Small Great Things, Jodi Picoult’s 2016 novel, takes its title from a quote by Dr. Martin Luther King Jr.: “If I cannot do great things, I can do small things in a great way.” The book takes its major section titles from the stages of childbirth, beginning with “Stage One: Early Labor” (1). This short opening section takes place in 1976, with Ruth Jefferson narrating an incident from her childhood in which she and her sister, Rachel, accompany their mother, Lou, to work at a rich white family’s house, where Lou works as a maid. That day, Ms. Mina Hallowell goes into premature labor and Ruth’s mother helps her successfully deliver, which Ruth calls a “miracle” (3). However, it isn’t the birth that’s the miracle, but rather the moment when differences of class and race fell away, something she then spends the next “thirty-nine years waiting to see again” (6).

The novel, which alternates between the point-of-view of three different characters, then enters “Stage One: Active Labor” (7), which takes place roughly thirty-nine years later, in 2015. Ruth is now a labor and delivery nurse, and while taking over care of a newborn named Davis Bauer, the parents, Turk (one of the other point-of-view characters) and Brittany ask for her to be barred from caring for him because they are white supremacists and Ruth is black. Ruth is upset but complies; we also see some of the smaller forms of racism she faces in her job and community.

When there’s an emergency C-section, Ruth is the only one available to watch Davis, and he stops breathing. Despite trying to take steps to help, she is worried about losing her job if she does more; others arrive and go into emergency mode to try to save Davis. They are unsuccessful, however, and Davis dies with Brit and Turk in the room and having seen Ruth performing chest compressions. In Turk’s sections, we see his history with black people (a black man was involved in a car accident that killed his brother when he was young) and his radicalization, becoming something of a legend in the White Power community as it shifts into the 21st century and moves underground. After Davis’s death, Turk presses murder charges against Ruth, convinced that she killed Davis. The prosecutor, Odette Lawton, a black woman, finds that there’s enough circumstantial evidence to move forward. Ruth is arrested in the middle of the night, ending the second main section of the novel.

The third section, “Stage One: Transition” picks up with Ruth’s arraignment, which is where the final point-of-view character, Kennedy, an idealistic public defender, becomes a major part of the narrative, as she is Ruth’s initial counsel and later fights to be her lawyer during her trial. Seeing that Ruth is a fish out of water, Kennedy does her best and is able to get Ruth out on bail. Ruth still has to go to prison until Edison can get the proper paperwork filled out. Meanwhile, in Turk’s world, Brit is taking sleeping pills and has largely cut herself off from everyone. Turk thinks back on how they got together, and his father-in-law tells him to “[g]et even” (158). Turk posts about Davis and reveals his real name on the blog. In the arraignment, Turk is thrown out and then talks to the media. Brit sees him on TV and starts to come out of her funk, telling him he’s a star. Kennedy successfully lobbies her boss to take on Ruth’s case, which is her first murder case. Ruth, finally getting out of jail, meets with her, and they get off to rough start, with Kennedy trying to avoid the issue of race in court but Ruth seeing it as essential. Despite her doubts, Ruth decides to trust Kennedy.

With Adisa’s help, Ruth goes on government assistance, and Adisa wants her to request help from Wallace Mercy, a TV personality and firebrand on issues of racial injustice, but Ruth declines. She also then takes on a job at McDonald’s, which causes difficulties with Edison, who fights with his former best friend and begins missing school. Kennedy’s continued dismissal of racial issues wears on Ruth and she calls Mercy, who then begins talking about her case on TV and soliciting donations from his viewers. Ruth and Kennedy begin to have more frank conversations about race, and Ruth invites her out shopping to see the sort of everyday discrimination she faces. They agree to put Ruth on the stand as a sort of compromise.

