"I remember that tour well," she says. "I was getting live updates from friends at home as Hillary lost, I was just devastated.

"That night we went out for dinner before my event and there was a big table full of Australians next to us who were making fun of the fact that Donald Trump had been elected.

"I've never done this but I got up and I walked over to them and I was like, 'I don't think you understand, there are a lot of people who are going to die as a result of that man being president', and they all got really quiet."

Her current book The Book of Two Ways is about the choices we make - that sliding doors moment, if you like - that sends us in one direction or the other, and the imagining of what life might be like in that parallel universe.

On the eve of this election, Picoult says she's been doing a lot of thinking about what the United States might have been like now if things had been different four years ago.

"There's this tremendous embarrassment in America, there's a complete lack of leadership" she says.

"We should be coming through the other side of this pandemic by now and we're nowhere close. It is a disappointment every single day to see the crises of leadership that have gotten us to this point and the fact that we aren't even going to come close to turning around until January - and that's only if we're smart enough to elect Biden. It's terrifying, it's really terrifying."

She says the nation is split down the middle, clouded by frustration and fear and denial.

"There are people who believe everything Trump is saying to them in spite of the science and in spite of the numbers because they listen to newscasts that are basically selling the lies that come from the White House."

Is it hard to be creative in such an environment?

"I didn't think a lot would change - I was still going to be working from home, I was still going to be writing," she says.

"But I was shocked to find out how very different it was and how dependent my work is on being in the same room with people. That really surprised me for about three months.

"I could not read a thing, I couldn't read, much less write - I just couldn't focus on anything.

"Michelle Obama called it a low-grade depression, that thing that just permeates your thoughts and keeps you from narrowing your focus on anything to get anything done. It took me a while to get back into it."

Picoult lives in Hanover, New Hampshire, with her husband Tim van Leer and their three children, Samantha, Kyle and Jake. It was her son Kyle who was the spark for this latest book.

"I've wanted to write this story for about 10 years now," she says.

"Kyle was an Egyptology major at Yale University and he came home one day with a book that was called The Book of Two Ways, which is the actual ancient Egyptian text that he was translating.

"I was like 'Wow, that's a great name for a novel', knowing nothing about it. When he told me what it was about - he explained there are two different paths but you wind up at the same place - I was like 'That's an even better idea for a novel'."

She knew, too, that she wanted it to have something to do with Egyptology and planned research trips to Egypt, which unfortunately coincided with the Arab Spring uprising. So she cancelled the trip and the book.

It wasn't until a couple of years ago, when Kyle got married and his former university adviser, Dr Colleen Darnell, came to the wedding, that the idea started percolating again. Dr Darnell took Picoult to Egypt and the book flowed.

While Egypt plays an important role in the novel, at its core The Book of Two Ways is a love story. Its heroine, Dawn Edelstein is involved in an accident where her life flashes before her eyes, and it's not the life she has with her husband and daughter. An old love, Wyatt, comes back into her life, and her work as a death doula has her questioning her own life and the choices she's made.

"As I get older, the things I'm concerned about are less specific and more global in general," Picoult says.

"A lot of my earlier books were very much about the balance of marriage or all the scary things that can happen to your kids, things that were real life fears to me.

"What concerns me now are things like the nature of good and evil or racism, or, in this case, who we might have been, if we didn't become who we are.

"Everyone has that question in them about what's the point in your life where you could have made another decision that would have taken you to a completely different place. Sometimes that's a person, sometimes it's a job, sometimes it's a move, everyone wonders that.

"I started to ask groups of people to picture the person they thought they would end up with, and 95 per cent of them were not picturing the person they were with."

I tell her I was worried that this would be her midlife crisis novel. That the regret and passion and desire that Dawn feels in her parallel universe life, if you like, were too close to home for this middle-aged woman at least. Is it the same for her? She laughs, and says she's promised her husband of 31 years that things are OK.

"The Book of Two Ways is about how we get to a point where, when we die, we are happy with the life we've led," she says.

"I'm old, I'm 54, and I am thinking about things like that - what have I left behind in the world, am I proud of that, is there more for me to do?

"The ironic thing, of course, is that these are not new questions. I mean, literally, people have been asking this since before the ancient Egyptians, and the answer still, I think, is the same.

"The answer remains: if you want to have a good death, you better have a good life.

"And it's up to each of us to figure out what does that really means."

She believes it's never too late to pivot, to take that different path.

"Very often, especially in America where we are all in this crazy rat race, we don't take time to stop and think 'How did I get to where I am, and am I happy being here?' And then it's too late. You get to the end of your life and you're like 'This is not where I wanted to wind up'.

"I hope people who read The Book of Two Ways pause and consider where they are in their lives and if that is a good spot for them, it is never too late to do something different, or to learn something new, or to question if you're being complacent.

"I hope this book gives you time to take a breath and ask yourself questions about your life, and whether you're satisfied with it and what you might do to change that."

And one might dare suggest, for her own nation at least, that choice starts with a vote.