Summary/ Plot: Conceived by means of in vitro fertilization, Anna Fitzgerald (Abigail Breslin) was brought into the world

to be a genetic match for her older sister, Kate (Sofia Vassilieva), who suffers from acute promyelocytic leukemia, in order to keep her alive. Her family members are introduced one by one and each tells about how Kate's illness has affected them personally and the family. When Kate turns 15, she goes into renal failure. Eleven-year-old Anna knows that she will be forced by her parents to donate one of her kidneys. She also realizes that she may not be able to live the life she will want to lead - she may be unable to cheer-lead, play soccer, or be a mother. Anna tells her parents that she does not want any of this, and proceeds to sue them for medical emancipation and the rights to her own body. Her overprotective mother, Sara (Cameron Diaz), who leads an obsessive campaign to keep Kate alive, is indignant at Anna's decision and even strikes her across the face when she receives the notice of intended prosecution. Attorney Campbell Alexander (Alec Baldwin) agrees to work for Anna as her guardian ad litem, suing for partial termination of parental rights. It is later learned he agreed to take the case not for the notoriety, but because he has epilepsy and understands her predicament of not having control over her own body. The film is interlaced with flashbacks that detail Kate and Anna's closeness, as well as how Kate's illness has affected her siblings' lives and their relationships. In a flashback, Kate also meets a fellow cancer patient, Taylor Ambrose (Thomas Dekker), whom she begins dating. After a date, they share their first kiss outside Kate's house, with Sara and Brian watching from their bedroom window. After this, he becomes her boyfriend in and out of hospital and supports her as she undergoes treatment. He then asks her to the hospital's "prom" for teen patients. A few days later, Kate is crying because Taylor hasn't called her for several days. Her mother Sara is furious when Kate mentions they did "stuff" after the prom and storms out to ask the nurse where Taylor, evidently believes that he had dated her daughter merely to sleep with her, and knew that he has died. Kate makes a request to go to the beach one last time, and Brian, her father, obtains permission from her doctor and removes her from the hospital to take her and the kids. Overprotective as ever, Sara is furious when Brian shows up at the house with Kate and demands that she be returned to the hospital. Brian angrily refuses and drives off, threatening Sara with a

divorce if she does not join them. Sara later shows up at the beach, where they enjoy one final family outing. To Sara's dismay, the judge (Joan Cusack) refuses to grant summary dismissal, and the case goes to a hearing. During the hearing, Anna and Kate's older brother, Jesse reveal that Anna's actions are actually under Kate's instruction; Kate, not wanting to live any longer, and knowing Sara refuses to hear any option other than her desired one, had gently persuaded Anna to refuse to donate her kidney. Sara is indignant at this discovery, but is finally forced by both Jesse and Brian to realize that Kate had been trying to tell her this for some time. Before the case is decided, Kate dies in her sleep at the hospital with her mother by her side. After Kate's death, Campbell brings the court decision: Anna won the case. The family moves on with their lives, but every year on Kate's birthday they go to Montana, which was her "most favorite place in the world." At the end, Anna says that their relationship continues because she will see Kate again.

Therapeutic and Non-therapeutic Communication: MOVIE CHARACTER TECHNIQUE USED (Label for the technique used (T) therapeutic, (NT) non-therapeutic) Sara: Eat, Kate. Giving Information (T) Kate: I'm eating. Sara: Is it not good? Exploring (T) Asking Information (T) Encouraging Broad Opening (T) Sara: Where are you going? Asking Information (T) Exploring (T) Kate: Bathroom, wanna come? Will you breathe on me later? Kate: It's really good, Mom. It's good to me. KATES RESPONSE

Sara: You gotta get up. You havent been out of that bed in two weeks.

Presenting the reality (T) Giving Information (T) Making an observation (T) Kate: I'm tired.

Sara: You can do it. It's a beautiful day outside. Brian: It's sunny. It's gonna be good for you.

Rejecting (NT) Disagreeing (NT) Using negative words (NT) Kate: I'm too sick. Kate: No.

Sara: You're not too sick. You're depressed. I'm not gonna feed you antidepressants...they're gonna just make you more numb. Now, get up. Kate: No! Brian: Hey, baby? Kate: You want to tell me what's really wrong? I'm tired. Don't you get that? I'm sick, and I'm tired, and I'm ugly. Sara: Stop it. Kate: Don't you dare tell me that I'm beautiful, because I'm not. Don't you dare tell me that nobody's gonna stare at me, because they will. Sara: Oh, God.

Kate: I'm a freak. Nurse: Quietly, girls. This is a hospital, this is not a sorority. I need a urine sample. Nurse: Well, drink something. Giving information (T) Defending (NT) Advising (NT) Using Negative words (NT) Kate: And I'm not thirsty. Kate: But I don't have to go.

