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Of the many titles it specifically mentions, two are particularly important. The Book Woman of Troublesome Creek is a book about the power of books in a harsh world. The medical tests and discoveries made by Doc in the novel are drawn from a study of the Blue Fugates conducted by a hematologist in the 1960s. In their small community, intermarriages meant that the recessive gene become widespread and blue-skinned Fugate descendants continued to be born through the 1970s.

Four of their seven children had blue skin. In 1820, Martin Fugate and Elizabeth Smith, who both unwittingly carried the recessive gene for methemoglobinemia (a condition that means a person’s blood carries less oxygen and their skin accordingly has a blue color), married and settled in Hazard, Kentucky. Her story fictionalizes aspects of the historical “Blue Fugate” family of Kentucky. Finally, the novel’s protagonist, Cussy Mary Carter, is the last of the “Blue Carters,” a family with a rare blood disorder that tinges the skin blue. Unionized coal miners in Harlan County trying to fight for better working conditions and pay ended up in a decade’s worth of hostilities with the powerful local coal companies. Miners also faced dangerous working conditions, from explosions and tunnel collapses to lung diseases from inhaling coal dust. Coal companies would establish mines, often in remote areas, then build up camps or towns around them and financially exploit their workforce. Coal was discovered in Kentucky in the late 18th century, and by the early 20th, coal had become one of the state’s primary commodities. 1930s Kentucky was also the site of the “Harlan County Wars,” which were fought between coal mine operators and unionized miners in southeastern Kentucky. Despite the New Deal programs, the United States economy didn’t recover its pre-depression size until 1939.

Its many agencies, including the Works Progress Administration (WPA) and the Civilian Conservation Corps, provided jobs for artists, writers, librarians, construction workers, firefighters, and foresters, among others. The New Deal combined a series of financial reforms and regulations designed to address monetary policy with a public works program designed create jobs. In the United States, the economy began to slowly improve starting in 1933, thanks in part to the New Deal program, which was created under President Franklin D. It caused a sharp drop in employment rates, wealth, and stability for many people. The Depression was a severe, worldwide economic crisis that began in 1929. The Book Woman of Troublesome Creek is set in the eastern Kentucky mountains during the final years of the Great Depression.