Making decisions about your reproductive health is anything but simple. Susan Wiggs' book "Sugar and Salt" brings those complexities to life. Join us as we discuss unintended pregnancies, abortion, and adoption (and some lighter stuff too!) with Susan Wiggs and OB-GYN Dr. Kate White. Trigger warnings: Sexual assault, abortion and domestic violence.
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Dr. Denise Millstine: Welcome to the “Read. Talk. Grow.” podcast, where we explore women’s health topics through books in the same way that books can transport us to a different time, place or culture. “Read. Talk. Grow.” demonstrates how books can also give a new appreciation for health experiences and provide a platform from which women’s health can be discussed at “Read. Talk. Grow.”
We use books to learn about health conditions in the hopes that we can all lead happier, healthier lives. I’m your host, Dr. Denise Millstine. I’m an assistant professor of medicine at Mayo Clinic in Arizona, where I practice women’s health, internal medicine and integrative medicine. I am always reading and I love discussing books with my patients, my professional colleagues, and now with you.
I’m excited to talk about today’s books. We will primarily be discussing Susan Wiggs’s Sugar and Salt, which I want to warn you, has some trigger warnings. Some spoilers will appear in this episode, so if you need to, pause the episode, read the book, and come back. My first guest today is Susan Wiggs. Her life is all about family, friends, and fiction.
She’s the author of more than fifty novels, including the beloved Lakeshore Chronicles series and the instant New York Times bestseller Family Tree. Her award-winning books have been translated into two dozen languages. She lives with her husband on an island in Washington State’s Puget Sound, where her favorite exercise is curling up with a good book. Susan, welcome to the show.
Susan Wiggs: Thank you so much for having me. I love podcasts and I’m excited to talk today about Sugar and Salt.
Dr. Denise Millstine: My second guest is Dr. Kate White, who is an associate professor of obstetrics and gynecology at the Boston University School of Medicine and the Vice Chair of Academics in the OB/GYN department at Boston Medical Center. She is a fellow of the American College of Obstetricians and Gynecologists and of the Society of Family Planning, and a member of the American Public Health Association. A board-certified OB/GYN, Dr. Kate has been caring for women for more than 20 years, helping them navigate periods, childbirth, pregnancy loss, and every other stage leading up to menopause. She also conducts research in contraception, teaches medical students, residents, and fellows, and lectures regionally and nationally on topics related to women’s reproductive health. She is the author of several books, including Your Sexual Health: A Guide to Understanding, Loving and Caring for Your Body. Dr. Kate lives outside of Boston with her husband and their three children. Dr. Kate, welcome to the show.
Dr. Kate White: Thank you so much. It is such an honor to be here. And Susan, I cannot wait to discuss your book. I am only a writer because I was a reader first. And I agree with you about the best sport being curling up with a book.
Susan Wiggs: Well, thank you. It’s such a pleasure to meet you. I was very apprehensive about knowing that I was publishing a book. I’m not from any medical field. but I tried to do my due diligence in researching the book and getting the proper information on the page without overloading it with technicalities. But I was always apprehensive about professionals reading it. So thank you and I appreciate the work that you do.
Dr. Kate White: Now these issues only come alive in writing like yours because people can only read so many think-pieces and news analyses. It’s really when you think about the context of women’s lives that these issues really, I think, can penetrate and hit people in different ways. I’m so grateful for you for taking the work I do in nonfiction every single day and making it really accessible to people.
Susan Wiggs: Well, thank you. Sometimes I think most of my knowledge about things that I have no familiarity with comes from fiction, so I depend on the authors to have done their homework, at least a little.
Dr. Denise Millstine: So, Susan, you’re a particularly popular fiction and romance author. We talked very briefly before we started recording about how many people might think that these are escapist reads or your beach read, or your weekend read. But in fact, many books in the genre actually intentionally bring up very serious topics that are researched. Talk a little bit about that.
Susan Wiggs: Well, like Kate. I was a reader before I was a published author. Books meant more to me than just an escape for the weekend. I really honor my readers for spending their time with something that I’ve written. In that way, I’m so grateful to be here and have you take this book, and any book, seriously.
Fiction informs us in ways that are subtle, and a story will kind of grow on you. You open Sugar and Salt, and you think you’re reading about this adventurous young woman. She’s going to open her signature barbecue restaurant in San Francisco, and her life looks like a really fun ride. And yet, as you get to know Margie in the book, you discover this backstory that happened to her that I hope is as authentically drawn as it could be in a piece of fiction.
What I found after the book was released was that readers were surprised, based on the way that the book was presented in the cover art, that there were some real dark threads to this story. I also found that what happens to Margie in the book resonated with readers in some pretty profound ways. One of the joys of the digital world is that I can get immediate feedback from readers, and I certainly did on this book.
