“He seemed to have fallen in love about an hour and a half earlier on his sofa in the middle of ‘Canto V’ before ever laying eyes on Rosie.” 

Penn and Rosie’s early compatibility foreshadows their attunement as parents. Throughout the book, Frankel characterizes Rosie and Penn’s relationship through their physical intuition, depicting them as picking up where the other leaves off. 

“My daughter will be named Poppy. Not a decision. A realization.” 

Penn’s prediction about Poppy foreshadows Poppy’s eventual transition. It also implies Frankel’s position on gender identification as being a personal truth as opposed to a choice

“Crying girls, even ones who were going to be fine and whose parents were on their way, broke Rosie in a way none of her other cases did.” 

Rosie’s enduring trauma is her sister’s death. Throughout the novel, we see this formative experience shape Rosie’s decisions and affect the course of her life.