Jenny Downham’s first novel plainly announces its theme in its title: “Before I Die.” The narrator, 16-year-old Tessa, has recently learned that the leukemia she has been living with for four years is now terminal, and the question is: What now? She decides to make a top-10 list of things she wants to do in the time she has left, and enlists her most reliably irresponsible friend, Zoey, to help. In his review, John Burnham Schwartz praises the novel’s “stark interior poetry,” and calls it “unforgettable.”

Ms. Downham answered a few questions about the book by e-mail.

—The Editors

Q. Your author’s bio on “Before I Die” says intriguingly little about your background—only that you live in London and that you were trained in the theater. How did you decide to write a young adult novel, and on this staggeringly difficult subject?

A. As an actor I worked for seven years with a community theater company based in London. We used improvisation techniques to take stories to young people who wouldn’t normally have access to them—in prisons, hospitals, young offender’s units, youth clubs and housing estates. I spent many years putting myself in imaginary situations and playing all sorts of people I had absolutely nothing in common with and would never normally be cast as.

When my second child was born I gave up acting—two young children out on the road was too difficult to manage. I’d always written, but began to do so with real commitment now that it was my only creative outlet.

I used all my acting techniques to do it. I still do. I keep notebooks for characters, researching them as if I’m going to play them on stage—what they like to eat, what their hopes and fears are. It might not all get in the book, but it helps me to know who they are.

I wanted to write for and about teenagers because they are on the cusp of adulthood and that interests me. I didn’t know Tessa was dying when I began writing. I just had this idea about two friends who were very different from each other and I started with their voices. It became apparent after only a few weeks that Tessa was ill. I knew if she was terminally ill that it would increase the narrative drive, but I knew I also risked losing tension because readers would know from the beginning how the story would end. So the challenge became how to make the book interesting when everyone knew what was going to happen. That’s where the ‘before I die’ list came in.

Q. In a first-person novel of this kind, there’s often a personal story somewhere in the background, but according to the publisher, the details of Tessa’s symptoms and medical treatment come from your own research. How did you go about getting inside the experience of a cancer patient?

A. I kept a diary for Tess whilst I was writing and every morning I started my day by writing the previous day’s entry. Tess read the paper and listened to the news. She went for walks. I began to see things through her eyes quite a lot because I knew I’d have to write her diary later. I spent hours and hours imagining how it might feel to be her.

I read a lot of books about cancer and I worked with nurses to make sure the story was factually correct, but it was never supposed to be a medical or hospital-based story. Tess has been sick for four years and has received a terminal diagnosis. She knows she will die. She lives with her condition. I wanted the reader to inhabit her body (by using first-person, present tense narrative) in the hope that they would have both a visceral and an emotional response. If Tessa’s body does the talking—If the reader experiences a lumbar puncture or a hemorrhage with her—then it inevitably pushes the reader closer to the physical self. I wanted to achieve an immediacy between the body’s decline and the words Tess uses to describe what’s happening to her.

Q. Many novels deal with the death of a child or sibling, but very few attempt the narrative from the point of view of the dying person. Were there any works of literature that were inspiring or useful to you, when it came to working out how to tell the story?

A. Susan Sontag’s “Illness as Metaphor” was very inspirational, as was Anatole Broyard’s “Intoxicated by My Illness” and Gillian Rose’s “Love’s Work. ” I read a lot of poetry about bereavement and loss, finding particular inspiration in Raymond Carver’s collected poems, “All of Us.”

Q. I would imagine you faced some resistance when you first took this book to publishers. Is that the case? And how are young readers responding to it?

A. Actually, no, I didn’t meet any resistance! David Fickling made a pre-emptive offer on the book within a week of my finishing it. Within less than 24 hours of the offer, the book had sold to Holland. It sold in a further ten languages within two weeks.

The book has been available in the United Kingdom since July 5th and so far both reviews and individual responses from young readers have been very positive. I’ve had a few letters and e-mails and it’s great to hear what people think of the story. One reader said to me that she was less afraid of dying now that she had read the book. I was absolutely stunned by that response.

Q. Did you read YA fiction when you were growing up? Any favorite authors?

A. As a young reader I devoured poetry, folk and fairy tales (Grimm, Andersen), and stories from the Arabian Nights and Ancient Greece. I loved Ann Holm (“I Am David”) and Robert C. O’Brien (“Z for Zachariah”)—my first realisation that I could be utterly transported by words on a page.

Q. Are you working on something new?

A. I’ve started my next book. I have a location and a voice and an event. It seems to be for young adults again, though I’m not quite sure where it’ll take me. I don’t like knowing in advance. I never plan a structure. I like surprises. I’m quite disciplined and sit at my desk every day and just write. Most of it goes in the bin, but I find I return again and again to the things that preoccupy and eventually I begin to see what the book might be about.

Originally published on the New York Times