Family, in all its various shapes and forms, is a persistent theme in the novel. There is the broken family into which Sarah is born, the camaraderie among sex workers in the brothel (a makeshift family), the unwanted marriage to Michael, the love of the Altman family, and the eventual miracle that provides Michael and Sarah with their own family. Each one differs, but they all represent how the strength of family bonds can triumph over anything. 

Sarah’s first experience of family is traumatizing. She is the product of her mother, Mae’s affair, with a married man who wanted Sarah to be aborted. Sarah’s father abandons both Mae and Sarah, causing Mae to resent Sarah for (in her view) driving away the man she loves. This is not a functional, loving family. At no point in her early life is Sarah truly supported by her family, which culminates in her uncle sexually trafficking her. The last time she sees anyone in her biological family is when she is forced to have sex with her father. 

Sarah’s next family is formed by the women she works with at a small-town brothel, who often bicker and tease like sisters. Though they are thrown together by their material circumstances, these women form a real bond. It is not ideal, but Sarah finally has something resembling a family’s support network—especially with Lucky, her closest confidante. However, this does not last. 

When Sarah is taken from the brothel to Michael’s home, she is introduced to a conventional family: the Altman family. When they first meet, Sarah is wary of the Altmans because of their closeness and evident love for one another. They represent the kind of open love that Sarah taught herself to avoid. But as much as she comes to love both the Altman family and Michael, their presence is also a curse. Sarah worries that her past will prevent her from functioning in a traditional family unit—in part because her forced sterilization means she cannot give Michael the children he wants.

Before Sarah can fully accept her place in Michael’s family, she gains valuable insight from two other families. First, Jonathan Axle saves her from Duke and makes her a part of his household. With the Axles, she learns about love, acceptance, and how to function in a family unit. Then, Sarah opens the House of Magdalena to offer sex workers a chance at a new life, which helps her recapture the family feeling she enjoyed in the Pair-a-Dice brothel. 

Family is Sarah’s reward for accepting God into her heart. After a lifetime of turmoil, listening to God’s words provides her with everything she has ever wanted or needed. This is especially evident in the epilogue, where it is revealed that, despite her sterilization, Sarah eventually bore four children.