Navigating a Pandemic: An Excerpt from Emma Donoghue’s The Pull of the Stars
Author: Edit Team
July 20, 2020
The following is excerpted from The Pull of the Stars (Little Brown and Company), the new novel by Emma Donoghue. Mirroring our current pandemic moment, The Pull of the Stars chronicles the relationship between three nurses who work in the maternity ward of a small hospital during the influenza outbreak of 1918.
I’d specialised in midwifery because the drama of it drew me in, but I’d never imagined myself as the woman at the centre of the mystery, the full moon rounding, only as the watchful attendant.
Thirty tomorrow. That ring of being past one’s best.
But thirty wasn’t so very old, I told myself. By no means too late to marry and have children; only, on the balance of probabilities, unlikely. And even less likely, I supposed, now so many men had been lost in the war, either facedown in some foreign field or just not interested in finding their way back to this small island.
I got Delia Garrett’s nightdress on and tied the side tapes, then tucked her back into bed and wrapped her up well against the autumn air whistling in the high window.
I finished stripping Ita Noonan’s mattress. I was relieved that the mackintosh drawsheet had caught all the urine; the cotton sheet and underblanket beneath it were still dry.
What I couldn’t quite put my finger on was whether I wanted a husband. There’d been possibilities along the way, pleasant young men. I couldn’t reproach myself with having thrust opportunities away, but I certainly hadn’t seized them.
Would you be Nurse Power?
I whipped around to see a youngster in civvies in the doorway, brassy hair scraped back and oiled down but a frenzy of curls at the back. Who are you?
No title, which told me she wasn’t even a probie. So many young women were being rushed through basic first-aid training these days.
Delia Garrett asked, And what might you be, Miss Sweeney, a volunteer nurse?
The stranger grinned. I’m not any kind of nurse.
Delia Garrett threw up her eyes and went back to her magazine.
Bridie Sweeney turned to me. Sister Luke’s after sending me to lend a hand.
So this was all the night nurse had managed to dig up for me—unqualified; uneducated, by the sounds of her accent; and with a clean, new-hatched look like nothing had ever happened to her. I could have slapped this Bridie Sweeney from sheer disappointment.
I said, The hospital has no funds left for casual staff. I hope Sister Luke told you there’s no pay?
I wasn’t expecting any.
She was the pale, freckle-dusted type of redhead, light blue eyes, brows almost invisible. Something childlike about her translucent ears; the one on the left angled a little forward, as if eager to catch every word. Thin coat, broken-down shoes; on an ordinary day, Matron would never have let her in the door.
Well, I said, I could do with a runner to fetch and carry, so I’m glad you’re here. This is Mrs. Garrett. Mrs. Noonan.
Good day, ladies, Bridie Sweeney said with a bob. I took a folded apron down from the press.
The volunteer was a scrap and looked even thinner once she’d taken her coat off; she had to wrap the apron’s ties around her waist twice. With frank curiosity, she watched Ita Noonan rocking on the little chair by her cot, wheezing a song. She remarked, I’ve never been in a hospital.
By the way, Miss Sweeney, I assume you’re immune? The young woman didn’t seem to know the word.
To the flu, the grippe. Since you’ve walked into a fever ward without a mask—
Oh, I’ve had the grippe.
But this year’s one, the bad one, I specified.
Got over it ages ago. Now, what do you want doing, Nurse Power?
It was a relief to be asked that. Let’s start by making up Mrs. Noonan’s bed.
I checked the base layers were all smooth, the wire-spring mattress in its canvas cover sitting just so on the boards, the hair mattress in its cotton one on top. A ruddy tan waterproof mackintosh base fitted tight, then an underblanket, then a sheet.
Aromatic with whiskey fumes, Ita Noonan tried to climb on.
Just another minute, I said as I blocked her gently with my arm.
I got a fresh drawsheet, under and upper sheets, and blankets from the bedding cupboard. I said, We pull every layer smooth and crisp, see, so there’ll be no wrinkles to hurt Mrs. Noonan’s skin.
Bridie Sweeney nodded.
As I helped Ita Noonan in, she heaved a breath and cried, Such malarkey!
The newcomer asked, What is? I shook my head.
Her face froze. Sorry—am I not allowed to talk to them?
I smiled. I only meant, don’t worry if Mrs. Noonan makes odd remarks. I tapped my scalp and said, A high temperature can rattle the pot.
I wound one shawl around the sick woman’s shoulders and draped another over the back of her head to keep draughts off.
Ita Noonan swatted at the air with her sipping cup. Awful yahoos, left my delph in smithereens!
Did they now? Bridie Sweeney fixed the pillows.
The young woman had a nice bedside manner, I decided; that couldn’t be taught.
I pushed the ball of soiled bedding down into the laundry bucket and jerked my thumb towards the passage. This goes down the chute—the one marked Laundry, not Incinerator.
