Sara Szal MD
I was in my 50s, sitting across from a divorce attorney, when I finally saw it.
It wasn’t the bargain that I was ending in my marriage. I saw the bargain I made 30 years earlier and never stopped making in my life since age 27, and probably before.
I was 27 when I made it, though at the time, I didn’t know recognize it as a bargain (and what I’d have to pay for it later).
I had just graduated from Harvard Medical School and moved to San Francisco to begin my internship in obstetrics and gynecology. I could deliver babies at midnight, manage a hemorrhage before sunrise, take out an ovary at 9 a.m., and keep going for 36 hours without sleep.
I called this competence. I now recognize it as my first bargain: if I could do everything myself, I wouldn’t need anyone.
I was learning how to care for women. I knew almost nothing about caring for myself.
Then I met a man. He was brilliant, emotionally unavailable, and clear from the beginning about what he wanted. No exclusivity. We’d see each other when it worked for him. The relationship would fit around his life.
I’d never been in an arrangement like that before. I said yes. It wasn’t because it was what I wanted, but because somewhere inside me, I believed demanding more might cost me the relationship, so I settled for the breadcrumbs.
That was my second bargain. It would not be the last.
For 30 years, I told myself the heartbreak came when he eventually left. It took another 25 years and another ending, sitting in that attorney’s office, to show me otherwise.
What I was taught: be easy and fun, don’t ask for too much, and it will all work out.
What I now understand: it works out for whoever was on the other side of the bargain. I disappeared a little more each time to make sure of it.
I realize this is one of the oldest female stories there is, and it is rarely only about romance.
Women make bargains with their bodies, careers, time, and worth, long before we are old enough to recognize the lesson being given.
I’ve been sitting with these bargains for months, not trying to resolve them but trying to understand them. As a physician, I know how tempting it is to look for a diagnosis or to run labs for them. While I suspect these bargains show up eventually in inflammation in the body, autoimmune disease, hormonal imbalances, cardiometabolic disease, and low heart rate variability, it’s also true that some truths ask to be witnessed before they are explained.
I’ve been sitting with these bargains for months, not trying to solve them, but trying to understand them. As a physician, I know how tempting it is to look for a diagnosis. Some truths ask to be witnessed before they’re explained.
Here are some of the bargains I keep seeing, in my own life, in my patients, and in the culture that shaped us.
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The bargain of productivity. I can rest after I’ve earned it.
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The bargain of beauty. If I look young enough, thin enough, pretty enough, I’ll be safe.
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The bargain of the good girl. Harmony matters more than honesty.
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The bargain of self-abandonment. If I betray myself first, no one else can reject me.
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The bargain of silence. If I don’t ask for too much, I won’t lose the connection.
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The bargain of competence. If I can do everything, I won’t need anyone.
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The bargain of accommodation. If I make myself easier to love, love will stay.
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The bargain of being chosen. If someone chooses me, I’ll finally feel worthy.
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The bargain of emotional labor. It’s my job to anticipate everyone’s needs before my own.
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The bargain of certainty. If I can just find the perfect protocol, I’ll finally feel at home in my body.
I’m no longer convinced that women’s greatest challenge is low estrogen, faltering mitochondria, or low testosterone. Those matter, and I’ve devoted my career to understanding them.
But I’m becoming more curious about something medicine rarely measures…
How often does a woman override herself in a single day?
How many times does she swallow a no?
How much pleasure leaks away, not because her body has failed her, but because she’s been taught that belonging requires self-diminishment?
I don’t have answers yet, only a growing suspicion that pleasure begins much earlier than the bedroom.
I believe it begins the moment a woman stops making bargains with herself, and starts to understand that sovereignty isn’t the opposite of love, it’s what makes love possible.
This is the invisible agreement millions of women inherit, one no one writes down or teaches it, yet somehow we learn it: trade small pieces of yourself for approval, harmony, love, and belonging. We don’t notice the cost because we pay it gradually, until one day we realize we’ve become experts at caring for everyone else except the woman living inside our own body.
I’m curious… What agreement are you ready to break?
xo, Dr. Sara