Dr. Denise Millstine: I’m so glad you brought that up because my friend showed me this advanced copy of Sugar and Salt and said, “This book is about reproductive rights,” and I thought, “That looks like it’s about cakes.” I agree that the cover doesn’t give warning to that, but hopefully the more it’s in the world and people are talking about the book, people will become aware of those themes – particularly for readers that need a trigger warning. But the book is very timely.
Doctor Kate, you had recently published a post for the Women’s Health blog through Mayo Clinic Press, about the confusing shift in the world with reproductive rights, and I think you would agree that Sugar and Salt is really an incredible example of what some women could deal with in this era of their rights being limited.
Dr. Kate White: Absolutely. And I’m so glad that the book doesn’t come across as an “issues” book. I’m glad that it has cake. I actually would’ve preferred barbecue on the cover, but I know it’s a publishing house decision.
But it’s the idea that these decisions are integrated into people’s lives; it’s not something that you sign up for. It’s not something that’s just a chapter that you close. Just like with Margot, who I think of as the heroine of the book – whether it’s the sexual violence, the unexpected pregnancy, the challenge you’re facing in what to do with that pregnancy, and what you might face in thinking about placing a child for adoption. This is a part of the fabric and the history of a lot of people in this country, and it co-exists along with other hopes and dreams and finding new love and making a big move and things like that, so I think the book was perfectly on point for that.
Susan Wiggs: Well, thank you for that comment. When I set out to write the book, I actually didn’t set out to write an “issues” book. That message sort of crept in as I was creating Margot’s story and what brought her to this point.
It came about from an article I read, in Rolling Stone or The New Yorker – it was the true story of a woman who killed the man who was sexually assaulting her in Alabama. The only way she could gain her freedom was by pleading guilty to murder. I learned a lot about the injustices that come about against women in particular, and poor women or women who don’t have the means. Margot’s story evolved organically the way, unfortunately, things have happened in our lives as well.
The other thing that I should point out for your readers, because the crime takes place in Texas, is that when I was writing it, it was 2019, and some of the new laws were not on the books yet. My editor actually made the very wise decision to have the book take place in 2017 or 2019, because some of the points that happened in the book would be moot now just because of that.
I feel for you so much because I know your profession is struggling with these new issues that have been dropped in your lap. How do you help women who need reproductive healthcare and the laws are now changing so fast? How do you meet the needs of your patients?
Dr. Kate White: I think a lot of readers, even of novels, aren’t necessarily huge consumers of the news, right? How many people read to the 24th paragraph in an article? Which is why there’s been so much confusion about what’s still legal and what’s not. And I think a lot of people don’t realize that these issues affect them and the people that they love.
It’s not until they face it, that they say, “What do you mean I can’t get birth control? What do you mean I can’t have an abortion?” that all of a sudden what had just been political rhetoric and noise in the background now has a really huge impact on their lives, which is what Margot faced in prison and a lot of women are now facing across the country.
Susan Wiggs: She’s a pretty typical woman of very little means. She grew up in a trailer, her mom passed away, and her stepdad was not a good guy – so she’s been on her own from teenagerhood, which is an unfortunately common situation for a lot of women. She wasn’t sophisticated. She was smart, but not really educated, so she did find herself in a situation that had never crossed her mind – being in prison and finding herself pregnant. Yet now she’s faced with it and discovers how limited her options are.
There was a note that I had from a reader that said I was mad because I was afraid that this book was pro-choice. but then I saw that it was pro-life – but then I realized that I wanted her to have a choice. It was both pro-choice and pro-life. I like that it sparks different sides of an issue for the readers.
It’s a book club book in that sense, where people can talk about both sides of an issue (and hopefully not come to fisticuffs). I didn’t want to promote my point of view. Of course, I have a very strong point of view about it, but I didn’t want to promote that because it’s a work of fiction. It’s not a work of the author’s opinion.
Dr. Kate White: Right. It was Margot’s point of view that you were trying to put forward, which I think you really did beautifully.
Dr. Denise Millstine: I just want to reemphasize the point about this being inspired by true events – that when you look at all of the things that happened to Margie (for those who haven’t read the book, Margie and Margot are the same character, but she changes her name as she changes her space in life), these things seem exaggerated, and yet you are really fictionalizing from real events – real women whose cases you were able to research and read about. While it might seem impossible, it has happened and it has not just happened once.
Susan Wiggs: That’s correct. There’s a brief author’s note in the back of the book that references a couple of the instances when this has happened. By the end of the book, I wanted to shine a light on it. I didn’t want to shout it from the rooftops, but people can learn more about it if they’re so interested.