Turk, meanwhile, tries to recruit other white supremacists to take more overt action but they refuse, and he thinks he’s done too good a job of taking the movement underground. As they go through the jury selection process and prepare for the trial, Adisa begins working with Mercy behind Ruth’s back, causing a fight. Kennedy takes on the new black lawyer in her office as co-counsel. Ruth and Edison then go to Kennedy’s house for dinner, which seems more like a social call. Ruth finds out her mother has passed away from a stroke. She and Adisa make up and the funeral brings up more memories from childhood. During jury selection, they think that they may have a problem with implicit bias in one particular juror. Kennedy takes more of a stand for Ruth than ever, and they allow the woman they’re worried about onto the jury. The section ends with Kennedy finding a possible defense for Ruth: Davis had an undiagnosed medical condition called MCADD.

The last main section of the novel, “Stage Two: Pushing,” is comprised of the trial proper. On the first day, Wallace Mercy and his followers are camped outside, and there’s a clash with white supremacists. Odette’s plan seems to be to present Ruth as bitter and angry, enough so to have spitefully not aided as much as she should have in Davis’s care, once he stopped breathing. She frames Turk’s and Brit’s prejudices as a patients’ rights issue. Kennedy, on the other hand, tries to frame the issue around the impossible situation Ruth was in and the fact that it might have all been a moot point because of the MCADD, which could have meant Davis would have died no matter what anyone did.

After calling a number of Ruth’s coworkers, Ruth begins to see the ways in which her friendships had more to do with proximity than actual feelings, and the ways in which the white people around her view her as angrier and more aggressive than she is. Odette also decides not to call Brit to the stand because she has shown herself to be unstable, instead banking on Turk. However, once on the stand and faced with cross-examination from Kennedy, he blows up and tries to attack her, which Odette tells him could very well lose them the case. Turk begins to doubt himself as well, wondering if he and Brit brought this on themselves.

As testimony continues, Ruth is at first encouraged and then discouraged and worried about having lied to Kennedy and everyone about not having attempted to help Davis. Finally, Kennedy wants to rest without putting Ruth on the stand, which she sees as a violation of her trust, and finally reveals her own lie. She insists on taking the stand and Kennedy goes through a long night of soul searching, before agreeing. Odette is then able to get a similar outburst from Ruth as Kennedy was able to elicit from Turk, saying Davis would be better off dead than raised by Turk, and so they all think Ruth has lost the case, and Ruth fires Kennedy.

That night, Edison goes out for a long time, worrying her, and then later is arrested for spray painting white supremacist graffiti on the hospital in an attempt to get Turk in trouble. Kennedy makes a discovery in Davis’s test results and calls Wallace Mercy for help. She also gets Edison out of jail. Kennedy assumes she is back on Ruth’s case, but Ruth tells Judge Thunder that she still wishes to fire her. They discuss it and finally Ruth agrees to take Kennedy back. Kennedy gives an impassioned closing argument in which she admits to her own biases and privilege.

While the jury is unable to make a decision, the Judge accepts Kennedy’s previous motion to acquit, and Ruth ends up winning.

Outside of the courtroom, Wallace Mercy and a black woman Ruth doesn’t know confront Brittany Bauer, with the black woman revealing herself to be Brit’s mother, confirmed by her father, Francis. Everyone is shocked, and Brit runs off. While trying to find her, Francis tells Turk the story of him falling for Brit’s mother then getting jealous and pushing her into the arms of a black man, at which point he began getting radicalized. Turk struggles with the inconsistencies of loving Brit but hating black people. They finally find Brit at Davis’s grave; she has cut into her arms trying to get her mother’s blood out of her. Ruth ends the novel exultant in the courtroom, and planning to meet with Kennedy as a friend.

The final section of the novel, like the first section, takes place outside of the main timeline, and is just one small chapter. “Stage Three: Afterbirth” takes place six years later and is from Turk’s perspective. He reveals that after he and Francis had been disowned and beaten by his former white supremacist crowd, Brit had committed suicide. He had then begun the process of healing, and now works with the Anti-Defamation League to try to convince white supremacists of the errors of their ways. He has remarried and taken his new wife’s last name, and they now have a 3-year-old daughter. He is waiting in a nurse’s office because his daughter has strep throat. The nurse ends up being Ruth, who also has a new last name. They don’t acknowledge their shared history, but it hangs between them and Turk thanks her.