Death of the caretaker
When Ptolemy faces his own death, something weird happens: his nephew dies in a strange tragedy, and now Ptolemy must face death from both sides, as a survivor, and as a terminal patient. This dilemma helps to clarify the unanimous problem of death.
Time or clarity?
Unfortunately, Ptolemy's only wish comes with a steep price. He can have the clarity his years of dementia have left him wishing for, but he might only live a few weeks. The medication speeds up his body's decay toward death, while accelerating his mind.
The irony of the orphan
On way to think of Robyn is as a messiah character. Just as religion is about facing life the right way, for Ptolemy, religion quickly becomes an issue of facing death the right way, so Robyn represents his divine helper who gives him a secret, mysterious tool to help him accomplish one more journey before he dies.
The violent death
It suits the novel well to give Ptolemy a dramatic, violent death, but it's still highly ironic for a 91 year old man with dementia to die with as much glamour and passion as Ptolemy was able to accomplish.
The irony of knowing and not knowing
One would hope for the sake of the patients that dementia would remove a person's ability to perceive pain or discomfort, but actually, the disease is quite horrifying, because most of the time it's a person's memory and orientation that are first to go. For Ptolemy this plays out in his dramatic decision earlier in life to remove himself from his relationships, because he knows that he can no longer communicate or think effectively. This is highly ironic.
