“The spectre had a dozen names: the great flu, khaki flu, blue flu, black flu, the grippe, or the grip… (That word always made me think of a heavy hand landing on one’s shoulder and gripping it hard.) The malady, some called it euphemistically. Or the war sickness, on the assumption that it must somehow be a side effect of four years of slaughter, a poison brewed in the trenches or spread by all this hurly-burly and milling about across the globe.”

In the year 1918, not only is a deadly influenza pandemic ravaging the world, but World War I is still raging. Julia reflects on the various names that people give the mysterious virus and points out that some link the pandemic to the war’s cruelties.

“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.”

Because of the pandemic, many businesses have had to close, and many people are dying. Julia sees these effects throughout Dublin as she commutes to work—and reminds herself that the whole world is affected.

“The bone man was making fools of us all. That was what we kids called death in my part of the country—the bone man, the skeletal rider who kept his grinning skull tucked under one arm as he rode from one victim’s house to the next.”

As a nurse working in a hospital during the 1918 pandemic, Julia sees death all around her. Throughout the novel, she pictures the bone man, a character from folklore who personifies death, coming after her patients and acquaintances.