Chris and Emily, teenagers from two neighbored and very close families, have been as close as siblings since birth, but as teenagers their relationship develops into a romance. When they are seniors in high school, however, both families are called to the hospital: Emily is dead at seventeen from a gunshot to the head, and Chris says the two had intended to carry out a suicide pact.

Every other chapter is a flashback to Emily and Chris's childhood life, leading up to the night of Emily's death. Some scenes include flashbacks on Emily and Chris's life while they were young (best friends) through their teenage years as lovers. It is revealed that, as a result of a dare made by Chris to go into a men's restroom, Emily is molested as a child. It is also discovered that she was impregnated by Chris, but she never revealed it to him. It is also revealed in flashbacks that Emily's feeling for Chris were more sisterly, yet she felt pressured to be with him in a romantic way due to the closeness of their families. She also felt uncomfortable having sex or being touched due to the molestation. She wanted to go to college, not raise a baby and she thought she'd brought shame on her family by becoming pregnant. She went for an abortion but couldn't go through with it in the end as it was a male carrying it out and it brought back flashbacks of her being molested. It was all of these things that made her suicidal.

In the end it is revealed that Emily's death wasn't really part of a suicide pact; Emily asked Chris to kill her because she couldn't do it herself. Chris tried to talk Emily out of it but pointed the gun to her head in the end to bring her out of her misery. Emily placed her hand on the trigger, over his.

Picoult was born and raised in Nesconset on Long Island, and moved to New Hampshire when she was 13 years old. She has described her family as "non-practicing Jewish".[3] Picoult wrote her first story at age 5, entitled "The Lobster Which Misunderstood." She studied writing at Princeton University, and graduated in 1987. She published two short stories in Seventeen magazine while still in college. Immediately after graduation, she landed a variety of jobs, ranging from editing textbooks to teaching eighth-grade English. She earned a master's degree in education from Harvard University.

She became the writer of DC Comics' Wonder Woman (vol. 3) series following the departure of fellow writer Allan Heinberg.[4][5] Her first issue (#6) was released on March 28, 2007, and her last was issue #10 (released on June 27, 2007).

She is married to Tim Van Leer, [6] whom she met while in college. They and their three children, Sammy, Kyle, and Jake, and a handful of pets, live in Hanover, New Hampshire.

Nineteen Minutes, Picoult's novel about the aftermath of a school shooting in a small town, has become her first book to debut at #1 on the New York Times Best Seller list. Her book Change Of Heart was published on March 4, 2008, and became Picoult's second novel to debut at #1 on the NYT Best Seller list.