David Henry's secret is so powerful it destroys his marriage and keeps him estranged from his children. David, haunted by childhood memories, makes a hurried decision immediately following the birth of his and his wife's twins. It is a decision made in a panic and only later will David realize the full extent of the consequences. All through the novel, David tries to reveal his secret to his wife. But the longer he hesitates, the more difficult this becomes. The burden of keeping the secret of having given his daughter away turns out to far outweigh the disadvantages the Down Syndrome child might have caused.

The issue of children with Down Syndrome, especially as they were in the past century, is another theme. This part of the theme is first demonstrated through David, a physician who should have known better. His rejection of Phoebe represents the fear that people have when facing a child with Phoebe's condition. David responds with only the negative aspects, and he even exaggerates them. He is, of course, influenced by his own childhood memories of having to take care of a very ill sister, but as someone who was out to heal the world, as David was, his actions were inexcusable. Most of Caroline's story is centered on helping Phoebe to adjust to a world that was often against her. Unlike David, Caroline sees beyond Phoebe's differences and fights for her rights to live a life defined by what was normal for Phoebe.

Norah and her son Paul represent the theme of loneliness. Neither of them seems able to connect with anyone, at least not until the end of the novel. Norah admits that at first she wants a man in her life who will protect and save her. Then as the story progresses, she realizes that this is not a very fulfilling life. Her sister Bree, who appears to live a carefree life, going against traditional roles of women and doing whatever she wants to do at the moment, influences her. This leads Norah to believe that by throwing perfect parties and entering into momentarily exciting but empty relationships will help her rid herself of the emptiness that she feels. She also tries to blame David for most of her problems. It is not clear, even by the end of the novel, that Norah has solved any of her problems. Yes, she has become a successful businesswoman and has found a man whom she believes she loves. But whether she ever realizes that she is responsible for her own happiness remains ambiguous.

Like his mother, Paul also has problems of loneliness and need. Paul never gets enough of his father, even though they spend time fishing and walking through the woods. Paul's father tries to be a part of Paul's life, or at least tries to make Paul a part of David's life. But Paul is forever suspicious of his father, which might be due to his mother's lack of trust in him. But Paul does not appear to be much closer to his mother. Although Norah acts as if she understands Paul better than David understands their son, Paul, at one point, becomes disgusted with his mother when he discovers she is having an affair. Paul turns to music to fill his loneliness. Despite the fact that Paul becomes very accomplished as a musician, he is incapable of understanding love until he meets Phoebe. By the end of the novel, it appears that Paul is the most changed character. He opens his heart for his sister and takes her into his life.