The Pull of the Stars opens on October 31, 1918, the day before Julia’s 30th birthday. Julia hurries to get to work, biking to the tram stop and then riding the tram to the hospital. During her commute, Julia reflects on the people who have died of influenza and the men who have died fighting in World War I. Some people wear masks to protect themselves from the flu; Julia sees a couple wearing “bluntly pointed masks like the beaks of unfamiliar birds” (5). The virus and the war have forced so many businesses to close that Julia, seeing the shuttered storefronts, thinks of Dublin as “a great mouth holed with missing teeth” (7).

At the hospital, Julia gets breakfast in the canteen that the hospital has set up in the basement and says hello to her friend, Gladys Horgan. Gladys and Julia trained together as nurses in their early twenties, but Gladys eventually went into eye and ear care while Julia pursued midwifery. After breakfast, Julia heads to a small room with the handwritten sign “Maternity/Fever” (17) on the door. An old supply closet, the hospital has converted the room to a ward for pregnant women infected with influenza to separate them from uninfected women in the regular Maternity ward.