I arrived at my first surgery consultation leveled by norovirus — literally horizontal in my telehealth window, my unshowered head pressed to a pillow. I hadn’t rescheduled the appointment because I didn’t think I had time to wait. I wanted a tubal ligation. I wasn’t sure how long I’d be allowed one.
I gave birth twice in my early 20s. Both pregnancies were unplanned; I was using contraception each time. I lived in Georgia back then, and as with other red states under Roe v. Wade, there were many obstacles between me and abortion: long drives, consultations and waiting periods, mandatory ultrasounds, pamphlets that insinuated I’d be murdering the Gerber baby if I took mifepristone. But if I wanted, at the end of all of that, there had been abortion access. I could have terminated without risking jail or death. Each time, I thought carefully about whether I wanted to continue the pregnancy. Both times, I freely chose parenthood.
After my second delivery, I had a good-for-12-years copper IUD inserted into my cervix. I was absolutely in love with my babies. I absolutely never wanted another. I vaguely planned to get sterilized after the IUD expired. But last year, halfway through its lifespan, an ultrasound showed it lodged in my uterine muscle. My primary-care nurse in Washington, D.C., where I live now, removed it and offered to insert another. “I want my tubes tied,” I told her, without much urgency. Biden was president, Harris was running, D.C. was a progressive city. Sterilization still felt like something I’d get around to.
Then there was the election and the inauguration, and a month after the inauguration, Senate Republicans — beneath the Capitol dome I could see from the end of my block — took the first step toward a reconciliation bill that would strip between 10 and 15 million Americans of their health insurance. The potential consequences of the legislation seemed baroque by design and metastatic. Many people with ACA coverage would lose it. Health-care workers would be laid off. Rural hospitals would close. But mostly, the One Big Beautiful Act would excise $1.1 trillion in Medicaid and SNAP benefits from the poor in order to offset over a trillion dollars in tax cuts for the rich.
Like one in five Americans, I receive health insurance through Medicaid. Like one in eight, I receive SNAP benefits. I talk about both openly to show that I value my own labor, the many hours of each day that I don’t spend earning wages, the hours I’m present with my kids. At the grocery store where I work, I earn $1.50 above D.C.’s minimum wage. I take only enough shifts to raise healthy kids and have time to write. Those are my priorities, in that order: my children, writing, earning money. So our household receives health insurance for free along with $654 a month in food assistance. I’m proud of this because I know my country can afford to be generous with food and with care.
I don’t want more children for the same reason I don’t work more shifts: I’m committed to the kids I have.
The nurse had wrapped my unruly IUD in tissue and said, “Sometimes doctors are resistant to sterilizations.” She deposited the tissue in the trash. “But you’re in your 30s and already have children — they shouldn’t give you too much trouble.”
The surgeon in the telehealth window gave me no trouble. She ticked through my medical history, listening intently as I tallied pregnancies, deliveries, diagnoses, prescriptions, and drug and alcohol use. Then, her final question: “And you want a tubal ligation because …” She answered for me in the same breath. “You want a tubal ligation.”
Yes, I thought from inside my norovirus-riddled body, I want a tubal ligation because I want a tubal ligation.
“You know,” the surgeon said, “we actually recommend removing the fallopian tubes entirely instead of just cutting them.” This type of sterilization, called a salpingectomy, could prevent ovarian cancer — reducing the risk by as much as 80 percent. I liked this doctor. She told me she’d had her tubes removed the year before. If someone was going to cut me open, she seemed like a good one.
“Unfortunately,” she said, “I can’t actually do it for you. Because I work at the hospital’s Georgetown location — and because of Georgetown’s Jesuit affiliation — we are not allowed to perform sterilizations.”
My stomach turned. The day of my consultation, on the other side of the world, dozens of robed men were gathering in the Sistine Chapel, preparing to elect yet another man who would teach yet another generation of girls that to exercise reproductive autonomy was sinful, that birth control and abortion and sterilization were all sinful, that girls’ and women’s sexuality itself was sinful, that our bodies would always belong first and foremost to men, to the patriarch. There would be no women allowed inside as the men voted. Right here in D.C., Congress prohibits Medicaid dollars from covering abortions, and bars the district from using local revenue to subsidize care. D.C. has no voting representation in Congress, which has total authority to criminalize abortion here or ban Medicaid from paying for contraception or sterilization. Withholding care has always been a way of withholding power.
