Opposite of Always

In Opposite of Always, protagonist Jack King falls in love with Kate, but her experience with sickle cell disease, a condition sometimes referred to as sickle cell, complicates their relationship. Kate’s description of her symptoms aligns specifically with sickle cell anemia, which is “one of a group of inherited disorders known as sickle cell disease” (“Sickle Cell Anemia.” Mayo Clinic, 22 Dec 2023). A change in the gene that governs the body’s production of hemoglobin causes this disorder. Hemoglobin is a compound in red blood cells that allows them to deliver oxygen throughout the body. Sickle cell anemia affects the shape of red blood cells, which are usually round and flexible. It causes some of them to be shaped like crescent moons, or sickles. These cells slow or block the flow of blood in the body as they become rigid and sticky.

People who have sickle cell anemia experience significant symptoms. Anemia refers to a shortage of red blood cells, which occurs because sickle cells usually die in 10 to 20 days, unlike healthy red blood cells, which live for about 120 days. With this shortage, the body doesn’t get enough oxygen, leading to fatigue and other major problems. Episodes of extreme pain are another symptom, clinically referred to as pain crises. These crises, which vary in frequency from patient to patient, require hospital stays. Kate alludes to these pain crises in Opposite of Always. Her hospital stays noticeably interfere with her life, including important milestones like prom. Sickle cells can damage the spleen, leading to an increased risk of infections. Sickle cell can delay growth and puberty by depriving the body of the oxygen and nutrients it needs for development. Many other symptoms may be present as well. They can eventually lead to fatal complications like stroke, lung infections, bone death, organ damage, or blindness (“Sickle Cell Anemia”).

Sickle cell anemia is a genetically inherited disorder that requires copies of the sickle cell gene from both parents. The communities most affected by sickle cell anemia in the United States are those of African, Mediterranean, and Middle Eastern descent. Over 90% of sickle cell people living with sickle cell in the US are Black (“Data and Statistics on Sickle Cell Disease” CDC). Prevention of this disorder can include consulting a genetic counselor before conceiving for those who carry the sickle cell trait. This can help potential parents understand their level of risk of having a child with sickle cell anemia (“Sickle Cell Anemia”). In Opposite of Always, Jack’s mother explains to him that she and his father were screened for the sickle cell gene before conceiving him because it’s a major concern in the Black community. She adds that she was surprised people from other communities are affected, too. This scene emphasizes that sickle cell is not specific to the Black community alone and shouldn’t be viewed exclusively in terms of race. She talks about what it was like seeing her friend experience painful symptoms from the illness. This emphasizes that sickle cell affects individuals and their friends and families. Jack experiences this for himself with Kate, developing the book’s theme about Loving Someone with a Chronic Illness.