The main narrator is Grace, whose thoughts and speech are in the first person, and sometimes blend into one another without quotation marks to indicate what is said out loud and what is not. This creates uncertainty at times, echoing the doctor's uncertainty about Grace's truthfulness, and the reader's uncertainty about her guilt. Dr. Jordan's thoughts and actions are told by an omniscient third-person narrator, allowing the reader to see the contradictions between his words, sometimes even his thoughts, and his actions, as does the inclusion of his correspondence in the book. Similarly, other people's letters and quotations from newspapers, letters, poems, and other textual sources echo the patchwork quilting metaphor in that the author used many sources from various perspectives to piece together the whole story.