charlotte doesn’t see Willow as tests are being run. Sean tells her that Willow has been diagnosed with Type III OI. They are relieved since Type III is severe, but not fatal at birth. Willow returns to Charlotte’s hospital room, bandaged and in a foam-lined bassinet. Piper encourages Charlotte to hold Willow, remarking that Charlotte “won’t break” her.
In the middle of the night, a nurse comes in to change Willow’s diaper. Charlotte urges the nurse to be careful with Willow, but the nurse ignores her. In the process of picking up Willow, a rib bone breaks, pushing her heart, organs, and trachea to the opposite side of her body. This leads to Willow being without oxygen for a few minutes. Doctors must revive Willow using chest compressions, breaking even more bones in the process. A doctor suggests the O’Keefes consider signing a do-not-resuscitate order (DNR) for Willow.
Charlotte talks to Piper about the DNR. Ultimately, Charlotte signs one.
Part 1, Chapter 1 Summary: “Amelia, February 2007”
Before this chapter is a recipe for Crème Patisserie, a custard dessert that requires tempering. This process of tempering “is about making something stronger by taking your time” (15).
The O’Keefes plan a vacation to Disney World, but Amelia is frustrated that Charlotte prohibits her from riding certain rides because they will be too dangerous for Willow. Amelia expresses jealousy over the fact that Willow gets so much special treatment and the fact that Sean is Willow’s biological father (he is Amelia’s stepfather). Sean promises to talk to Charlotte and find at least one ride the girls can go on.
As the family is leaving for Disney World, Charlotte asks Amelia to grab a doctor’s note from the car. The doctor’s note is from Willow’s physician explaining her condition. Amelia forgets to grab the note.
At Disney World, the O’Keefes stop for ice cream. While waiting, Amelia points out to Willow that Goofy is outside the shop. Willow walks over to see Goofy and slips on a napkin, breaking her leg.
Willow is quickly taken to a local hospital. Since Willow has so many previous breaks, the doctors call the Department of Children and Families because they suspect child abuse. Charlotte asks Sean for the doctor’s note but quickly realizes it was left at home. The O’Keefes are split up for questioning.
Donna Roman, the agent from the Department of Children and Families, questions Amelia. Through their conversation, Roman believes that Sean is abusing Willow since he was with her during her accident and was upset. Because of this, Roman puts the children into protective custody.
Amelia goes to a temporary home. After she is tucked into bed, she sneaks downstairs and grabs a variety of food from the kitchen. She eats all of the food and then forces herself to throw up.
Part 1, Chapter 2 Summary: “Sean”
Sean is interrogated for child abuse at the local police station. He is eventually arrested but is let go the following day. A police dispatcher back home and Piper (whom Charlotte used her one phone call to contact) confirmed Willow’s illness to the police, ending the investigation.
Charlotte, Sean, and Amelia are reunited at the police station and head to the hospital to get Willow. Charlotte is thankful that the ordeal is over, but Sean remarks, “It’s not over […] Someone is going to pay” (35).
Part 1, Chapter 3 Summary: “Charlotte”
Willow is released from the hospital in a spica cast, which extends from her knee to her ribs and keeps her legs apart to allow her femur to heal. After four months, the cast will be cut in half, and she will sit in it to rebuild her stomach muscles. The family rents a larger Suburban and starts driving home. News has already spread in their small town about Willow’s accident, so they are met at home with casseroles.
Charlotte spends the next day arguing with the insurance company over Willow’s stay in the hospital. Willow sits on the couch watching Amelia skate on the frozen pond at the edge of the yard. Piper calls to check in and offers to take Amelia to skating lessons the next day, something Charlotte forgot about. Piper must get off the phone because she has to deliver a baby but encourages Charlotte to look for the bright side of this situation.
Following Piper’s advice, Charlotte decides to take Willow skating. Charlotte brings Willow outside to Amelia and then runs back inside to grab her skates and a rolling desk chair. She puts Willow in the desk chair and Amelia pushes the chair around the ice. Charlotte joins the girls skating.
Part 1, Chapter 4 Summary: “Sean”
When Sean returns to work, he is teased by his police colleagues over his arrest in Florida. He pretends he is unbothered by their teasing but punches a locker when they leave him alone to dress. He calls a local plaintiff’s attorney and schedules an appointment. That night Sean asks Charlotte to bring Willow along to the lawyer’s appointment, explaining that he wants the people who made their vacation so disastrous and traumatic to be held responsible.
The family goes to meet with Robert Ramirez and his associate Marin Gates. Charlotte and Amelia are annoyed to be there, and it is clear that Charlotte is disgusted by the work Ramirez and Gates do. Sean explains what happened at Disney World and says he wants to sue everyone who separated the family during the process. Ramirez explains that the family doesn’t have much of a case and acknowledges that while it was traumatic, “embarrassment isn’t a just cause of action” (48).
Ramirez then asks about how Willow was conceived and when Charlotte and Sean knew about her OI diagnosis. Charlotte mentions that there was something odd about her first ultrasound: Willow’s brain looked very clear, but Piper didn’t mention anything about it. Ramirez asks for the O’Keefes to release their medical records to him, noting that they may have a case—albeit not the one Sean thought—after all.
Part 1, Chapter 5 Summary: “Marin”
Following a health scare after an abnormal Pap smear, Marin looks back on her life, considering the relationships and family life she gave up to pursue a legal career. When the doctor asks about her family history, she realizes she doesn’t know her family history because she was adopted. This spurs her to search for her biological mother.
Marin tells Ramirez that she finds the O’Keefes filing a wrongful birth lawsuit “unpalatable,” but he counters that she won’t feel that way when they win the biggest wrongful birth settlement in New Hampshire history.
