White Coat, Black Art·Q&A

Emma Donoghue 'spooked' by overlapping narratives between her new novel and COVID-19

The Pull of the Stars tells the story of three women — a nurse, a doctor and an activist — in war-ravaged Ireland during the 1918 Spanish flu pandemic. Emma Donoghue spoke with Dr. Brian Goldman, host of White Coat Black Art, about the inspiration for the novel.

The Pull of the Stars explores the impact of the Spanish flu pandemic on marginalized people

Author Emma Donoghue immersed herself in researching early 20th century medicine for her book, The Pull of the Stars. (David Chidley/The Canadian Press)

Irish-Canadian author Emma Donoghue's novel, The Pull of the Stars, was so relevant to the current pandemic that its publication date was moved up to July from 2021.

Set during the 1918 Spanish flu in Dublin's inner city slums, the novel puts the perspective of women healers — whose lives intersect at the maternity ward where pregnant mothers infected with this new virus are quarantined together — front and centre.

In order to write plausible medical scenarios, Donoghue immersed herself in researching early 20th century medicine and bolstered that with modern medical books and websites. She took it a step further by enlisting the help of a midwife, who agreed to read the draft while in quarantine in March. Even Donoghue's copy editor at her American publishing house was an emergency room doctor.

"If you're going to dare to write a novel about health care, you really have to get it right," she said.

The novel has been longlisted for the Giller Prize.

Donoghue spoke with Dr. Brian Goldman, host of White Coat, Black Art, about the inspiration for the novel, why she chose to focus on a midwife and the parallels between the 1918 pandemic and the one happening right now.

Here is part of their conversation.

What interested you about the Spanish flu, a pandemic, as a jumping off point for a novel?

I happened across an article about the centenary of the Spanish flu and was suddenly struck by the atmosphere of all these big, busy cities all over the world; these people, who much like us, had a very industrialized, speedy life.

They were on trains and buses and cars, and even sometimes, airplanes. And their world was suddenly grinding to a halt because of the terror of this unknown illness.

Donoghue came across these images during her research: a couple, left, wear masks with disinfecting cotton wool to protect themselves against flu infection, England, 1932. On the right, masks are used during a flu epidemic in Hollywood, 1937. (Imagno/Hulton Archive/Getty Images)

I realized that a historical novel about the flu of 1918 could have a very post-apocalyptic atmosphere … I wrote the whole novel before COVID. I wasn't thinking of any contemporary relevance whatsoever.

Your main character is a nurse and midwife named Julia Powers, who works in the maternity fever ward. Why focus on a midwife?

One of the quirky facts I came across early on was that apparently, women in late pregnancies or even a few weeks after birth, were particularly liable to catch this mysterious strain of the flu and have disrupted births as a result … I thought it would narratively be such a gift to have women who are suffering or struggling through both these events at the same time. They've got very different rhythms to them.

Set during the 1918 Spanish flu in Dublin's inner city slums, the novel provides the perspective of women healers. (Punch Photographic, HarperCollins Canada)

The funny thing is I have not come across any actual factual evidence of these maternity fever wards that I'm imagining they must have had. Because you wouldn't put a birthing woman in the middle of a fever ward and you certainly wouldn't put a contagious woman right in the middle of a birthing ward. So I thought there must have been somewhere they stashed them together. But I've not found any evidence on this.

I thought that such an ad-hoc room would be a really interesting bringing together of patients. It could also be under the charge of maybe just one nurse, if it was that small … running things on her own that could allow her to be a bit more of a maverick and appealing to modern readers.

COVID-19 has disproportionately impacted marginalized people. A century after the Spanish flu, even with medical advances, who pandemics impact hasn't changed all that much. Did you intentionally want to talk about class and poverty in relation to health care?

I did in a way. The earliest decision I made was what kind of hospital would Julia be working in? I decided I would go for the inner city Dublin slums because I wanted to see her getting politicized for her work.

Dr. Kathleen (Katy) Lynn, was a physician who worked in Dublin during the 1918 flu outbreak. She is also a character in Donoghue's new novel, The Pull of the Stars. (The Royal College of Physicians of Ireland)

In Ireland, there was such political havoc going on in those years from most people wanting to be loyal subjects of the king through to just a few years later, most people wanting Ireland to be a separate country.

Just by paying attention to her patients, Julia would start to ask those big questions about poverty and injustice.

The key decision for the novel was to set it in the inner city, because then all these questions came up about whether a pandemic is in any sense a leveller? Or does it really just hit those who we've already agreed to keep down?

That's what I've been spooked by since COVID. It's not just the kind of external similarities between this year and the events in my novel, but those deeper narratives of health care being based on social determinants that I'd never really thought through much before writing this novel.

How much were the health professionals in the book of their time and how much were they inspired by the doctors and nurses we have today?

I certainly tried to capture the atmosphere of some modern medicine. The research you do for historical novels — it's not all historical research … anything, which captures the vibe of, say, a busy emergency room or ward where you're using dark humour and sometimes private slang with other health-care workers to get you through a really long shift. No shift ends when it's meant to because there's always a bit of extra work.

A cartoon published by the Topeka Health Service of Shawnee County between 1918 and 1919, illustrating precautions to combat and prevent the further spread of the influenza. Donoghue used this information when researching her novel. (Kansas Historical Society.)

So I didn't want to show off my health-care workers as saintly. I wanted to be realistic about what it might be like to be so desperate for a break or to wish somebody else would do the task.

A lot of fiction writers draw on their own lives or people they know. I wondered if you drew on the doctors and nurses you've had as a patient?

I did draw on my own life and that I'm one of the patients, basically. I was trying to think up birth dramas to include. I'm not completely her, but I gave her my birth problem. I had a birth that went fine. But then the placenta didn't come out and suddenly an obstetrician was rushing in and hauling it out of me by hand.

That moment made me realize how lucky I am to be living in a country with good, free health care for all, because birth is not an illness, but it can kill you. It's one of these things that we absolutely have to put social resources into. So I was so grateful to the midwives and doctors who worked so smoothly there together to look after me. So I thought, I'll put that scene into my novel, but I'll have my 1918 nurse figuring out how to remove the placenta herself.

The medicine of the book was utterly plausible. To what lengths did you go to achieve that?

I keep worrying that a doctor will write to me and say, "You fundamentally misunderstand the cervix." I looked at a lot of sources in the early 20th century and checked them against modern, reliable medical websites to figure out what was really going on.

If you're going to dare to write a novel about health care, you really have to get it right.- Emma Donoghue

I also had a huge amount of help — I found a midwife who agreed to read it for me while she was in quarantine in March. And my copy editor with my American publishing house is an emergency room doctor as well. So she was going between COVID patients and my book … She caught many of my errors and I was so grateful.

To me, it was crucial to get the medicine right. You can't be in any way vague about medical matters. If you're going to dare to write a novel about health care, you really have to get it right.


Q&A has been edited for length and clarity. Interview produced by Dawna Dingwall

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