Isabel Allende wrote Paula while tending to her daughter, Paula Frías Allende, who was in a coma arising from complications of porphyria. Allende started the book as a letter to Paula, explaining what she was missing so she would not be confused when she recovered. The novel includes accounts both of Paula's treatment and of Allende's life, sometimes overlappingwith the content of Allende's first novel, The House of the Spirits . Paula died on December 6, 1992. She was survived by her husband, Ernesto Diaz, and other family members.