Small Great Things: A Novel

#1 NEW YORK TIMES BESTSELLER • In “the most important novel Jodi Picoult has ever written” (The Washington Post), the acclaimed author tackles race, privilege, prejudice, justice, and compassion—and doesn’t offer easy answers.

“A gripping courtroom drama . . . Given the current political climate it is quite prescient and worthwhile. . . . This is a writer who understands her characters inside and out.”—Roxane Gay, The New York Times Book Review

Ruth Jefferson is a labor and delivery nurse at a Connecticut hospital with more than twenty years’ experience. During her shift, Ruth begins a routine checkup on a newborn, only to be told a few minutes later that she’s been reassigned to another patient. The parents are white supremacists and don’t want Ruth, who is Black, to touch their child. The hospital complies with their request, but the next day, the baby goes into cardiac distress while Ruth is alone in the nursery. Does she obey orders or does she intervene?

Ruth hesitates before performing CPR and, as a result, is charged with a serious crime. Kennedy McQuarrie, a white public defender, takes her case but gives unexpected advice: Kennedy insists that mentioning race in the courtroom is not a winning strategy. Conflicted by Kennedy’s counsel, Ruth tries to keep life as normal as possible for her family—especially her teenage son—as the case becomes a media sensation. As the trial moves forward, Ruth and Kennedy must gain each other’s trust, and come to see that what they’ve been taught their whole lives about others—and themselves—might be wrong.

Jodi Picoult is the #1 New York Times bestselling author of twenty-nine novels, including By Any Other Name, Mad Honey (co-authored with Jennifer Finney Boylan), Wish You Were Here, The Book of Two Ways, A Spark of Light, Small Great Things, Leaving Time, and My Sister’s Keeper, and, with daughter Samantha van Leer, two young adult novels, Between the Lines and Off the Page. She lives in New Hampshire with her husband.

“Small Great Things is the most important novel Jodi Picoult has ever written. . . . It will challenge her readers . . . [and] expand our cultural conversation about race and prejudice.”—The Washington Post

“A novel that puts its finger on the very pulse of the nation that we live in today . . . a fantastic read from beginning to end, as can always be expected from Picoult, this novel maintains a steady, page-turning pace that makes it hard for readers to put down. It also allows for conversations to be had and for people to sit back and look at their lives, actions (past and present) and wonder how they will move forward. This is a fantastic book not only because it addresses something that happens in America and around the world every day, but it also shows us that change is possible too.”—San Francisco Book Review

“A gripping courtroom drama . . . Given the current political climate it is quite prescient and worthwhile. . . . This is a writer who understands her characters inside and out.”—Roxane Gay, The New York Times Book Review

“Small Great Things embraces . . . empathy, hope and humility.”—Newsday

“[An] author at the top of her heart-rending game.”—The National

“A gripping read about an issue of urgency.”—The Vancouver Sun

“A book that needs to be read.”—The Detroit News

“Exciting and fast-paced.”—New York Journal of Books

“[Picoult] offers a thought-provoking examination of racism in America today, both overt and subtle. Her many readers will find much to discuss in the pages of this topical, moving book.”—Booklist (starred review)

“Powerful . . . revelations abound.”—The Free Lance-Star

“Picoult has outdone herself.”—St. Louis Post-Dispatch

“A courageous and important work.”—Minneapolis Star Tribune

“I couldn’t put it down. Her best yet!”—New York Times bestselling author Alice Hoffman

“A compelling, can’t-put-it-down drama with a trademark [Jodi] Picoult twist.”—Good Housekeeping

“It’s Jodi Picoult, the prime provider of literary soul food. This riveting drama is sure to be supremely satisfying and a bravely thought-provoking tale on the dangers of prejudice.”—Redbook

“Jodi Picoult is never afraid to take on hot topics, and in Small Great Things, she tackles race and discrimination in a way that will grab hold of you and refuse to let you go. . . . This page-turner is perfect for book clubs.”—Popsugar

Small Great Things by Jodi Picoult is a powerful, emotionally layered novel that explores racism, privilege, and moral responsibility through the story of a tragic event and its aftermath. The book centers on Ruth Jefferson, a highly skilled African American labor and delivery nurse who has spent years caring for newborns and their mothers. Ruth is professional, calm, and respected by many of her colleagues, but she also lives daily with the subtle and not-so-subtle realities of being Black in a largely white, privileged environment. One morning, Ruth is assigned to care for the newborn son of Brittany and Turk Bauer, a white couple. Right away, Ruth notices something different: Turk, a loud and aggressive man, is a committed white supremacist, and his body is covered in racist tattoos. When he sees Ruth holding his baby, he demands that she be removed from the case. He tells the charge nurse and then the supervisor that he does not want a Black nurse touching his child. The hospital, instead of rejecting his hateful request, quietly agrees in order to “avoid trouble,” and a note is placed in the baby’s chart saying Ruth is not to care for him.

This humiliating incident shakes Ruth deeply. She is used to working twice as hard to be taken seriously, but having her race used as a reason to block her from doing her job cuts to the core of her identity and pride. A short time later, there is a crisis. The baby, named Davis, suddenly goes into cardiac distress when Ruth is alone in the nursery. Ruth sees the child struggling to breathe and knows she is the only trained nurse nearby, but she also knows there is an order on the chart telling her not to touch him. Confused and stunned, she hesitates. She calls for help, and eventually begins CPR when urged by another nurse, but the baby’s condition worsens and he dies. The tragedy devastates everyone involved, but Turk and Brittany are consumed by rage and grief. Turk, already filled with hate, directs all of his fury at Ruth. He is convinced that she either caused the baby’s death or let him die out of malice. He demands that she be punished, not just professionally but criminally.

