The grim realities of illegal abortions at the turn of the century are well described in the second chapter, backed up by footnotes referring to cases and books known to Irving's grandfather, a physician. Larch's decision to accept the position as director of an orphanage, where he will also perform abortions, is understandable against the backdrop of the post-abortion deaths he witnesses.

But in the beginning of the third chapter, after Homer discovers a dead fetus, he begins to ask the simple questions about the continuum of life which set the stage for his later opposition to abortion. "'Sometimes,' said Dr. Larch, 'the woman knows very early in her pregnancy that this child is unwanted.' 'An orphan, from the start,' said Homer Wells. 'You might say,' said Wilbur Larch. 'So she kills it,' said Homer Wells. 'You might say,' said Wilbur Larch. 'You might also say that she stops it before it becomes a child--she just stops it.'"

Irving's project seems to be to portray both sides and to encourage the reader to reserve final judgment of the characters and their actions. When various subplots reveal an adulterous love triangle, incest, homosexuality, huge lies, and other violations of rules and norms (including racial ones) the same applies. Irving's ambition is revealed at the end when he describes a novelist as "a kind of impostor doctor, but a good doctor nonetheless."