Marin goes back to her office to read her mail. She finds a letter with her adoption decree enclosed from the Hillsborough County Court. The letter doesn’t include any new information. Marin starts a folder for the O’Keefe case, noting that the phrase “wrongful birth” feels bad in her mouth and realizes that she is thankful her biological mother did not terminate her pregnancy.
Part 1, Chapter 6 Summary: “Piper”
Piper arrives to take Amelia to skating lessons, which Charlotte had forgotten about. Charlotte asks why Piper has to be so perfect all while working a full-time, high-powered job. Piper tries to relate by talking about problems she’s having with her daughter, but Charlotte snaps at her, telling her she doesn’t want to hear about Piper’s problems.
As Piper starts to leave with Emma and Amelia, she attempts to comfort Charlotte by reminding her that she is the most devoted mother Piper knows. Charlotte asks Piper about Willow’s first ultrasound, which Piper remembers because they could clearly see Willow sucking her thumb. Charlotte repeats the fact that the image was so clear.
Part 1, Chapter 7 Summary: “Charlotte, March 2007”
As Charlotte goes about her life, she begins to wonder whether she may have grounds for a wrongful birth lawsuit. She feels tremendous guilt for loving Willow as much as she does while simultaneously feeling overwhelmed and exhausted by caring for her.
While helping Willow change one day, Charlotte receives a phone call from Marin asking for a second meeting. Sean, Charlotte, and Willow meet with Ramirez and Marin, and Marin brings headphones and a movie—Ratatouille—for Willow because the adults’ conversation could be upsetting to her. Ramirez tells Charlotte and Sean that they have spoken to an expert on OI who says that Piper should have been able to diagnose Willow with OI during Charlotte’s first ultrasound. He explains that Piper’s negligence allows the O’Keefe’s to file a wrongful birth lawsuit against her.
Sean is outraged that Ramirez and Marin are implying that Willow should have never been born. Ramirez tries to calm him down, explaining that while the term “wrongful birth” sounds hurtful, it is simply a legal term. Sean picks up Willow and leaves the office, calling for Charlotte to follow him. Charlotte hangs back to ask what would happen if they won the lawsuit.
Prologue-Part 1 Analysis
Part 1 primarily focuses on the inciting incident for the plot: Willow’s fall at Disney World, which leads to the family considering a wrongful birth lawsuit against Piper. The recipe that precedes Chapter 1 involves the technique of tempering, which is “to heat slowly and gradually” (15). This recipe mimics the plot: Slowly and over time, the conflict between the characters begins to heat up. Picoult carries this baking motif—specifically by including recipes to precede key chapters—through the entire novel.
The first part of the novel establishes a motif of breakage. When Charlotte prepares for Willow’s birth, she imagines all the things that break in daily life: “Glass, and dishes, and fingernails […] a record, a horse, a dollar. You can break the ice. […] Chains can be broken. So can silence, and fever. […] I made lists of these things, in the hopes that it would make your birth easier” (1). Charlotte looks to other broken objects to find strength in the face of uncertainty surrounding Willow’s birth. However, she refuses to name Willow after one of these broken objects. Instead, she “wanted to give [Willow] a prophecy to carry with [her], the name of a tree that bends instead of breaking” (5). This implies that even though Charlotte sees the strength in broken objects, she still views them as damaged and hopes that Willow can overcome that stereotype.
Relationships begin to cleave and break in Part 1 as well. While Piper and Charlotte are not related, they function as sisters, sharing everything. Charlotte even calls Piper before she calls a lawyer when she is arrested for suspected child abuse. Piper is Willow’s godmother, a role often given to family members. However, cracks begin to show in their relationship as Charlotte considers filing the lawsuit, and, because they are not related by blood, their sisterhood will not be able to survive.
The recurring motif of the frozen pond is also introduced. Charlotte views the pond as “cruel and unusual punishment for Willow” and begs Sean to fill in the pond because it reminds Willow that she couldn’t skate on it (42). This—along with Charlotte’s musing that “[i]ce can break” (1), foreshadows the fact that Willow will eventually die in this pond. However, in this part of the novel, the pond serves as a place for Charlotte and her daughters to bond as they skate. By having them skate on such a fragile surface, it is implied that soon these relationships could break, too.
The theme of Food as a Source of Connection appears multiple times in this first section. When Willow is first born, Charlotte describes her as “spun sugar,” emphasizing her fragility but also her connection to Charlotte. Charlotte worked as a pastry chef before having Willow, and this image paints Willow as an intricate pastry that Charlotte has created. When Sean, Charlotte, and Willow return to speak with Ramirez and Marin, Willow watches the cartoon movie Ratatouille on a DVD player. The food-centric film is one of Willow’s favorite films and again harkens back to Charlotte’s past career of working in restaurants.
However, food can also symbolize a lack of connection between characters. Amelia begins to binge eat and throw up when she is separated from her family. She does this to gain some control over her situation: “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 […] I felt horrible—but this time there was a physical reason I could point to” (27). This introduces the theme of Visible and Invisible Illnesses and Disabilities. Many neighbors flood the O’Keefes with casseroles when they can see that Willow has been injured because “[f]ood is the currency of aid” (38), but few connect with the O’Keefes to help them in any other meaningful manner. No one can see Amelia’s condition, so she is ignored.
Each chapter of the novel is from the point of view of a different character, which allows for multiple characters to provide their interpretations of the narrative’s ethical dilemmas. Additionally, each character directly addresses Willow in their chapters, highlighting that she is the connective tissue that holds the novel together. Picoult’s narrative style thus creates a sense of community and intimacy surrounding Willow.
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