I really wanted to love this one. Kritzer has proven she can write smart, character-driven speculative fiction, and the premise — an OB-GYN, already prosecuted for performing a life-saving abortion, kidnapped by a fundamentalist cult that needs an obstetrician — felt like it had real teeth. The problem isn’t the setup. It’s that the book gestures at four genuinely rich themes and then settles for thriller mechanics instead of actually sitting with any of them.
Bodily autonomy is the theme the premise promises — Liz’s whole arc starts because she made a choice about a patient’s body and the state punished her for it. Then she’s literally stripped of autonomy herself, treated as a captive resource. That’s a great structural irony, and for about a third of the book it’s doing real work. But the back half drops it almost entirely in favor of escape-plot logistics. I wanted the book to sit in that discomfort — what does it mean for a doctor who’s spent her career defending bodily autonomy to now be the one without any? Instead that question gets asked once and then the plot moves on.
Cult behavior is handled competently but stays surface-level. There are a few sharp moments showing how members are conditioned to police each other, and how isolation does the regime’s work for it. But we don’t get real interiority from any of the cult members beyond functional roles (true believer, doubter, victim). A book actually interested in cult psychology would’ve spent time on how belief gets built and maintained, not just shown the results.
Female empowerment gets short shrift too. The girls and women on the compound are mostly rendered as people to be rescued rather than people with their own agency, contradictions, or complicity. Liz “growing to care” about her patients isn’t the same as the book giving them inner lives. A more ambitious version of this story gives at least one of the compound women a real arc — maybe someone who doesn’t want to leave, or whose loyalty is genuinely conflicted — instead of using them as stakes for Liz’s escape.
The future of obstetrics in the U.S. is the angle I was most disappointed by. The opening — Liz prosecuted for an abortion in a near-future America — is the most politically alive the book ever gets. Once she’s on the compound, that larger world basically disappears. I wanted the book to keep one foot in that bigger picture: what’s happening to maternal care nationally, what other doctors are doing, what this means structurally and not just for one captive woman. Instead the cult becomes an isolated bottle episode, and the “near-future America” framing ends up doing very little beyond setting the plot in motion.
What it gets right: clean, fast prose, a genuinely strong opening, and a protagonist whose professional ethics feel real and lived-in even when the plot around her flattens out. It’s a perfectly competent thriller. I just don’t think “competent thriller” is what this premise deserved — it had the ingredients for something as unsettling as The Handmaid’s Tale and instead played it safe.