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Melfort, Saskatchewan, Canada
I am a lawyer in Melfort, Saskatchewan, Canada who enjoys reading, especially mysteries. Since 2000 I have been writing personal book reviews. This blog includes my reviews, information on and interviews with authors and descriptions of mystery bookstores I have visited. I strive to review all Saskatchewan mysteries. Other Canadian mysteries are listed under the Rest of Canada. As a lawyer I am always interested in legal mysteries. I have a separate page for legal mysteries. Occasionally my reviews of legal mysteries comment on the legal reality of the mystery. You can follow the progression of my favourite authors with up to 15 reviews. Each year I select my favourites in "Bill's Best of ----". As well as current reviews I am posting reviews from 2000 to 2011. Below my most recent couple of posts are the posts of Saskatchewan mysteries I have reviewed alphabetically by author. If you only want a sentence or two description of the book and my recommendation when deciding whether to read the book look at the bold portion of the review. If you would like to email me the link to my email is on the profile page.

Friday, July 14, 2017

Small Great Things by Jodi Picoult

(25. – 912.) Small Great Things by Jodi Picoult – When I read a book featuring the defence of a criminal charge I, as a defence counsel in part of my real life legal practice, inevitably go through the book assessing the case presented by the author. My review of Small Great Things in this post and my next post will follow my assessment of the murder charge against Ruth Jefferson. My reactions and/or thoughts as a lawyer are in italics. Some of my remarks will be spoilers if a reader wants to limit their knowledge of the plot. I do not reveal the result of the trial but there may be more information than some readers would like in a review. (While I have defended many types of charges and assisted on murder cases I have never conducted the full defence of a charge of murder.)

In Small Great Things Ruth is a labour and delivery nurse at Mercy - West Haven Hospital. She has been working as a nurse at the hospital for over 20 years and is well respected for her skills and professionalism.

A jury will start out with respect for her as a dedicated health care professional.

One night she is called to assist with Davis Bauer, the newborn child of Brit and her husband, Turk, who is described as “hulking”. They are white supremacists appalled that Ruth, who prefers to be referred to as a woman of color rather black or African American, is his nurse. Turk insists the nursing supervisor put a note on the chart that no one like Jefferson can take care of the baby.

Race is going to be an issue in the trial. Will it help or hurt the defence?

While reluctant the supervisor posts a hot pink Post-It note on the chart saying:


I think the hospital is in real trouble civilly when a supervisor posts such a note and it remains on the chart. Criminally the note is making the accused a victim.

During her examination of the baby Jefferson detects a possible heart murmur.

A day later, Davis is recovering from an operation for circumcision when there is an emergency C-section taking the other nurses from the ward and Ruth is directed to watch the baby. While she watches him he stops breathing. Uncertain what do because of the note she freezes but then assesses the baby. Hearing someone coming she wraps up the baby. She tells the supervisor returning to the ward that she was doing nothing. Ruth has lied and repeats the lie during the subsequent investigation and to her lawyer.

Lying, even well motivated lying, to another witness is harmful but more often than you would expect not decisive in a criminal case. Lying to your lawyer is stupid though it happens all too often.

The supervising nurse takes charge and a full scale effort is made to resuscitate Davis. Ruth is directed to commence compressions. Using two fingers she begins compressions of the baby’s chest. At one point she is told her compressions are too intense. Despite all efforts Davis dies.

What is the actual cause of death?

It is:

…. Hypoglycemia leading to hypoglycemic seizure leading to respiratory arrest and cardiac arrest.

How is Ruth legally responsible for such a death? What is the expert evidence in support of the official cause of death? Could there be another cause?

Ruth is charged: count one is murder and count two is negligent homicide. 

Murder is a reach. Where is her pre-meditation? She had no idea she was going to be put in charge of monitoring the baby. With regard to compressing the baby’s chest she was following orders. There is no indication in the cause of death that her compressions factored into Davis’s death. With regard to negligence could her hesitation be criminal? Yet what was she supposed to do when the hospital said she was not to care for the baby? Is it her legal responsibility to ignore the order of her supervisor not to care for this baby? She has been given contradictory orders – care and not to care.

(To be continued.)


  1. I like this kind of discussion as I've been an avid legal beagle since I read and watched Perry Mason years ago, and then watched the fantastic show "The Defenders."

    I would ask if it doesn't violate anti-discrimination laws for a hospital to post that no African-American staff should care for this patient.

    If that were done here in a restaurant or bus station or hotel, the owners would be slapped with charges of discrimination. Isn't a hospital also liable for this charge?

    And, yes, I ask how could Ruth be responsible for hypoglycemia? What caused the hypoglycemia? Was it not noticed by doctors? Was the baby not being given proper nourishment? Or was there a medical reason for the baby to develop hypoglycemia?

    Lots to chew on. I'll be reading the next post.

    1. Kathy D.: Thanks for the comment. In real life I do not expect any nurse would put such a note on a chart. The issue would have gone to administration. I would not be surprised if the decision would have been to either advise the Bauer's they can be transferred to another hospital or shift Ruth's shifts so she was not on duty for the 1-2 days the baby would still have been at the hospital.

      You are asking the right questions about hypoglycemia.

  2. This is a fascinating assessment, Bill, of the basis on which Ruth is charged with murder, and of your assessment of the case. It's also a complex situation for the characters, and that can make for fine reading in and of itself. I look forward to your next post on this.

    1. Margot: Thanks for the comment. Picoult gives a nuanced picture of the white supremacists that will make a reader think about lives not just beliefs.

  3. Wow, that's quite a setup. Look forward to reading more...

  4. On asking the right questions, my mother constantly told me when I was a teenager and she had to listen to my multi-fold arguments to bolster my cases on whatever, that I should become a lawyer.

    In this country, I wonder how a hospital could put up such a sign. That's an instant discrimination case.

    I mean a restaurant can't put up a sign saying who they won't serve. It seems a hospital can't declare this. An administrator would have to tell these people that it's illegal to do what they want; it violates the 1953 Civil Rights Act.

    I suppose there are ways around it, like assigning Ruth to another department for a few days or giving her time off, but still, people have to stand up to this horror and nor enable it.

    I saw a video of a white woman in Canada in a clinic demanding a "white" doctor for her child, and on she ranted. The staff told her that he would see whatever doctor was available. But a few people who were also in the waiting room, including people of color, told her off. The staff stayed strong.

  5. I meant the 1964 Civil Rights Act.

    1. Kathy D.: Thanks for the comments. I was very surprised in the book when they acceded to the white supremacists. I was sure the staff supervisors would be insisting on treatment by Ruth.