In the case that sparked the backstory ofSugar and Salt, the woman’s name was Brittany Smith and she was in Alabama. And another thing your comment reminded me was that the laws change – they’re meant to evolve like that, but one of the ones that I referenced in the book was called “No Duty to Retreat,” which is a controversial law in Texas. Well, I don’t know if it’s controversial in Texas – it seems like it would be – about what is allowed when you’re defending yourself from a violent act. What are you allowed to do, and what is considered a crime?
That definitely comes into play as well, especially since there was a dichotomy I tried to show between the way the justice system treats a person of wealthy means versus a woman who comes from a poor background.
Dr. Denise Millstine: And not just the justice system. For those who haven’t read the book yet, this happens very early on: You have this woman, as you said, who grew up really on her own with some help from people she connects to in the community, where she learns to make her amazing barbecue sauce. But then it’s the hometown hero who assaults her.
What happens is the community is mourning his loss and blaming her for being in her own kitchen, making her barbecue sauce, when a man (with whom she thought she might like to be involved with and had cut it off with) comes in uninvited. That part is actually a very common story, and how we treat, as a community, as a culture, the woman who was assaulted by looking for how it’s her fault, is something that has to change.
Susan Wiggs: I totally agree. Thank you for bringing that up, because it persists even today. We like to think that we have evolved beyond, but you still encounter situations where they say, “What were you wearing? Did you have anything to drink?” The point I hope readers take away from that situation with Margot is that there’s one cause of rape and that is a rapist. Nothing that she was wearing, nothing that she said, and nothing that she had done in her past. I assume that’s the takeaway. That’s definitely the feedback that I’m getting.
I don’t write books to enrage people. There are other things in the book. There’s a really, really sweet love story, which was a bit of a juggling act as well for me creatively, because how do you take someone who’s had this incredibly damaging thing happen to her in the past to where she’ll never be the same person again, but have her find somebody she can move forward in her life with?
Jerome, the love interest, is quite the fantasy man. It was a real creative juggling act for me to make him number one, believable, but number two, someone you could see Margot with for the rest of her life.
Dr. Kate White: So many women have lived through trauma, whether or not they have PTSD, as they’ve survived these things. But women are survivors – a lot of people are. I love the idea that even with the most traumatic history and the most difficult upbringing, and the ‘against all odds’ story, that you can still find love and that there can still be someone for you.
I know it’s a little bit of a fairy tale – Jerome, certainly was very fairytale-like in a lot of ways. But that idea that you are not broken, that your past does not define you, that you still get to go on and deserve to have love and happiness and your dreams come true, is a really wonderful message. When you start to think about just how often assault happens, how often trauma happens, it’s really easy to get caught up in rage and despair – so it’s wonderful to see someone really thrive on the other side of that.
Susan Wiggs: Thank you. I tried to embed situations in the book showing Margot growing in her empowerment as she moved away from that incident. She joins a self-defense class, she moves ahead with her career plan, she starts a food truck, and meets some really positive mentors along the way. I hope that women who are surviving something like that look for mentors the way that Margo did in her life, because that is key: getting yourself some self-care, therapy, and if there’s physical problems, help from your doctor.
I appreciate the medical community so much for their support of women in this way. Pretty much every doctor I know or have met is incredibly concerned with this and supportive of this. So thank you to your whole profession for that.
Dr. Denise Millstine: I just want to restate as well that this one of the beauties of this book being in the romance genre is that you know the end, you just don’t know how you will get to the end; but the reader is assured that they’re going to walk away with an ending that feels at least hopeful, full of love in that type of energy, as opposed to all of the darkness that you go through with Margot as she navigates her past.
I love how every single one of your relationships, other than with the rapist, is driven by love. Even his family loves him so much that they’re sort of blinded by his actions and not that that justifies how they attack her, but without conflict, there is no novel. I think it’s really beautiful that all of the people are just demonstrating love.
Susan Wiggs: Thank you. And thank you for mentioning the fact this being a romance novel is a message to the reader that if they pick it up, no matter what happens through the course of the story, there will likely be a positive, uplifting message – maybe not totally wrapped up with a bow, but it will be a positive, uplifting message. I think that’s the promise of a romance genre book, that people will get what they earned at the end of the book.
In that sense, I do agree that maybe a book with really hot topics like this should have a trigger warning. But the fact that it’s a romance novel is going to tell the reader, go ahead and go through this with her because it will turn out in the end.
Dr. Denise Millstine: Another inspiration for the book is the adoption process. Dr. Kate, you help women navigate choices with unexpected or unintentional pregnancies all the time. Talk a little bit about how you approach that.
Dr. Kate White: We conduct options counseling a lot for people who are facing an unintended pregnancy that they genuinely are not sure what to do about. Obviously, there are three choices when someone becomes pregnant: they can choose to not have the pregnancy, they can give birth and then parent, or give birth and then place the child for adoption, which is not an option that a lot of people will consider.