Ruth is suspended and then arrested, accused of negligent homicide. For Ruth, this is a nightmare that seems completely unfair. She has spent her life saving babies, yet now she is being treated like a criminal for one heartbreaking incident where institutional racism and fear shaped everything. Her entire world unravels. She is a single mother raising her teenage son, Edison, and suddenly she is facing the possibility of prison and the loss of her career, her reputation, and her ability to provide for him. Edison, who is used to hearing his mother talk about the importance of hard work and dignity, now sees her in handcuffs and in court, and the family’s sense of safety is shattered.

The legal system becomes the second major stage for the story. Ruth is assigned a white public defender, Kennedy McQuarrie, who is ambitious, intelligent, and dedicated to her job, but also initially blind to many aspects of her own privilege. Kennedy believes Ruth is innocent and wants to help her, but at first she insists that they should avoid making the trial “about race.” She thinks focusing on racial discrimination will alienate the jury. Ruth, however, knows that race is at the very heart of what happened. The hospital followed Turk’s request because she is Black. The accusation against her is tangled with assumptions about who is trustworthy and who is dangerous. This tension between Ruth and Kennedy becomes one of the central dynamics of the novel: Ruth is forced to educate Kennedy about what it means to live as a Black woman in America, while Kennedy slowly realizes that ignoring race is itself a form of privilege.

Picoult structures the narrative through alternating perspectives, mainly Ruth, Kennedy, and Turk. Ruth’s chapters show her inner world: her memories of growing up, her mother’s experiences as a maid for wealthy white families, and the many moments when she has had to swallow anger or accept unfair treatment because pushing back might have cost her everything. She loves her son fiercely and worries constantly about the dangers he faces simply because of his skin color. Kennedy’s chapters reveal her journey from a woman who believes in fairness but sees racism mostly as individual bad acts, to someone who begins to understand systemic injustice and how she herself has benefited from it, even without intentional cruelty. Turk’s chapters are disturbing and complex; they show how someone becomes a white supremacist, the communities of hate he moves in, and how his grief over his son drives him even deeper into extremism.

The courtroom scenes highlight how race operates not just in personal interactions, but in institutions. The hospital administration tries to protect itself, distancing the decisions that led to Davis being left in Ruth’s care alone. The prosecution paints Ruth as negligent and even suggests she may have been resentful because of the parents’ treatment of her. Kennedy, as Ruth’s lawyer, faces the challenge of deciding how much of Ruth’s story to tell. For a long time, she tries to present Ruth simply as a dedicated nurse who followed instructions and did her best. But Ruth pushes back, telling Kennedy that the full truth includes the racism she endured and that pretending race doesn’t matter is itself part of the problem. This forces Kennedy to confront her own discomfort and to begin questioning everything she thought she knew about justice and neutrality.

Outside of the courtroom, the novel also shows the impact on Ruth’s family and on Kennedy’s personal life. Ruth’s son, Edison, struggles with anger and confusion. He has tried to live up to his mother’s expectations, but now the world seems to be telling him that, regardless of his efforts, he is seen as dangerous or lesser because he is Black. Ruth must balance her own fear with the need to support him, teach him resilience, and protect him emotionally. Kennedy begins to notice how her own life—her marriage, her friendships, her neighborhood—exists in a bubble separated from the daily experiences Ruth describes. She starts reading, listening, and changing in small but meaningful ways, becoming more aware of microaggressions and systemic barriers.

Turk’s journey is dark, but Picoult does not make him a flat villain. Instead, she portrays a man consumed by hatred, shaped by a history of pain and indoctrination. He channels his grief into violence and propaganda, working with other extremists and planning ways to use Davis’s death to further his hateful beliefs. As the trial continues, however, cracks begin to appear in his certainty. He faces conflicts in his own relationship with Brittany, who is quieter, less committed to ideology, and more broken by grief than he is. The loss of their child exposes the fragility of their marriage and the cost of living in a world built on hate.

The climax of the book rests on the trial’s outcome and the emotional confrontations that surround it. Ruth must stand up and tell her story honestly, including the times she has felt invisible or dismissed. Kennedy must decide whether she is willing to risk her case strategy to confront race head-on. The jury’s reactions, the judge’s decisions, and the final verdict all reflect how deeply embedded racism is in the justice system, while still leaving room for moments of humanity and recognition. Along the way, there are revelations that shift the characters’ understanding of each other and themselves, including a twist about Ruth’s connection to someone in Kennedy’s life, which forces Kennedy to see Ruth not as a client, but as a person linked to her own story.

By the end of Small Great Things, no one remains unchanged. Ruth finds a new kind of strength in speaking honestly about her experiences and refusing to shrink herself to make others comfortable. Kennedy begins to commit herself not just to individual cases, but to the larger work of confronting racism and using her position to amplify the voices of people like Ruth. Turk faces the possibility of letting go of hatred, though it comes at a high emotional cost. The title of the book, drawn from a quote often associated with Martin Luther King Jr. about doing “small things in a great way,” underscores the idea that change often happens through individual choices—listening instead of dismissing, stepping up instead of staying silent, and choosing compassion over fear. The novel ends on a note that is not neatly happy, but offers hope: the recognition that facing uncomfortable truths is necessary if we are ever to move toward a more just and empathetic world.