Jodi Picoult's new novel, "Small Great Things," features an African-American...

Jodi Picoult's new novel, "Small Great Things," features an African-American maternity nurse as a protagonist faced with treating the newborn son of white supremacists. Credit: Getty Images / atbaei

SMALL GREAT THINGS, by Jodi Picoult. Ballantine, 470 pp., $28.99.

Jodi Picoult is at it again. The author of 25 enormously popular novels, including “Leaving Time” and “My Sister’s Keeper,” is adept at taking on thorny issues — medical ethics, mass shootings, the death penalty — and recasting them on a relatable human scale. Her latest plunge into the current, “Small Great Things,” arrives at a pointed time when institutional racism — its violence and the entitlement it confers on some — is the subject of near daily commentary.

Picoult’s protagonist, maternity nurse Ruth Jefferson, has always played by the rules. The child of a housekeeper, she got a scholarship to New York City’s Dalton prep school, went to a state college, then on to Yale Nursing School and a 20-year career at the fictional Mercy-West Haven Hospital. Her husband died serving in Afghanistan. Her son, Edison, is a stellar student at his predominantly white high school. Ruth is beyond upstanding.

Kennedy McQuarrie is a public defender who could have chosen the corporate law route. Instead, the income of her ophthalmologist husband and the baby-sitting help of her mother enable her to fight the good fight.

These two women were not likely to cross paths, even though they live in the same New Haven neighborhood. Yet they do, when Ruth is accused of a homicide in the death of an infant, and Kennedy becomes her attorney.

Shortly after Davis Bauer’s birth, the newborn’s father demands Ruth be removed as his nurse. You see, Turk and Brittany Bauer are young white supremacists. Ruth’s longtime supervisor acquiesces. A note is added to his chart: “NO AFRICAN AMERICAN PERSONNEL TO CARE FOR THIS PATIENT.”

When a C-section emergency leaves Ruth alone with the baby, he stops breathing. Should she obey directives or intervene? The baby dies. The prosecution seizes on Ruth’s deep sense of professional betrayal as a motive.

Before Turk’s quest for retribution wends its way to a provocative courtroom climax, Ruth and Kennedy — and many readers — will be forced to tussle with set ideas about race and possibility, but also about justice and the American legal system presumed to uphold it.

Weaving three first-person accounts — Ruth’s, Kennedy’s and Turk’s — “Small Great Things” is big on ambition. Which doesn’t save the setup from feeling stacked and melodramatic. Does Turk’s character require a childhood trauma — even one that isn’t quite as he recalls — to fuel his racist ideology? Would a hospital’s lawyer really throw Ruth under the bus? (“Why would you sue the hospital, she asks Turk, “when everything suggests that Ruth Jefferson was the individual who killed your baby?”) Ruth’s subsequent arrest and arraignment is outrageous and nearly Kafka-esque. It’s meant to be.

Many of the novel’s most tender observations have little to do with race but with Ruth’s gifts as a nurse, her grace. An account of a hurried birth midwifed by Ruth’s mother is followed by the story of the beautifully handled yet wrenching death of an infant born with a fatal birth defect. Each episode speaks not of a vocation but of a calling.

Stunned by the hospital’s treatment, Ruth seeks out her older sister. Adisa, who changed her given name from Rachel, sees everywhere evidence of the grand racial conspiracy that, until now, Ruth has refused to acknowledge. “She answers the door with a toddler on her hip and a wooden spoon in her hand and an expression on her face that suggests she has been expecting me for years,” Ruth observes. It’s Adisa who reaches out to activist Wallace Mercy, clearly a nod to MSNBC commentator and activist Rev. Al Sharpton.

Though it’s rife with unnerving details about the contemporary white supremacy movement, Turk’s affiliations don’t preoccupy the novel most. It’s Ruth and Kennedy’s tango of trust and mistrust, their fundamental disagreement on courtroom strategy: Should race be front and center in Ruth’s defense or not? Ruth feels it must. Kennedy cautions it’s the last issue they should pursue with a jury.

Given that Picoult is wrestling with the subject of white privilege, writing Ruth’s story in the first person might seem like an exercise of that very prerogative. Can Ruth be the hero of her own story? Or must she be saved by Kennedy?

Turns out, this is Picoult’s driving concern, too. That “Small Great Things” embraces this question with empathy, hope and humility is no small feat.

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