1. Parental Relations - Both John and Lorraine have poor relationships with their parents, who regard them as disturbing burdens. John's parents regard him as a disturbance that must be controlled, molded, and shaped into a carbon copy of his father
2. Consequences - John and Lorraine both realize that they were involved to some degree in Mr. Pignati's death, but differ in the amount of responsibility they're willing to take.
3. Life & Death - The book is filled with images and questions about life and death. Lorraine's father is dead, and her mother comes home daily with gripes and callous words about her dying patients. In Mr. Pignati's house, John and Lorraine find documents from Conchetta Pignati's funeral and read them with mingled sadness, horror, and fascination.