Bridie Sweeney hurried out with the bucket.
Delia Garrett asked, Did that girl just walk in here off the street?
Well, if Sister Luke recommended her…. A snort.
We’re so short-staffed that I’ll gladly accept any help, Mrs. Garrett.
She muttered into her magazine, I never said you shouldn’t.
When Bridie Sweeney came back in, I took her through the distinctions between various gauze dressings (squares, balls, six-foot strips in tins), flax-tow swabs, single-use cloths, ligatures, and catgut.
The actual guts of cats?
Sheep, actually. I don’t know why it’s called that, I admitted.
She beamed around her. So these ladies are here for you to cure their grippe?
I let out a breath. I only wish I knew how to do that, but there’s no cure as such. The thing has to run its course.
For how long?
Days or weeks. (I was trying not to think of those it killed with little warning, in the street or on their own floorboards.) Or it can linger for months, I admitted. To be perfectly frank, it’s a toss-up. All we can do is keep them warm and rested, fed and watered, so they can put what force they have into beating this flu.
My young helper seemed fascinated. She said under her breath, Why’s Mrs. Noonan that colour?
Ah, here was something simple I could teach. I told her, They go dark in the face if they’re not getting quite enough oxygen into their blood. It’s called cyanosis, after cyan—the shade of blue. She’s not blue, though, said Bridie Sweeney. More like scarlet.
Well, I said, it starts with a light red you might mistake for a healthy flush. If the patient gets worse, her cheeks go rather mahogany. (I thought of the turning of the leaves in autumn.) In a more severe case, the brown might be followed by lavender in the lips. Cheeks and ears and even fingertips can become quite blue as the patient’s starved of air.
I remembered to turn to the other patient and say, Don’t worry, Mrs. Garrett, you’re not in the least cyanotic.
She gave a little shudder at the idea.
Bridie Sweeney asked, Is blue as far as it goes?
I shook my head. I’ve seen it darken to violet, purple, until they’re quite black in the face.
(Nurse Cavanagh’s fallen Anonymous this morning, as dark as cinders by the time she ran up to him in the street.)
It’s like a secret code, Bridie Sweeney said with pleasure. Red to brown to blue to black.
Actually, in our training, we made…
I wondered if she’d know the word mnemonic. Or alliterative.
. . . little reminders to commit medical facts to memory, I told her.
Well… the four Ts that can cause postpartum haemorrhage—bleeding after birth—are tissue, tone, trauma, thrombocyto- penia.
You know an awful lot, Nurse Power.
I gave the young woman a tour of the other shelves and cupboards. If I hand you a metal instrument that’s been used, you can take for granted that I want it sterilised, Miss Sweeney. Lower it into this pot of boiling water with these tongs here and leave it for ten minutes by your watch.
Sorry, I haven’t—
There’s a clock on the wall over there. Then lay out a fresh cloth from this brown-paper packet and use the tongs to set the instrument on the cloth. Anything you haven’t time to boil can be disinfected in this basin of strong carbolic solution instead.
But was she grasping the importance of what I was saying?
When each item has air-dried, I went on, you move it with the tongs to a sterile tray up on this shelf, where everything’s sterile—thoroughly clean, ready for a doctor. Never touch any of them unless I tell you to, understood?
Bridie Sweeney nodded.
Delia Garrett let out a series of coughs that turned into whoops.
I went over to check her pulse. How’s your stomach now, Mrs. Garrett?
A little steadier, I suppose, she conceded. I blame what happened on that nasty castor oil.
I very much doubted the dose I’d given her could have liquefied her at both ends.
It’s ludicrous keeping me shut up here for a touch of flu! My babies pop out the week they’re due and not before, and I spend no more than half a day in bed, no fuss. Why’s this chit gawping at me?
Bridie Sweeney’s hand shot up to cover her grin. Sorry, I didn’t know you were . . .
Delia Garrett glared, hands on her belly. You thought this was pure fat?
I pointed out, It says Maternity/Fever on the door, Miss Sweeney.
She muttered, I didn’t know what that meant. I was taken aback by her ignorance.
Well, I said. Now I’ll show you how to wash your hands. Amusedly: I think I know that much.
I asked a little sharply, You’ve heard of childbed fever? Of course.
It can come on a woman anytime from the third day after birth, and it used to kill them at a terrible rate. Our only modern defence is asepsis—that means keeping germs from getting into patients. So now do you see how cleaning one’s hands thoroughly could save a life?
Bridie Sweeney nodded, abashed.
I told her, Roll your sleeves all the way up so you don’t wet them.
She seemed hesitant. When she bared her right forearm, it had a melted look. She saw me notice and she muttered, A pot of soup.
That must have hurt.
Bridie Sweeney shrugged, a monkeyish little movement.
