I picked this up in the wake of links highlighting award nominees beyond this year’s poisonous Hugo debate. Winner of this year’s Philip K Dick award, The Book of the Unnamed Midwife is a brutal apocalyptic novel set in a nearly-now. The world has been ravaged by a flu-like sickness that has spread like wildfire, killing 98% of infected men – and more women.
The midwife recovers in a hospital full of the dead, and must make her way in a dangerous new world where women have become prized commodities and men stop at nothing. Aware that her medical skills are now rarer than hen’s teeth, she is rapidly apprised of the terrible situation the few surviving women find themselves in. Disguising herself as a man, she sets off in search of a refuge, swearing to help as many women as she can. If she can’t free them from their immediate predicament, she can at least help them avoid pregnancy (an almost-certain death sentence as the plague claims every newborn and most mothers).
This is not a cheerful post-apocalypse. While it’s not entirely clear how long it is since the main die-off, the world is practically empty. The midwife must come to terms with the immediate difficulties of survival – including the threat posed by other humans – and the more insidious threats of loneliness and despair. Elison takes the harshest lines here; civilisation is non-existent, and social contracts have expired. Where pockets of human goodness survive, they are constantly under threat.
I do think it’s flawed. I repeatedly tripped over the narrative structure: it is introduced as the midwife’s diaries, but is predominantly third person (whuh?) – and sometimes swaps briefly to an omniscient third person to detail what happens to characters after the midwife has moved on, or to outline events elsewhere in the world that the midwife is ignorant of – none of which makes sense given the set-up. I honestly think Elison would have done better to leave this broader world-building for her own reference and cut it out of the final draft. This is an intimate tale of one woman’s survival in a world gone to hell in a handbasket – and for my money would have worked even better with a tighter focus.
Elison also re-uses a few tropes that are too well-trodden for my liking: waking in a hospital and unlikely radio messages promising salvation both recall 28 Days Later (although the hospital waking is an older and more tired trope), and her depiction of a small Mormon enclave in Utah suffered from my recent read of A Study in Scarlet. Are the Mormons really still that close to 19th century attitudes? Perhaps they are – they’re not a community I know much about, beyond a couple of terribly normal blokes I’ve worked with.
There is apparently a sequel in the works, which also feels extraneous (but then I do tend to like my apocalypse as a one-off thought provoker – although if she moves on to how society is rebuilt, that could be interesting).
Overall, not one to read lightly or if you’re feeling down on humanity, but worth picking up if you have a particular interest in (post)apocalypse downers. Particularly notable for focusing on the mental/emotional aspects of survival, as well as for showcasing a strong female protagonist.