Reader Notes

This book features content related to the death of a parent, parent/child relationships, and aid in dying.

Recommended Audience

This book is not recommended to be read during the first few months after a loss, particularly if the reader was a caregiver.



In Anna Quindlen’s novel One True Thing (1994), narrator Ellen Gulden traces in hindsight the months she spent caring for her terminally ill mother, Kate, whose death by morphine overdose leads to Ellen being accused of killing her mother out of mercy. Much of the novel centers on the development and maturation of Ellen, who leaves her journalism career begrudgingly to move home to an affluent New England college town and assist Kate, a traditional homemaker with whom she never had felt close and whose company she shunned in favor of that of her erudite father, George, an English professor. As Quindlen’s novel progresses, Ellen forges a bond with Kate that culminates at Kate’s death, while her relationship with her father is progressively shaped by frustration at his frequent absence in caregiving duties, his extra-marital affairs, and his seeming incapacity to grasp that his wife is dying.

I have read and returned to One True Thing many times since I first read it twenty years ago. As a younger reader, I was initially drawn to a narrative of a 24-year-old, professionally successful woman being pressured into caregiving for a parent with whom she shares little closeness and a good amount of contempt. I sympathized with Ellen’s development from a begrudging nurse / cook / domestic laborer to a more attuned and emotionally intelligent daughter and women. 

As a university educator, I have taught this novel a number of time, in courses spanning topics of loss in literature, end-of-life ethics, and communication with the dying. In a chapter of my doctoral dissertation, I analyzed One True Thing alongside Margaret Edson’s 1993 play, Wit, to uncover patterns in literary representations of dying women in American culture in the 1990’s and how they contributed to the right-to-die movement. 

However, many years after my initial reading of this resonant piece of fiction, I find myself drawn even more to Kate, whose dying process is marked both by her increasing urgency in needing to be heard by those around her – principally, her husband and children – and by her self-determination through her dying process. There are both eloquence and tragedy in Kate’s character development that may be overlooked initially. Through Quindlen’s skilled use of vivid detail and pithy prose, the reader feels Kate’s frustration in being silenced in her suffering and is reminded of the continued and crucial importance of extending attunement and empathy to those in their dying trajectories. 

In one scene of the novel, when Ellen attempts to confront her father about his emotional absence in the household, their interchange is telling. George cuts off her concerns brusquely, stating, “I think this time should be about your mother. It calls for a little empathy”; she replies, “You never taught me empathy,” and he responds, “Learn it now,” leaving her to ask, “And you? Where is your empathy?” – a question to which he does not respond. Throughout the novel, neither Ellen nor George displays empathy or understanding toward one another as they become silent adversaries circling Kate’s increasingly-wasted body. They frequently communicate through Kate; George spends increasingly long hours in his office at the college or in a local bar, unable to face his wife’s decline, and Ellen grows stoic in her slavish attention to her mother even as she feels acutely put-upon by her father. Lost to each of them in this dynamic is a capacity to understand, validate, or hear the very person over whom they fight and from whom they compete for affection. 

When discussing empathy in my own work, I refer to a non-patriarchal conception of the term that resists projection onto another and instead engages in the work of reception from and feeling with another. This definition of empathy is best articulated by ethicist and philosopher Nel Noddings, who writes, “I do not project; I receive the other into myself, and I see and feel with the other. I become a duality. I am not thus caused to see or to feel – that is, to exhibit certain behavioral signs interpreted as seeing and feeling – for I am committed to the receptivity that permits me to see and to feel in this way. The seeing and feeling are mine, but only partly and temporarily mine, as on loan to me.” 

In many ways, One True Thing remains a skilled and deeply felt fictional account of the complications of parent-child love and loss. Most impressively, this text implicates and underscores the timeless need to bear witness to the suffering of those who are dying and to practice empathy – both to the dying individual and to others impacted by their death. 

Discussion Prompts

  1. The central relationship highlighted in this novel is that of Ellen and Kate, and it changes radically over the course of the narrative. However, Ellen’s relationship with her father also changes in indirect proportion to the closeness she develops with her mother, and even her relationships with her brothers alter. Have you ever experienced a significant change in your relationship with someone as a result of someone’s dying process? What impact has death had on the individual relationships within your own family system?
  2. This novel also explores complications of gender roles in homemaking, caregiving, and parent-child relationships, both directly and subtly. What expectations for women as caregivers do you think have changed since this novel was published in 1994? Which do you believe have remained the same? What are some effects of gendered expectations for providing care to those who are dying?
  3. In one of the most poignant and powerful scenes in this novel, Kate implores Ellen to listen to how she feels, saying, “I want to talk before I die. I want to be the one who gets to say things, who gets to think the deep thoughts . . . Let me talk now without shushing me because it hurts you to hear what I want to say.” What do you think about the silence around death and dying in American culture and its impact on individuals who are dying? Do we have a responsibility to encourage dying persons to speak about their suffering and, if so, what are the limitations of that responsibility? 

About the Reviewer

Sara Murphy, PhD, CT, is a death educator, certified thanatologist (Association for Death Education and Counseling), and suicidologist. She is a faculty member at the University of Rhode Island and conducts workshops on death, dying, and bereavement nationwide for professional organizations, schools, and community groups. Dr. Murphy is also a bereavement and suicide consultant and the author of the booklet, Grieving Alone & Together: Responding to the Loss of Your Loved One during the COVID-19 Pandemic, a free resource available to grieving families and helping professionals published by the Funeral Service Foundation. She can be reached at