Reader Notes

This book features content related to perinatal loss and loss during a pandemic.

Recommended Audience

This book is recommended for young adults and adults.



"Every week, more grippe cases were carried into our wards, more cots jammed in. The hospital’s atmosphere of scrupulous order – which had survived four years of wartime disruption and shortages and even the Rising’s six days of gunfire and chaos – was finally crumbling under this burden. Staff who fell sick disappeared like pawns from a chessboard. The rest of us made do, worked harder, faster, pulled more than our weight – but it wasn’t enough. This flu was clogging the whole works of the hospital.

Not just the hospital, I reminded myself – the whole of Dublin. The whole country. As far as I could tell, the whole world was a machine grinding to a halt."

Award-winning Irish-Canadian writer Emma Donoghue is known for crafting texts that engross and embed themselves in readers. Her previous novels, including The Wonder (2016) and Room (2010) – the latter adapted by Donoghue into the critically-acclaimed 2015 film of the same title – linger after reading due to their vivid detail, subtle moments, and often-dark content. The Pull of the Stars does not depart from these hallmarks of Donoghue’s previous work but instead presents an uncannily timely and compressed narrative of love and loss; contagion and care; and hope versus suffering in this remarkable historical novel.

The text’s protagonist, Julia Power, is a nurse working in an understaffed and overwhelmed hospital at the center of Dublin in the first year of the 1918 influenza pandemic. A labor and delivery nurse, she is confined to work in a makeshift ward created from a storage closet in order to quarantine and care for expectant mothers who have been diagnosed with the flu. The text spans three days in Julia’s work and life, taking place largely within the claustrophobic confines of her ward and depicting the chaotic yet ceaseless demands on her, on the young female volunteer assisting her, and on the new staff physician, who is also a woman.

In her Author’s Note, Donoghue explains how she had been working on this story since 2018, initially inspired by the centenary anniversary of the influenza pandemic. She submitted the final draft of the novel to her publishers in March 2020, just before COVID-19 exploded into global attention and response. While our current pandemic has not yet given rise to works of creativity and context that will certainly be written in the years to come, The Pull of the Stars offers an eerie parallel, in several important ways, to the losses and stressors of the last year.

Readers will be moved by the sheer scope of loss in this novel, from losses of death to shell-shock and the impact of poverty on patients and staff alike. Julia and the other characters are caught up in a simultaneous battle against the effects of war and those of the pandemic, all while trying to deliver healthy infants from suffering mothers.

The narrative subtly and powerfully widens the scope of losses, particularly for women, and the implications of their often-overlooked secondary losses as they work tirelessly to treat patients and combat explicit discrimination and gender hierarchy in the workplace. In one scene, a male orderly holds forth that women should not receive the right to vote because, unlike enlisted men, they haven’t earned it by paying the "blood tax." The quiet irony of his pronouncement, delivered to women who are frequently covered in the blood of other women in the throes of difficult deliveries, is as impactful to the reader as the staff skepticism surrounding the radical figure of Dr. Kathleen Lynn, who, like her real-life historical counterpart, is released as a political prisoner to treat patients during the pandemic.

The character of Kathleen Lynn caused me to consider another parallel to our times; while we are not, thankfully, caught up in both a pandemic and a World War, the political divisions and social tensions of the past year are eerily similar to those that influence the novel. Two years following the Easter Rising of 1916 and a year before the commencement of the Irish War of Independence 1919, political tensions and factional unrest in Ireland were again steadily building, further dividing Protestants and Catholics, and Sinn Féin activists against those loyal to the British Crown. As in this past year, the demands and losses of a pandemic were complicated by turbulent and contentious political unrest and fears for the future.

As you may have suspected in reading the above, The Pull of the Stars is not an “easy read.” In addition to the reminders of our times, there are many graphic and visceral depictions of labor and some heartbreakingly historically accurate and now-outdated means of assisting delivery. All of that said, I found surprising comfort in this novel, from depictions of walking past closed businesses and cafés to the strange sight of masks, “bluntly pointed . . . like the beaks of unfamiliar birds” on every face. Perhaps, for me, this novel served as a reminder that we are not, in fact, living in a historically unprecedented time, even as it prompts more sober reflection on the little-changed expectations thrust on overworked and under-supported nursing staff in a time of national emergency.

Discussion Prompts

  1. How does reading a historical novel set in a time of pandemic as someone living in a present-day pandemic impact what details you notice and consider within the narrative? In what ways does the novel force you to compare and contrast characters’ experiences with your daily life? 
  2. The Pull of the Stars encompasses many losses in addition to the loss of life. Which non-death or secondary losses were most resonant, moving, or troubling to you as a reader and why?
  3. What parallels can you draw between Julia’s described experiences and feelings working in her ward and what we know of nurses’ professional demands and lives during the current pandemic? 

About the Reviewer

Sara Murphy, PhD, CT, is a death educator, certified thanatologist (Association for Death Education and Counseling), and suicidologist. She is a faculty member at the University of Rhode Island and conducts workshops on death, dying, and bereavement nationwide for professional organizations, schools, and community groups. Dr. Murphy is also a bereavement and suicide consultant and the author of the booklet, Grieving Alone & Together: Responding to the Loss of Your Loved One during the COVID-19 Pandemic, a free resource available to grieving families and helping professionals published by the Funeral Service Foundation. She can be reached at