The story in Middlesex is an epic journey in which Cal traces the damaged genes that were contributed by grandfather and grandmother to create Cal's damaged hermaphroditic sexual identity. The story starts in Greece in 1922 and moves through the family's immigration into America and ends in 2001.
The image on the book jacket for Middlesex by Jeffrey Eugenides is on shipboard and the clothing of the family (mother, father and two children) sets the time in the early 1920s. The hazy shoreline in the background is the skyline of New York, which was the portal for European immigrants entering America.
The inverted image in red tones also looks like the skyline of New York. The inverted city images underscore the thematic element of duality, first in the double inheritance of damaged genes and second in the double inheritance of sexual identity and third in the struggle of choosing to identify with two opposing ideas, places, ways of life.