Julia marks the patients who die under her care by scratching symbols on the back of her watch. She uses a loose nail in the wall to make the marks, privately, so that patients won’t notice. Julia explains, “I’d formed this habit the first time a patient died on me. Swollen-eyed, at twenty-one, I’d needed to record what had happened in some private way” (34). When an adult dies, Julia etches a circle to symbolize a moon; when a baby dies, she etches a crescent. Julia notes, “A newborn’s prospects were always uncertain, but in this hospital we prided ourselves in losing as few mothers as possible, so there really weren’t that many circles marked on my watch. Most of them were from this autumn” (34). Fall 1918 was the height of the pandemic, when the influenza virus spread most rapidly.

After Ida Noonan dies, Julia pulls out her watch to make a mark and realizes, “I’d reached the point of each woman’s round moon having to overlap with that of one who’d gone before her or with the crescent or broken line of an infant lost after or before birth” (121). Looking at her watch, she thinks, “The hieroglyphic tally of the dead floated past me, a stream of stardust” (121).