A quick skim through the opening pages of Emma Donoghue’s latest novel reveals a grimly recognizable state of affairs. People walk the streets wearing masks. Health notices warn of coughs and sneezes spreading disease. Sports and music events have been canceled or postponed. Shops are shuttered, offices deserted. Only undertakers are busier than ever. The casual reader might be forgiven for thinking they had picked up something contemporary, particularly after learning that “the whole world was a machine grinding to a halt.”

In fact, “The Pull of the Stars” is set over 100 years ago, at the height of the 1918 influenza pandemic that claimed more lives than World War I. This plague felled Miranda, the journalist protagonist of Katherine Anne Porter’s exemplary tale “Pale Horse, Pale Rider” until she was “past praying for.” In Donoghue’s outstanding book, the heroine, nurse Julia Power, is more fortunate, having recovered from the disease. Now immune, she spends long days at a Dublin hospital caring for expectant mothers who have come down with “the grippe.”

On the day before her 30th birthday, Julia arrives at work and discovers that due to chronic staff shortages she will be on her own and in at the deep end. However, she isn’t entirely unaided, for a young volunteer helper called Bridie Sweeney shows up. Though unqualified and uneducated, Bridie turns out to be eager to please and quick to learn. Battling brownouts, a lack of resources, and constant crises, the pair go beyond the call of duty to protect their ailing patients and deliver babies safely into this drastically altered world.

Despite their best efforts, not every mother or “tiny passenger” makes it. Untimely deaths are as common as premature births. It isn’t long before Julia’s tiny makeshift maternity ward comes to resemble “an antechamber of hell.”

Donoghue ensures that her reader feels Julia’s pain. We despair at her patients’ naiveté (one teenage girl believes her baby will come out of her navel; others think garlic, rhubarb and treacle will ward off the flu), and are profoundly moved by tragic cases of poverty, hardship and cruelty.

Although there is much suffering in this novel, there are also many glimmers of light representing hope, unexpected love and Julia’s medical triumphs. These operations constitute stunning set pieces imbued with drama, tension and rare emotional force. Equally compelling are Julia’s tender exchanges with poor castoff Bridie and her frank discussions with Dr. Lynn, a “socialist, suffragette, republican firebrand” on the run from the police. “The human race settles on terms with every plague in the end,” Lynn assures her. “Or a stalemate, at the least.”

This intense and intimate novel unfolds over three days. But we would gladly spend longer with Julia, watching her in awe as she grapples with life and death in her “small square of the sickened, war-weary world.”

Malcolm Forbes has written for the Times Literary Supplement, the Economist and the New Republic. He lives in Edinburgh, Scotland.

The Pull of the Stars
By: Emma Donoghue.
Publisher: Little, Brown, 304 pages, $28.