The 1918 'Spanish' flu, unlike Covid-19, struck hard at people in their prime. "This new flu was an uncanny plague, scything down swathes of men and women in the full bloom of their youth," explains the narrator of Emma Donoghue's new novel, "and wasn't this flu infamous for expelling babies before their time?"
Pregnant women were at a high risk from the "grip" and it is into this perilous setting The Pull of the Stars takes us. Death, by influenza, or "the influence of the stars", is the motif of this absurdly pertinent book.
Written before the pandemic, though publication was moved forward to this month, Donoghue's 13th novel is set in Dublin during three exceptionally dramatic days in the small lying-in maternity ward looked after by Nurse Julia Power, a 30-year-old "spinster". The country is also in the grip of war, and Nurse Power has a wounded brother at home, returned from the front.
Outside, a "tarnished city" comes to life in observation that is sharp and painterly, forensic and dreamy. Propaganda notices such as "COVER UP EACH COUGH OR SNEEZE…FOOLS AND TRAITORS SPREAD DISEASE" create unsettling parallels with a modern state breathing down the necks of its citizens in efforts to control the spread. You may get a kick of déjà vu from the handwashing, opened windows, 14-day quarantines, visitor bans and signs like "SPIT SPREADS DEATH".
Arriving at work in the short-staffed hospital, Nurse Power meets a young volunteer, Bridie Sweeney, and the formidable Dr Kathleen Lynn - the only character drawn directly from history (she was a 1916 rebel and pioneer of children's health who founded St Ultan's hospital). The three women's relationships unfold as they tend to a group of quarantined pregnant women in various states of febrile terror. Imagine Call the Midwife in ragged period dress, with masks and a massive body count.
We know from the Booker-nominated Room that Donoghue loves to tell stories inside an enclosed space, and the book's most engrossing passages are set in Maternity/Fever, where everything happens from the removal of cadavers to latching newborns. The women drink a lot of hot whiskey. Donoghue describes the "clockwork torture" of birth almost in real time, with protracted, claustrophobic scenes set out in eye-popping detail. She reports meticulously the treatments, poultices and procedures dealt out during the period, from heroin syrup to the abusive symphysiotomies that tore up women's pelvises in Catholic Ireland.
This is childbirth at a knife edge, with fine drama made of its pickings, but the book comes from a place of profound sensitivity and respect for women and their little ones. We are told about the horrors of multiple childbirths, stillbirth and maternal death, the mortal shaming of unmarried women, all mediated through one nurse's shrewd understanding of everything that can go wrong. If pregnant, don't even think about reading this book now.
One of the complications of the 1918 virus was cyanosis of the liver. Sufferers developed tell-tale red spots in their cheeks before their skin turned brown, blue and finally black. The book is divided into four quarters named after each colour, a formal device that causes tragedy to mount up with scientific inevitability.
Donoghue, a cultural historian of no minor stature, understands the superstitions and religiosity that permeated everyday life. "The bone man", death, is alluded to with chilling repetition. People drop like flies and Donoghue is fearless in killing them off one by one, which might be hard to read, say on a beach in post-pandemic Ireland, but is probably an accurate portrayal of the mortality rates of the time.
We are never allowed forget about the turbulent historical context of war, revolution and its aftershocks. Between saving lives on the wards, Nurse Power has passing discussions about the Rising, suffrage, industrial schools and mother-and-baby homes. Information is pushed into the story, action piles up, and a stranger-than-fiction number of things start to happen.
This is not unproblematic as the story reaches fever pitch. Among the twists and turns are a tragic lesbian love affair, arrests, and a chase scene involving a nun and a swaddled baby.
At times it feels like there is a passionate if didactic impulse to teach the reader some history instead of letting the characters live in their historical setting. A blockbuster tale begins to be implausible. But this is Emma Donoghue, giant of letters. It is rare for such a fast-paced story to be told so beautifully, and the writing is comical and exquisite. There is something terrifically real about a nun with a "bulging eye", or an underfed working-class girl with "monkeyish" movements.
The Pull of the Stars is also, if briefly, a love story set under the stars, as Donoghue continues her work reclaiming queer characters from history. But it's death, not romance, that is the abiding theme here. In a way the more relentless death becomes, the less frightening.
At a moment of attrition, Dr Lynn reassures her nursing comrades that the virus will pass: "The human race settles on terms with every plague in the end. Or a stalemate, at the least. We somehow muddle along, sharing the earth with each new form of life." By life, she means the virus. Plus ça change.