In 2018, Australian author Inga Simpson received an email from Kath O'Connor, a GP who had always dreamed of writing a novel.
"She contacted me online out of the blue and asked me if I would mentor her through the process of writing a book," Simpson told ABC RN's The Book Show.
There was nothing out of the ordinary about the request. Simpson, whose most recent novel Willowman was published in 2022, received similar queries from younger writers all the time.
After talking to O'Connor, Simpson said yes.
However, there was a hitch: O'Connor was undergoing treatment for ovarian cancer.
Ultimately, she managed to finish the second draft of her novel before she died in 2019 at just 45 years old.
It then fell to Simpson, and O'Connor's family, to prepare the manuscript for publication.
Finally, in January 2023, Affirm Press published O'Connor's debut novel: Inheritance.
A lifelong love of writing
O'Connor's father, Kevin, says she had always wanted to be a writer and had a lifelong love of literature.
"Words and expression and ideas were … central to her life," he told ABC RN's Life Matters.
After receiving her cancer diagnosis in 2015, O'Connor threw herself into fulfilling her dream of writing a novel.
When she reached out to Simpson in 2018, she was looking for a mentor to hold her accountable; someone she could send words to each fortnight, who would provide feedback and help her through the final stages of the writing process.
After hearing O'Connor's pitch, Simpson agreed to help: "We got on really well – and as if I could say no.
"She told me up-front she had the BRCA1 gene [a mutation that increases the risk of breast and ovarian cancer], she'd recently had two major operations associated with … ovarian cancer, and she was in recovery.
"This was both part of the story for her as a writer and part of the story she was writing."
From the start, Simpson was struck by O'Connor's optimism.
"She was very positive … She described it as a chronic illness that she had to manage, which surprised me," Simpson recalls.
"I was taking it all much more seriously than that. [But] she was very upbeat right until the end."
Art imitating life
Inheritance follows two women: Rose King, an oncologist who discovers she has the BRCA1 gene while seeking fertility treatment in 2016, and her grandmother, Nellie, who undergoes treatment for ovarian cancer in 1945.
The premise draws heavily on O'Connor's family history: Her grandmother, Eileen, died of ovarian cancer in 1950 when she was 48.
In Inheritance, Nellie shields her young sons from her illness and impending death. Similarly, Kevin O'Connor's family initially kept his mother Eileen's death from him and his brother, who were considered "too small" to attend the funeral and were sent to an aunt's place instead.
In both cases, the women's families believed their grandmother died from other types of cancer, not ovarian.
It was only upon inspection of their death certificates decades after their passing that their families discovered the truth – and were able to track the passage down the generations of the deadly BRCA1 gene.
"[Inheritance is part] detective story to figure out where the gene has come from … which Kath would have certainly identified with," says Simpson.
"As I understand it, she did not know she had that gene until she was diagnosed with cancer."
While O'Connor remained buoyant throughout her illness – outwardly, at least – her protagonist Rose struggles with the discovery that she carries the defective gene.
Rose was not as gracious in the face of adversity as her author, reflects Simpson.
"I wonder if that was Kath's way of riding out some of her less-positive feelings, getting them on the page [and] not exposing them to anyone in her life," she says.
In the novel, Rose and her partner Salima must contend with the dilemma posed by the King family's genetic legacy.
"Rose is very proud, very stubborn, and it's complicated – they're in the middle of this fertility process and discussing having children, and this really throws a spanner in the works.
"Would you want to pass that on? It's a point of radical reassessment of Rose's life."
An unusual editing process
Simpson is a seasoned editor, but even so, working on O'Connor's manuscript was "a big learning experience", she says.
For one, she found it intensely emotional.
O'Connor, with her wealth of medical knowledge as a GP, describes in agonising detail Nellie's symptoms, which include pain, swelling and nausea.
She also details the brutal treatment Nellie receives in hospital and the callous manner of her doctors, both of which were typical of the time.
In 1945, before the advent of chemotherapy, cancer patients were often treated with radium, which had debilitating side effects, including burns to patients' skin.
In Inheritance, Nellie describes her ordeal: "After twelve days of treatments, my abdomen is red raw, with blisters and blackened areas."
Another effect is pain. The day after a radium treatment, Nellie feels an ache: "A grazing, a scraping. It turned into a searing pain, like my insides were being dragged over sandpaper, or rough stone."
Her prognosis is grim, with a doctor giving her 12 months at most.
When an ailing Nellie muses on her mortality, it's easy to imagine O'Connor is describing her own experience too:
"I wonder what the dying will involve. Will the pain that has already leached into my bones get stronger, so that finally it drowns me out? Will it be a drifting or a ripping away? I can imagine a ripping. A ripping feeling has already taken residence inside my chest. I can feel it growing. It is stronger than I am."
While cancer treatment in the 21st century is much more sophisticated, O'Connor ultimately faced the same fate as Nellie – and her grandmother, Eileen.
"She must have known by the end that she was going to die of the same disease," says Simpson.
"It must have been very hard to write those sentences."
But it's O'Connor's unenviable firsthand experience of the debilitating disease that imbues these scenes with their remarkable pathos and authenticity, Simpson says.
"[It was] obviously easy for her to imagine herself in the situation, which is perhaps why those scenes are so powerful and so well done.
"They're really delicately crafted; they're not over the top. It really leaves space for the reader to fill in with their own emotions and experiences."
Just as distressing for Simpson was seeing the evidence of O'Connor's talent as a novelist on the page.
The Sydney Morning Herald praised Inheritance, calling it a "limpid, deeply empathetic novel" and O'Connor "a writer of rare talent".
Simpson says: "I found it quite devastating to read the manuscript – to see how good it is, what a career she would have had, and the strength it must have taken to keep going, the determination to keep writing right up until the end."
A delicate project
O'Connor's manuscript was "nearly finished" when Simpson stepped in to prepare it for publication.
"There were really only a couple of unfinished scenes, a couple of gaps and a few inconsistencies," she says.
Simpson, a publishing veteran with seven books to her name, knew well the hard work required to finish a novel.
Had O'Connor been alive, Simpson says she would have been much more ruthless in her edits.
"I would have asked a lot of questions, made a lot of comments, marked up the manuscript and pinged it back to her with great confidence."
However, with a posthumous manuscript in her hands, Simpson couldn't rely on her old methods.
"Because [Kath] wasn't there to push back, to resolve any of those questions or issues in her own voice, in her own way, it felt really delicate," she says.
Simpson wanted to avoid leaving too much of a mark on O'Connor's novel.
"I didn't want to intrude – I probably already had some influence on the manuscript, so I didn't want there to be any more.
"What we all wanted now was for Kath's voice to be heard."
'A beautiful book'
Working on Inheritance changed Simpson's view of the editing process, which is typically designed to smooth out a manuscript's rough edges.
Perhaps, she reflected, it's the rough edges that give a text its character.
"Editing should make a book more like itself, not less," she says.
Simpson no longer mentors other writers, partly due to the experience of bringing Inheritance to publication: "My time doing that is up," she says.
Now that it is out in the world, Simpson hopes Inheritance finds a wide readership, calling it "a beautiful book" and "an incredibly strong debut".
"Knowing the story of the author … makes it all more poignant. It really is a little parable for living your life every day – being absolutely present every day."
Inheritance is out now through Affirm Press.