Nurse: Listen to me, young lady, I don't like a lot of back talk. Drink, don't drink, I don't care. But you just better fill it. Nurse: You ready? Nurse: You are disgusting. Dr. Chance: Hello, Kate. One to 10, hows your pain? Dr. Chance: Six? All right, let's take care of that. Questions answerable by yes or no (NT) Using Negative words (NT) Asking for Information/ Seeking for Information (T) Disapproving (NT) Encouraging description (T) Seeking Information (T) False Reassurance (NT) Encouraging Collaboration (T) Sara: You just stay strong enough for surgery, okay? Giving Information (T) Kate: Six. Kate: And so are you Kate: All set. Oh, wait a minute. Looks a little cloudy. I think I should filter it again. Much better. What do you think?

Kate: Okay, Mom. Taylor: The free cocktails. Giving Information (T) Kate: What are you here for? Seeking Information (T) Taylor: I'm Taylor. AML. Encouraging Broad Opening (T) Taylor: A rarity. Kate: Yeah, right? Taylor: You're in remission? Kate: Today, anyway. Chemo? Kate: Kate. APL. Kate: Right. Happy hour.

Taylor: Yeah. So, what do you do when you're not here at the hospital? Kate: Nothing. Just wait for something that makes me come back. Taylor: Well, then maybe we could hang together sometime? Kate: Yeah. Taylor: Okay. Can I get your phone number? Kate: Okay. Taylor: Thanks. Kate: Thanks, Mom. So, what do you think? Nurse: Girl, that boy is fine. Making an

Observation (T)

Kate: I know, right? So do you think he'll call?

Sara: I don't know, baby, I...

Using Negative words (NT) Kate: Hello?

Taylor: Okay, I just wanted to make sure you didn't give me a bogus number. Anna: How did you know what to do?

Giving Information (T) Seeking clarification (T) Exploring (T) Seeking Information (T) Encouraging Broad Openings (T) Kate: I don't know. I just did. He has scars on his hands......from graft. versus. host. I could feel them when we were holding hands.

Anna: Was that weird? Kate: It was kind of like we matched. Taylor: How far into it are you? Exploring (T) Seeking Information (T) Taylor: A hundred bucks says you won't make it till 3 without tossing your cookies. Encouraging Broad Openings (T) Using Negative words (NT) Kate: You're disgusting. Such a slacker. Don't you have anywhere to be? Taylor: No, no where. And what are you doing? Kate: You're trying to weasel Kate: Just started.

your way out of the bet? Taylor: I'm trying to spare you. Sara: Kate. Sara: You're angry. Doesn't mean you have to take it out on the world. Kate: She's a bitch. Did you see her looking at my scarf? Sara: Maybe she liked the pattern. Kate: Really? Anna: Yeah. Kate: That dress sucked anyway. Sara: It was awful. Kate: You know what? I'm not going. I'm never gonna find a stupid dress anyway. Sara: Don't you think that Questioning Making an Observation (T) Anna: You look like a banana. Saleslady: I think it's very nice. Very modest. And it does cover up a lot of cleavage. Exploring (T) Seeking Information (T) Encouraging Broad Openings (T) Presenting the reality (T) Agreeing (NT) Acceptance (T) Using negative words (NT) Kate: Let's go. Kate: Really? Will it cover this? Kate: It's a little low, don't you think?

every girl going feels the same way?

answerable by yes or no (NT) Making an comparison (NT) Presenting the reality (T) Kate: I don't care about any other girl. I just wanted to look good, really good, for one night Kate: You ever think about dying?

Taylor: Not really.

Using negative words (NT) Giving Information (T) Kate: You're not scared?

Taylor: No. If I didn't have cancer, I never would have found you. So yeah, I'm glad I'm sick. Questioning answerable by yes or no (NT) Sara: Did you guys get into a fight after prom? Sara: Well, maybe hes busy, you know? Maybe he went out of town...for an emergency? Maybe it has nothing to do with you. Kate: We did it, okay? We did it and now he wont call me back. Kate: Its been three days, Mom. He wont return my calls. I leave messages and he

Giving Information (T) wont call me. Seeking Information (T) Encouraging Broad openings (T) Clarifying (T) Kate: No.

Sara: You did it? Kate: Thats right. Sara: What do you mean, did it? You did it it? Kate: No, but we did some stuff, okay? Sara: Stuft? What kind of stuff? Kate: I dont wanna talk about it with you. I just told you because Im mad Brian: What did you say, baby? Anna: What's going on? It smells like booze in here. Anna: A party? Anna: What are you doing? Kate: I'm going to see Taylor. Anna: What? No! No! Anna: Oh, my God. Oh, my God. Giving literal responses (NT) Seeking Information (T) Kate: Dont worry. Its just the new medicine getting ready Kate: Sissy. Seeking Information (T) Making an Observation (T) Clarifying (T) Using Negative words (NT) Disagreeing (NT) Kate: Yeah, a going. away party.See you, Mom! Goodbye, fucking hospital! Damn! Kate: Having a little party. Clarifying (T) Kate: I wanna go to the beach.

 Anna: You in pain?

Exploring (T) Questioning answerable by yes or no (NT)

for the kidney.

Kate: Pain? My whole life is a pain. This is the end, sissy. It just gets scarier from here on out. Gonna chop me and cut me...till Im a vegetable. Two cells in a Petri dish that she shocks with an electric cord.

