Handle with Care is a 2009 family and medical drama by Jodi Picoult. Like many of Picoult’s novels, Handle with Care explores controversial ethical dilemmas; this novel explores the legal concept of wrongful birth. The narrative focuses on Willow O’Keefe, who was born with osteogenesis imperfecta (OI), a condition that makes her bones fragile, meaning that she will experience hundreds of broken bones in her life. Following a particularly traumatic and embarrassing broken bone, Charlotte O’Keefe, Willow’s mother, decides to sue her obstetrician—and best friend—for wrongful birth. The novel explores the aftermath of the lawsuit, focusing primarily on the themes of Visible and Invisible Illnesses and Disabilities, The Power and Shortcomings of Motherhood and Maternal Love, and Food as a Source of Connection.

Handle with Care is Picoult’s 17th novel and a New York Times bestseller. This guide refers to the 2009 Atria paperback edition of the novel.

Content Warning: This source material includes depictions of medical procedures and trauma, self-harm, sexual assault, suicide, disordered eating, outdated and offensive mental health beliefs and terminology, police brutality, and the death of a child.

Plot Summary

In Part 1, the O’Keefe family decides to go on a family vacation to Disney World. The O’Keefes rarely travel because their youngest daughter, Willow, has OI, a condition that causes her bones to break easily and often. On their first day at Disney, Willow breaks her leg. The family forgot to bring documentation of Willow’s condition, leading to Charlotte and Sean, Willow’s parents, being accused of and arrested for child abuse. Willow’s 13-year-old sister, Amelia, is taken into protective custody. While a doctor from back home eventually confirms Willow’s diagnosis to the police and the O’Keefes are released and reunited with both their daughters, the family is shaken and embarrassed by the situation. Amelia, in particular, is traumatized by the family separation and develops an eating disorder.

Unable to move past his embarrassment, Sean decides to reach out to a plaintiff’s lawyer to discuss suing Disney, the hospital, and the police. He is told that he doesn’t have much of a case, but that because of some information in Charlotte’s medical records, he might have grounds for a wrongful birth suit against Charlotte’s obstetrician, Piper. Piper is also Charlotte’s best friend and Willow’s godmother. When Charlotte was pregnant, Piper diagnosed Willow with OI at her second ultrasound; however, there is a chance she could have diagnosed or encouraged more testing earlier at the first ultrasound. The O’Keefes struggle with a wrongful birth suit because they never considered terminating Willow and fervently love her and want her to be alive. However, they cannot provide her with the essentials she needs to live a full life, and a lawsuit could allow them to provide for her. Because of this, Charlotte and Sean consider suing Piper, both strongly believing they would only do so to help Willow. Their lawyer, Marin, finds their actions off-putting. Marin is currently searching for her biological mother and is thankful her mother she didn’t terminate her pregnancy, and this search colors her opinion on the O’Keefes’ case. However, she will represent them if necessary.

In Part 2, the O’Keefes follow through with suing Piper, which shocks and surprises her since she had no idea they were upset or felt like she had done anything wrong during Charlotte’s pregnancy. The lawsuit destroys her friendship with Charlotte, ruins Piper’s career, and ends Amelia’s friendship with Piper’s daughter Emma. Despite initially agreeing to be part of the lawsuit, Sean begins to second-guess his decision and how it will affect Willow’s life. Amelia begins to self-harm as her world becomes more and more chaotic.

In Part 3, Sean drops out of the lawsuit, ultimately deciding to testify on behalf of Piper. This causes immense damage to the O’Keefes’ marriage, and Sean files for divorce. Willow breaks her femur, which adds more stress to the family. As trial prep begins, Piper has fully quit her job to focus on redecorating her home, while Charlotte has returned to her previous career as a pastry chef. Using money from her pastry job, Charlotte takes Amelia and Willow to an OI convention. While Willow feels seen and included for the first time, Charlotte is ostracized by her fellow conventiongoers for filing a wrongful birth suit. As the trial eventually begins, she continues to struggle with her true intentions for filing the lawsuit, wondering if she filed the lawsuit for selfish reasons rather than altruistic ones.

In Part 4, Marin meets her biological mother but is rejected by her. However, she feels thankful for the chance to meet her and even more thankful to her mother for raising her. Willow cuts herself badly with a razor after seeing Amelia do the same thing. Her subsequent hospitalization brings Sean and Charlotte back together, and they reconcile. After Willow’s accident, Piper realizes that Amelia has an eating disorder and a tendency to self-harm and tells Sean, leading to Amelia receiving treatment. Charlotte wins her lawsuit, receiving $8 million, which is the largest payout in state history. However, several months after the lawsuit, Willow drowns in a frozen lake. The O’Keefes remember Willow through family recipes and by burying their settlement check in her casket.