“I’m so sorry,” the Georgetown doctor said. “But I will refer you to another surgeon.”
She asked me how soon I’d like to schedule the procedure.
“As soon as possible,” I said.
My new surgeon was unencumbered by the Jesuits. At my consultation with her, she held up a diagram of my internal anatomy and circled where she would cut and cauterize me.
“Have you ever been under anesthesia?” she asked.
“I had my wisdom teeth out,” I said.
“This is a little bit different,” she said. General anesthesia required intubation. My lungs would be functionally paralyzed and my abdomen would be pumped full of carbon dioxide to give her room to work without damaging my other organs.
She asked to see my belly button, where she would make one of three laparoscopic incisions. She asked if I could remove my septum piercing before the surgery. “Just in case we need another airway,” she said.
The procedure was scheduled six weeks out. I was scared about every part of it. I didn’t like the idea of my lungs not working or of a blade slicing through my abdominal muscles. I didn’t want to imagine a tube scraping down the inside of my throat and trachea. I was scared the anesthesia wouldn’t work. A neighbor who didn’t know about my procedure told me about a friend whose bowel was nicked during tubal ligation. The friend of a friend went septic and flatlined twice. I almost canceled the surgery.
As my anxiety intensified, I pored over the r/sterilization sub-Reddit, where 18,000 members discussed salpingectomies. They coaxed each other through pre-op fears and celebrated in post-op recovery updates. They helped each other correct billing errors: “Make sure the primary procedure and diagnosis code (Z30.2 and 58661) are applied to each claim in addition to the code for the claim’s line item,” commented a user who’d compiled an entire guide on claim appeals.
There were dispatches from red states recommending surgeons who would provide care without judgment. There was advice for patients still insured under unsupportive parents’ plans — how to keep sterilizations private, how to pass off the procedure as a cyst removal, how to intercept insurance companies’ explanations of benefits before they reached Mom and Dad. “In Texas I had to fill out something called a confidential-communications request,” wrote one commenter. “It was a short form which I mailed to my insurer, stating that if my father knew my medical history it would subject me to danger or abuse.”
On the sub-Reddit, women wrote about wanting to get sterilized even though they were queer or partnered to men with vasectomies.
“Rape,” said one user, “happens to one in five women.”
“And Republicans are working to make parental rights easier for rapists,” added another.
“You deserve medical care and peace of mind, even if it’s just for the ‘what-ifs’,” said a third who was also queer and had been sterilized when Roe fell.
Like me, these people were scared of surgery. Like me, they were more scared of getting pregnant. We were carving an act of autonomy from a geography of coercion. “My body is mine,” wrote a sterilized user. “I’m finally comfortable in it.”
The day of my surgery, I biked to the hospital in a heat index above 100. A bag slung over my handlebar contained a yellow envelope of documents I’d just had notarized at the UPS: my last will and testament and a health-care power of attorney. I biked to the hospital because I knew I wouldn’t be able to bike for a while afterward and because I didn’t all-the-way believe I’d make it through surgery. If I was going to die, I wanted to have biked.
My partner met me in admissions, where I was handed a pamphlet to make a living will if I didn’t already have one. My frantic estate planning seemed less hyperbolic. Maybe my fear was reasonable.
In the expansive pre-op hall, I asked the surgeon questions I hadn’t known to ask at the consultation, questions I’d learned from the sub-Reddit: Would she use a catheter? What about a uterine manipulator? Would I feel as though I couldn’t breathe as I went under? Could I have something for the nausea afterward? Should I expect throat pain from the intubation? What about shoulder pain from all that carbon dioxide pumped inside me? Would she try to deflate me before she closed me up? When could I swim? When could I have penetrative sex? What would she do if she found endometriosis or something else? Could I see pictures to know that the tubes were really gone?
A nurse placed my IV port, drew my blood, and put a scopolamine patch behind my ear. I swallowed a collection of pills from inside the kind of tiny paper condiment cup you fill with ketchup when you’re dining in at a fast-food restaurant. I told the nurse how nervous I was. “You’ve got a great team,” he said. “It’s nobody’s first time or anything like that.”
A second nurse asked to confirm my name, my birthdate, and my procedure again, and then said, “There will be a lot of people in the OR and they’ll all be saying things, but I will be there and I will be your advocate.”