I hoped she wasn’t the clumsy sort. She didn’t seem so. Her hands were reddish, which told me she was used to hard work. First we pour out boiling water from this kettle, Miss Sweeney, and add cold from the jug.
She immersed her hands in the basin. Lovely and warm! Take this boiled nailbrush and scrub your hands well, especially the nails and the skin around them.
I waited for her to do that.
Then rinse them in fresh water to get all the soap off. Finally, soak them in a third basin of water . . . with a full capful of this carbolic here.
I poured it out for her and added, Antiseptics such as carbolic can actually be dangerous—
—if you swallow them or splash them in your eyes, I know, she said eagerly.
I corrected her: If one relies on them lazily instead of taking care to scrub really well.
Bridie Sweeney nodded, hands dripping.
I gestured to a stack of clean cloths so she wouldn’t try to dry them on her apron.
No one had been back to collect the breakfast trays yet. I said, I wonder could you take these to the kitchen?
She asked, Where’s the—
In the basement, two floors down.
When she was gone I checked temperatures, pulses, respirations. No change. That was reassuring in Delia Garrett’s case, worrying in Ita Noonan’s. The whiskey might be providing some comfort, but that was all.
Thanks, I said when Bridie Sweeney came back in. It’s a real help, having another pair of hands.
She looked down at her knuckles and scratched their reddened, swollen backs.
She nodded, sheepish. Driving me wild.
Thin girls were susceptible, for some reason. I said, Here, this should soothe the itching.
I got the medicated balm down off the shelf but she made no move to take it, so I scooped a fingerful from the jar, reached for her hands, and rubbed it well into the scarlet patches. On the back of the left one, there was a raised, red circle—ringworm, the brand of poverty I saw on so many patients. But it was fading, so no longer contagious.
Bridie Sweeney breathed in a giggling way, as if what I was doing tickled. The scent of eucalyptus filled the room. Apart from her fingers, the rest of her was so white, almost blue.
I told her, Don’t let your hands get cold or wet in the winter.
Always wear warm gloves when you’re out.
I’m not often out.
Delia Garrett coughed pointedly. Whenever you two are finished titivating, I’m gasping for a cup of tea.
I directed Bridie Sweeney to the kettle and took down the caddy and pot from the shelf. Patients can have as much tea as they like.
She said, Very good. With sugar, Mrs. Garrett?
Two spoons. And milk. Or, no, actually—that condensed stuff is so horrid, black will do.
I told Bridie Sweeney, Offer arrowroot biscuits with tea if the patient has any appetite.
Unlike plump armed Delia Garrett, our poorer mothers came in here with too little flesh on their bones, and in Maternity our policy was to feed them up as much as possible before their time of trial.
Bridie Sweeney was a skinny malinks herself, but the tough, wiry kind that food went through like water, I supposed. And you can make us each a cup while you’re at it, Miss Sweeney.
I seized my chance to nip out. But at the door, I turned and said, I hope you know enough to know that you know nothing?
Bridie Sweeney stared—then nodded, head bobbing, a flower on its stem.
I told her, I was taught that being a good nurse means knowing when to call a doctor. So being a good runner means knowing when to call a nurse. If these ladies need a cup of water or another blanket or a clean handkerchief, give it to them, but if they’re in any distress at all, run out to the lavatory and fetch me.
She made a small, comical salute.
I won’t be two ticks, I said and dashed off.
What would Sister Finnigan say about my leaving the ward in the hands of this greenhorn? Well, I was doing my best. So were we all.
After the lavatory, I found myself thirsty for a glimpse of the outside world, so I went to the window and stared down at the sparse passersby. The rain had cleared up but the day had a damp cling to it. A lady in full-length furs—an odd get up when it wasn’t even November yet—stepped down from a cab and glided in the gates with a large leather bag in one hand and a cumbersome wooden case in the other. She shook back her lavish hood, baring two old-fashioned coils of hair. Well, I supposed the porter would explain the visitor ban to her.
Back in the ward, Bridie Sweeney was draining her tea, crumbs in the corner of her mouth. Delicious!
I didn’t think she was being sarcastic. I raised my own cup to my lips and tasted ashy sweepings off some faraway floor.
Ita Noonan was muttering, It’s all bockedy, banjaxed.
Bridie Sweeney came over to murmur in my ear, Is she by any chance an alco?
No, no, Dr. Prendergast ordered that whiskey for her flu.
She nodded and tapped her temple. Will her pot stay rattled permanently now?
I assured her that delirium was only temporary. So… she’ll get better? I found myself crossing my fingers so tightly it hurt. A silly habit, I knew. I told Bridie Sweeney in a low voice: These mothers are often stronger than they look.
From Pull of the Stars by Emma Donoghue (Little Brown and Company, July 2020). Reprinted with permission from the publisher.