False Reassurance (NT) Use of negative words (NT)

Anna: Youll be all right. Kate: Its over. Time to go. I need you to do me a favor, sissy. Anna: What favor? Kate: You can release me. Anna: Mom and Dad are gonna kill me. What am I supposed to tell them? Kate: Tell them youre important too. Tell them you wanna play soccer. Tell them you wanna cheerlead. Anna: Theyll never believe me. Kate: Yeah, they will. And you wanna know why? Because its the truth. Anna: You scared? Seeking Information (T) Anna: What do you think Kate: No. I know I'll be okay.

happens? I mean, where do you go?

Encouraging Broad Openings (T) Questioning answerable by yes or no (NT) Kate: I don't know, baby. But who knows? Wherever it is, maybe I'll run into Taylor.

Anna: Will you wait for me?

Clarifying (T) Acceptance (T) Kate: What?

Anna: If you go anywhere crazy, will you wait? I mean, how will I know How to find you? Kate: If you're ever lost or scared...go to Montana. Anna: Montana? Kate: Yeah. That's where I'll be. Anna: Okay. Sara: Nope. Sara: I'm not mad at you, I'm just mad. You gotta get some rest, okay? You be strong for surgery. Disagreeing (NT) False reassurance (NT) Giving Information (T) Kate: Are you mad at me? Seeking Information (T) Acceptance (T) Kate: You don't wanna talk?

Kate: I made this for you. Sara: What is it? Kate: It's everything. It's us. It was a good one, wasn't it?

Sara: The best. Kate: Remember that summer when I went away to camp? And I was so scared that I'd miss you guys. Sara: Yeah. Kate: Before I got on the bus...you told me to take a seat on the left side...right next to the window...so I'd be able to look back and see you there. Sara: I remember. Kate: I get the same seat now. It's gonna be okay. It's gonna be okay, Mom. I promise.

Defense and Coping Mechanism: 1. Isolation: When Kate already experienced the effects of her treatment she frequently self-pity. She considers herself as ugly and every one would stare at her because she is bald and no one could love her because of her appearance. She stayed at her room for two weeks and spends her time in crying. 2. Displacement: There was a time that Kate starts banging her stuffs and had a party, a goodbye party. She will throw everything, shout, and then cry. 3. Compensation: At the hospital, she start reminiscing her life, the things that she has done, her parents, siblings, her family and her boyfriend (who also passed away because of cancer). She looked at the scrap book and accepts that she is dying. Theres a lot of things and beautiful memory to remember. 4. Denial: This defense/ coping mechanism is not applicable to the client but to her mother, Sara. Sara denies that her daughter will die. She has done everything to keep Kate alive. She did the Savior Child, to donate/ provide everything that is needed to the treatment.

She also gave up her profession for her child, to take good care to Kate. She cant let go her daughter though she sees that her child is dying. Sara also denies that Kate was trying to tell her to give up, but Kate do it and she never listen. But later on, in the court, when Jesse reviled that Kate asked her younger sister Anna to sue her parents, Sara realized that she must let go of Kate.

Medical- Surgical Intervention: At the very young age, in the time that theyve discovered that Kate has the symptoms of Leukemia, Kate undergone Bone Marrow Aspiration at her Lumbar area to confirm what specific kind of blood cancer. Sara and Brian (parents of Kate) considered having a Savior Child, a genetically engineered child that has the same characteristics of the genes of Kate that can provide her in everything that she needs. The child can support her sisters needs and may be the cure to her disease. Sara conceived Anna, and she is the savior child. In some point view this kind of situation is very unfair to the savior child. When Anna was born, they took stem cell and transferred to Kate. They say that stem cell is effective in curing blood cancer. Then she also undergone blood transfusions specifically White Blood Cells and that is provided by the savior child, Anna. Kate also has undergone bone marrow transplant. These transplants restore lost blood cells thereby allowing doctors to use higher doses of chemo and radiation to fight the cancer. When Kates kidneys failed to function, she undergone dialysis and consider surgery: a kidney transplant. All of the things she needs are courtesy of Anna.

Pharmacotherapeutics: There is no direct list of drugs used to save Kates life but she does undergone Chemotherapy and Radiation Therapy. She also experienced the side effects of these treatments; she has lost her hairs, and has the higher risk of infections, decreased appetite, bleeding, nausea and vomiting. She was saved by radiation therapy, she has the remission but afterwards she had a relapsed.

Nutrition and Diet: There is no specific diet seen in the entire movie for Kate but Sara usually prepares steamed, organic and germ-free food, just to make sure that Kate will stay healthy. Maybe and just maybe Kate is allowed to eat whatever she wants to eat.

Republic of the Philippines CAVITE STATE UNIVERSITY Don Severino De Las Alas Campus Cavite, Philippines College of Nursing

A Movie Analysis Regarding Cancer:

My Sisters Keeper

Submitted by: Sumaya, Ana Faye T. IV- BSN 3 Submitted to: Prof. Ederlyn C. Papa, RN July 2011