1. General Impressions 

Gather initial thoughts and broad opinions about the book.

• Did you previously know about the forced sterilization practices addressed in the novel? How did this novel shape your understanding of the past and institutionalized racism?
• What did the title suggest to you about the book before reading it? Now that you have finished reading, what meaning does the title hold?
• What was your experience of the novel’s direct addresses to the reader? Have you read other novels that use the second person in this way? What effect was the author striving for?

2. Personal Reflection and Connection 

Encourage readers to connect the book’s themes and characters with their personal experiences.

• At the beginning of the book, Civil sees herself as different than her patients (and, to a degree, more deserving of a good life) because of her upbringing, background, and education. As the novel unfolds, her eyes are opened to the way her privileged life has benefited her, but also the way that it has kept her ignorant of the atrocities around her. Have you ever had a similar experience in which you realized your thinking or perception was wrong in some way? What caused your beliefs to change? 
• Portions of the novel are addressed to Anne, Civil’s daughter, and sections alternate between an older and younger version of Civil.