Across the room, a patient gowned, capped, and footsied identically to me signed through an ASL interpreter. Somewhere out of view, another interpreter translated between English and Spanish. That Friday, four days earlier, Trump had signed the One Big Beautiful Act into law. Some 95,000 D.C. residents would likely lose their Medicaid benefits. Across the country, people with disabilities and immigrants — both documented and undocumented — would be disproportionately stripped of Medicaid and marketplace coverage. There in pre-op, with the anesthesiologist’s assistant leading me gently back to the OR, it felt political to be cared for.
Later, I read the surgical notes — the log of my body during those two hours I was under anesthesia, when I formed no memory. “A 5-mm. vertical skin incision was made at the umbilicus with an 11 blade,” the notes read. They’d placed my body on an incline, my feet slightly higher than my head. They’d made two more incisions, one on either side of my pelvis. “… Attention was turned to the left fallopian tube,” the notes continued. “The fimbriated end was grasped with an atraumatic grasper and elevated laterally. The LigaSure device was then used to cauterize and transect the fallopian tube from the ovarian and uterine attachments through the mesosalpinx.” I had to look that up — there were whole territories of my reproductive anatomy I’d never learned to name. My left tube was extracted; the process was repeated on the right. “… The patient tolerated the procedure well,” the notes concluded. “Lap and instrument counts were correct x2. Anesthesia was reversed and the pt was taken to the recovery room in stable condition.”
I woke up swaddled in cotton blankets. I drank apple juice with ice and ate saltines. I was not nauseous. I was not in too much pain. My partner pulled our camper van curbside with my bike safely tucked inside and drove me home, where I slept for a long time.
In the morning, still inflated, I received a flurry of emails from the Planned Parenthood a block from the grocery where I work. That clinic had been my insurance-assigned primary-care provider for years — the nurses there had diagnosed my pelvic pain, removed my IUD, and performed my partner’s vasectomy. Now the director was writing to all patients on Medicaid: “The final reconciliation bill passed into law on July 4, 2025, included a new mandate disallowing Medicaid from being used to cover any form of health care at Planned Parenthood,” the email read. They were “legally barred” from taking my insurance. They’d offer a discount on services through the end of the summer, but we’d have to find new primary care.
My surgeon called that day. “Do you have the pictures we sent home?” she asked.
I did have the pictures; I’d been staring at them for hours. Now she decoded them for me: my smooth, jam-colored liver; the baby-pink pinky of my appendix; the stunning dandelion of visceral fat. She explained the “before” image (my uterus photographed from above, its two slender arms reaching down toward the ovaries) and the “after” (the same opal ovaries and glossy fundus, but now tubeless, neatly cut and cauterized corners at either side).
In most of the photos, I couldn’t tell what I was looking at without her interpretation. The foreignness of my own interior made me even more protective over it. I’d never seen myself like this, and seeing myself like this, so soft and easily punctured, filled me with rage. “What the fuck,” I wanted to scream out my window at the Capitol, “does the inside of me have to do with you?”
The surgeon was calling to check on me, but she was also calling to say that she’d found something. “See the dark areas in the middle image on the left?” she asked. “That’s scarring from endometriosis. And the spots in the bottom-left and -center photos — that’s endo too,” she said. The call blunted my post-op jubilee. Did endometriosis — another chronically understudied disease, just like ovarian cancer — explain an assortment of past pains? Did it guarantee far worse future pain? I knew how difficult it was to get a diagnosis. At least these pictures had given me that.
Later, I showed my kids the before and after photos of my uterus, told them that was their first home. “Really?” the younger one said. He looked carefully at each image, asked me about my ovaries, my fallopian tubes, the long, prodding laparoscopic tool.
“We should say thank you,” I said. “That muscle made two kids just right and pushed you out just right.”
We were back in Georgia visiting family. A thousand miles away, in Concord, New Hampshire, HB 606 had just been signed into law. It codified the right to be sterilized for adults over 18, regardless of age, marital status, number of existing children, or future fertility goals. The sub-Reddit celebrated and grieved. “I am in Indiana and I am so happy for the state of New Hampshire!” wrote one user. “It took me over eight years of paying doctors to tell me ‘no’ till I finally found one that took me serious.”
In Georgia, my older child and I lay in a hammock under the oaks. We were nested on our backs, like otters. He put his hand on his own chest. “It’s amazing to think that this heart,” he said, his voice like dusk, his fingertips touching the before image, “this heart was inside there.” His head rested gently on my belly button, on the centermost of my incisions, now halfway healed.