Meg Elison’s The Book of the Unnamed Midwife won the 2015 Philip K. Dick award for distinguished science fiction published in paperback original form. This award always interests me because so much science fiction has originally appeared in this form over the years, and also because PKD was such a strange and interesting man himself. I won’t go into detail on him here except to say that he lived most of his life in poverty only to have many of his works made into movies and TV shows after his death, the revenues of which total more than a billion dollars so far. A few examples of these are Total Recall, Blade Runner, Minority Report, The Adjustment Bureau and on and on and on. So when this award comes around every year, I can’t help but notice the winner.

Meg Elison’s novel is set in the aftermath of a largely unexplained plague that has decimated the world population, especially women, who number only ten percent of the survivors. Childbirth appears impossible through most of the narrative, though we know this will change since the narrative structure has most of the text as the diary of the unnamed midwife as preserved by a future civilization. The unnamed midwife takes on various false names throughout the text, so I’ll simply refer to her as UM. And speaking of narrative structure, Ms. Elison uses symbols like “=” in the diary entries to stand in for words and presumably give the feel of a real handwritten diary. Maybe I’m just old, but I found this narrative gimmick annoying and it kept grabbing my attention and pulling me out of the text. Perhaps young readers are more used to this kind of thing from text messaging and don’t find it so annoying.

UMs story begins in the immediate aftermath and is quite engaging. As you can imagine, there is the immediate need to survive and find a way to get along in a rapidly devolving society. There is the expected violence, and with the sexual imbalance it is particularly harrowing for women. These parts are particularly ugly and ring all too true. UM was a labor and delivery nurse before the world fell apart, so she is particularly devastated by the inability of babies to survive birth in the aftermath of the plague.

UM travels widely through this post-apocalyptic world both physically and emotionally. Ms. Elison does a particularly good job of carrying the readers’ emotions along with those of UM. At first, I thought UM was going to evolve the attitude of the atheist mocking religious enclaves that survived. At another point, I thought she was going to take the opposite course and evolve into a religious true-believer. She never quite does either, and it is a very interesting journey the reader takes along with her. All in all, I think this novel is a worthy winner of the PDK award.