The novel’s title is a recurring motif whose meaning changes as the story progresses. Initially, the “man who died twice” seems to reference Marcus Carmichael, the “dead man who had never lived” (25). Carmichael is dead in two respects. As a creation of Elizabeth, he never existed, and his death was staged with another man’s corpse. His introduction into the text reminds Elizabeth “of the grand illusions of her trade” (382), creating the expectation that the novel’s plot will involve the complex subterfuge of a spy thriller.

When Carmichael turns out to be Douglas Middlemiss, Elizabeth’s former husband becomes the second likely candidate for “the man who died twice.” Douglas survives his first assassination attempt, and the circumstances surrounding the second suggest that he may have faked his death. Douglas’s association with the novel’s title again proves transitory when it emerges that “[t]here were no fake corpses, there was no grand cover-up” (383), and Douglas was dead all along.

The true significance of “the man who died twice” is revealed in the novel’s final chapter. The title refers to Sylvia Finch’s husband, Dennis, and the effects of his dementia. Sylvia feels that she lost Dennis twice: once to the isolating effects of dementia and then to death.