You’ve probably seen the cover. It’s stark, often featuring a lone bird or a minimalist medical motif. But Small Great Things a novel by Jodi Picoult isn’t just another beach read or a standard medical drama you can breeze through in an afternoon. Honestly, it’s a bit of a gut-punch. Published in 2016, it arrived at a moment when the United States was grappling with massive identity shifts, and somehow, it feels even more relevant now in 2026.
It's heavy. It’s uncomfortable. It forces you to look at things most people would rather ignore.
The story centers on Ruth Jefferson. She’s a labor and delivery nurse with over twenty years of experience. She's excellent at her job. But everything changes when she’s told she can’t touch the baby of a white supremacist couple. When that baby later goes into cardiac distress and Ruth is the only one there, she faces a choice that carries impossible weight. Does she follow orders? Or does she save a life?
The True Story That Inspired Small Great Things a Novel
A lot of people think Picoult just made this up for the sake of drama. She didn't.
Back in 2012, a real-life incident occurred at Hurley Medical Center in Flint, Michigan. A man—a self-identified white supremacist—demanded that no Black nurses be allowed to touch his newborn daughter. The hospital actually complied. They put a note on the assignment clipboard. It was a blatant violation of labor laws and, frankly, basic human decency.
The nurse involved, Tonya Battle, sued the hospital.
Picoult saw this news clip and realized she had the seed of a story. But she struggled. She’s talked openly in interviews about how she started and stopped this book multiple times over two decades. She was afraid of "getting it wrong." She was a white woman trying to write about the Black experience in America. That’s a minefield.
To get it right, she did something most authors skip. She spent months interviewing Black women, civil rights lawyers, and even former skinheads. She wanted to understand the "why" behind the hate and the "how" behind the survival.
Why the title matters
The title itself comes from a quote often attributed to Martin Luther King Jr.: "If I cannot do great things, I can do small things in a great way." It’s a bit of a recurring theme throughout the narrative. Ruth isn’t trying to be a hero or a martyr. She’s just trying to be a nurse. She’s trying to be a mom to her son, Edison. But in a system built on "small" biases, those tiny actions eventually snowball into a trial that threatens to dismantle her entire life.
The Perspective Flip: Why It Works (and Why It’s Controversial)
The book uses a multi-perspective narrative. You get Ruth. You get Turk, the white supremacist father. And you get Kennedy, the white public defender who thinks she’s "one of the good ones."
This is where the book gets messy.
Kennedy is probably the most relatable character for a large portion of the book's target demographic. She’s well-meaning. She’s educated. She claims she "doesn't see color." But as the trial progresses, Ruth has to repeatedly call her out. Kennedy wants to win the case by pretending race isn't a factor. She thinks she can win on medical technicalities.
Ruth knows better. She knows that in a courtroom, race is never not a factor.
The Turk Problem
Writing from the perspective of a white supremacist is a risky move. Turk is hateful. His inner monologue is filled with slurs and a worldview that most readers find revolting. Picoult doesn't sugarcoat it.
Some critics argued that giving him a "voice" at all was a mistake. They felt it humanized someone who shouldn't be humanized. Others argued it was necessary to show the banality of his evil. He’s not a cartoon villain; he’s a guy who thinks he’s doing what’s right for his family. That’s the scary part. It shows how hate is taught, passed down, and nurtured in the dark corners of the internet and the home.
What Most People Get Wrong About the Ending
If you haven't read it yet, stop here. Or don't. I'm not the boss of you.
The "twist" in Small Great Things a novel is something that split the fanbase right down the middle. Without giving every beat away, there’s a moment involving a secret about Turk’s past and a realization Kennedy has about her own privilege.
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A lot of readers felt the ending was a bit too "neat." They wanted more consequences. They felt like the resolution let the white characters off the hook too easily.
But if you look closer, the ending isn't really about forgiveness. It's about awareness. Kennedy realizes that she has been benefiting from a system she didn't even realize existed. She realizes that her "neutrality" was actually a form of participation.
That’s a hard pill to swallow for a lot of people.
Beyond the Pages: The Legal Realities
The legal drama in the book is surprisingly accurate. Picoult worked with real defense attorneys to map out the trial strategy. In the U.S. legal system, "colorblindness" is often used as a legal strategy to prevent juries from considering systemic bias.
- Jury Selection: The book highlights how prosecutors and defense lawyers use "peremptory challenges" to shape a jury’s racial makeup.
- The "Good Character" Defense: Ruth has to be perfect. If she were a mediocre nurse, she’d be finished. This reflects the "twice as good" rule many Black professionals feel they must follow.
- Medical Malpractice vs. Negligence: The nuance between an accident and a deliberate act of omission is the thin line Ruth walks.
Why You Should Care in 2026
We live in an era of intense polarization. It’s easy to stay in an echo chamber. Small Great Things a novel is a tool for breaking that chamber. It’s not a "perfect" book. It’s been criticized by some Black writers for centering the white experience of learning about racism rather than the Black experience of enduring it.
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That’s a valid critique.
However, for a mainstream audience, it serves as a bridge. It’s a starting point for conversations that are usually too uncomfortable to have over dinner. It’s about the difference between being "not a racist" and being "anti-racist."
The Impact on Modern Literature
Since this book came out, we've seen a surge in "socially conscious" commercial fiction. Authors like Angie Thomas and Brit Bennett have taken these themes further, often with more nuance regarding the lived experience of People of Color. But Picoult’s work remains a landmark because of her reach. She sells millions of copies to people who might never pick up a sociology textbook or a memoir about civil rights.
Actionable Steps for Readers and Book Clubs
If you’re planning to read this or have already finished it, don't just put it back on the shelf. The book is designed to provoke action.
- Audit Your Own Bias: Take the Harvard Implicit Association Test (IAT). It’s eye-opening. Like Kennedy in the book, you might find you have biases you never consciously acknowledged.
- Read the Afterword: Picoult’s note at the end of the book is essential. She explains her research process and her own evolution while writing it. It provides context that the narrative alone sometimes lacks.
- Diversify Your Shelf: If you liked the themes in this book, read authors who live these experiences. Look for The Vanishing Half by Brit Bennett or Caste by Isabel Wilkerson.
- Discuss the "Uncomfortable" Parts: If you’re in a book club, don't just talk about whether you liked the characters. Talk about the scene in the supermarket. Talk about the "passive" racism displayed by the secondary characters. That’s where the real growth happens.
Small Great Things a novel isn't meant to make you feel good. It’s meant to make you feel. It’s a mirror. And sometimes, what we see in the mirror isn't exactly what we expected. But you can't fix what you don't acknowledge.
Start by acknowledging the "small" things. They usually aren't that small after all.
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Next Steps for Deepening Your Understanding:
- Research the 2012 Tonya Battle case at Hurley Medical Center to see the parallels with the fictional trial.
- Explore the concept of "unconscious bias" in healthcare settings, specifically looking at maternal mortality rates among different demographics in the U.S.
- Check out local community workshops or online courses focused on systemic advocacy and racial justice to turn the book's themes into real-world engagement.