I think most women will only consider either parenting or having an abortion – but for people who would find this as a third path or different way, I think it can be incredibly rewarding. My mother was adopted, so there’s a very big pro-adoption thread in my entire family, and one of my best friends became a parent through adoption. The person who birthed his son also became pregnant as a result of rape, and just like Margot, really wanted something positive to come out of the experience. She chose an open adoption, where she keeps in contact with my friend and his husband and is in the child’s life in a very remote but still present way.
Adoption can be incredibly positive and it’s nice to see more positive adoption stories in the media and in books. I wasn’t sure how much we wanted to spoil with this book, so I wasn’t going to bring it up – but since Denise went there – watching the relationship develop between Margot and the adoptive couple that she chooses, and how much they would love her in their life to whatever degree she is ready for, I think shines a light on what adoption looks like in modern times.
It’s very different from when our mothers were growing up where a girl was sent away to have a baby, and it was shameful to see the baby, let alone hold it, and then she was supposed to come back and never think about it again. That led to so much trauma for people who placed babies for adoption under those circumstances, as opposed to it being a very empowering choice, the way it is for Margot in this book.
Susan Wiggs: Thank you, Kate. And also thank you for the language that you’re using around adoption. I was quickly drawn to the fact that you place a child for adoption – You don’t give them up. You don’t give them away. All of those are outmoded phrases. I tried to be really careful in the book with the messaging around the adoption process.
That was such a fascinating deep dive that I did into that world. I was so unfamiliar with it, and it’s fascinating and also heartbreaking and uplifting as well. When I see people who choose that path, it’s not always the easiest. It probably never is.
Margot struggled with the choice, thank goodness. Back in 2019, she had the choice – but I liked her struggle. I liked living through it with her. The outcome just seemed satisfying. Her adoptive couple was quite the fantasy as well – the bazillion-aires with the guest house and the perfect dog and everything. But I thought, well, she needs a little uplifting fun in her life. I made them a very fun couple that she would have confidence in.
Dr. Kate White: Margot needed a fairy tale at that point. She needed a little bit of something to pull her out of this. What I think was really telling and so important about Margot’s story is that she was able to make the choice that felt right-est to her. And the right choice doesn’t always feel good. It’s not always full of happiness, but it is sometimes the thing that you just know deep in your soul is what is right for you.
That is what I wish that all women and people who could have pregnancies could feel. Margot started out pursuing an abortion and was not able to get one because the system effectively prevented her from being able to exercise her right to get one, which was still a right in 2019.
But in the end, she still might have had that choice, but what evolved over time was that a different choice then felt right. As hard as it was – and it doesn’t mean that she didn’t still think about it and still have feelings – she didn’t really regret the decision, even though it was hard. The idea that something could be hard and right at the same time is a really important message for all of us, honestly, for all of our decision making, but particularly around pregnancy.
Dr. Denise Millstine: Your story was actually inspired by friends of yours, right, Susan?
Susan Wiggs: That’s correct. I have a friend whose son and son-in-law wanted to have a family together, and so they pursued that. I got an up close and personal view of how fraught that process can be. It’s exciting, but it’s also incredibly dicey. Is it going to happen? Is it not? It was really fun for me to be on the sidelines looking at a happy outcome for this family. One of them is actually a physician, so I got some other information from them too, to inform the book.
Dr. Denise Millstine: Well, the book is clearly so well researched and I think really quite brave. I hope that everyone who’s listening to the podcast will pick up Sugar and Salt by Susan Wiggs, and if you have young women in your life, absolutely pick up Your Sexual Health which talks a bit about contraception and reproductive rights in a very brief snack, accessible way that you can leave on someone’s bookshelf to dive into when those questions come up for themselves or for their friends.
My guests today have been Dr. Dr. Kate White and Susan Wiggs. It has been such a pleasure to talk to you both about women’s health, reproductive rights, abortion, adoption, and sexual assault. We covered a lot all from your amazing book, Susan. Thank you so much for joining us.
Susan Wiggs: You’re so welcome. It was an honor to be here today.
Dr. Kate White: Thank you so much.
Dr. Denise Millstine: Thank you for joining us to talk books and health today on “Read. Talk. Grow.” To continue the conversation and send comments, visit the show notes or email us at readtalkgrow@mayo.edu.
“Read. Talk. Grow.” is a production of Mayo Clinic Press. Our producer is Lisa Speckhard-Pasque and our recording engineer is Rick Andresen. The podcast is for informational purposes only and is not designed to replace a physician’s medical assessment and judgment.
Information presented is not intended as medical advice. Please contact a healthcare professional for medical assistance with specific questions pertaining to your own health if needed. Keep reading everyone.