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I have a question now...did the title give it away for anyone?
No, for me, it did not give it away. By spelling it "Nots", you lead the reader to think it is a play on words, in that Lois is being negative and "not" accepting what the doctor suggests. Then, at the end, we relate the original phrase, "tied in knots" with the tubal ligation. I thought it was quite clever, actually.

- Vicki

EDITED TO ADD: Oh, looks like you were posting at the same time I was. I see you intended the "not" to apply to the negativity of the doctor. I actually applied it to Lois, but it's 6 of one, half dozen of the other. Either way, nice title!

"Hold on, my friends, to the Constitution and to the Republic for which it stands. Miracles do not cluster and what has happened once in 6,000 years, may not happen again. Hold on to the Constitution" - Daniel Webster