An uncanny parable for our own troubled times, Donoghue's novel dips into pandemic history and an Ireland under siege by a specter, a sickness that is a poison brewed in the trenches or "spread by all this hurly-burly and milling about across the globe." Nurse Julia Power walks the rain-slicked Dublin streets on her way to the grand old-fashioned silhouette of the central city's hospital. Julia works in a Women's Fever Ward, where a group of women are often coughing too hard to speak.

Thus begins Donoghue's rather gloomy, explicit birthing novel, with a waft of eucalyptus and word of soldiers lost in the various theaters of war. Julia is sent to the ward to work three afternoons a week. She must meet the needs of three patients: Eileen Devine, Ita Noonan and Delia Garrett. The hospital's atmosphere is one of scrupulous order, having survived four years of wartime disruption even as the dreaded flu clogs up "the whole works of the hospital."

While the "bone man" (one character's metaphor for death) is never very far away, most of the novel is about the celebration of new life, even through a pandemic. Alternating between the graphic and tenderhearted, the novel is vaguely carnivalesque. Donoghue immerses us in the action and the intimate parts of women as seen from within.

With the doctors busy on the other wards, a somewhat dazed Julia is left to fend for herself. This flu is not a mere "culling of the weakest... nothing like the familiar winter bane that snuff[s] out only the very oldest and frailest." How will we ever get back to normal after the pandemic? Will Julia ever find herself relieved to be demoted to a mere nurse under demanding Sister Finnigan again? Luckily, pale, freckle-faced volunteer Bridie Sweeney arrives to help. At first, by the sounds of her accent, Bridie comes across as unqualified and uneducated. Julia could slap Bridie from sheer disappointment. Asked to be a runner, to fetch and carry, Bridie is soon learning the tricks of the trade that can't be learnt in any manual but are passed down midwife to midwife.

As the day takes her toll on Julia, she becomes a little wobbly and lightheaded. With Bridie watching, Julia tries desperately to save Mary O'Rahilly, the pain of a laboring exacerbated by illness. Julia and Bridie are thrust together in star-crossed adversity as Julia wonders how long Doctor Lynn spent in prison and how she managed to stay so sturdy and lively.

Though the endless descriptions of vulvas and vaginas, all the blood associated with childbirth and the horror of obstructed labor, are a bit much, Donoghue shines in the more symbolic aspects of her novel: the meaning behind influenza, an illness which some think proves that the heavens are governing their fates. The book is a journey, a scathing indictment of a world (and of a hospital) constantly on edge.

Though the novel never really surprises us with big disclosures, or catches us off guard (apart from the Bridie's sudden tragedy and Julia's work, which she tells us is like a three-day fever dream), the author clearly wants to keep us guessing about Julia's vocation and the women for whom she cares for in this small square of a sick, war-weary world.