The reversal of the parents
In Ajay's family, the working mother and stay-at-home father motif is shown in a dysfunctional light. This novel's suggestion is not that the mother works because of passion and capability, but rather, the implicit narrative is that the father would not work and the mother found a way to take care of the family despite him. There is only so much she can do, though, because the community's economy is not designed to reward women fair salaries, so she struggles to earn enough.
The move to America
America is the big question mark in the novel. They won't have enough money to continue living in India, but perhaps if they move to America there will be more opportunities and better opportunities. They are accepting a great risk by moving, but that risk is compensated by a perceived increase in opportunity. Broadly, America represents their desire for "fortune," not in the lavish monetary sense, but in the "wheel-of-fortune," sense. They need a better life, but it isn't clear how to get one.
Birju as foil
Birju stands as a contrast for Ajay's fate. This can be seen in many ways. First of all, their names start with "A" and "B," as if to suggest comparison and contrast. Also, Ajay struggles socially, but Birju is a natural socialite. This shows Birju as a symbol for success. But, when Birju is injured, the foil is reversed, and instead of being a narrative of envy, the foil becomes a narrative of sorrow. Birju's fate shows the capricious effects of racism in the healthcare system.
Racism and mistreatment
The motif of racism is what defines the cost of moving to America. Although before, America seemed the land of endless opportunity, the reality is that racism limits opportunities drastically. The novel shows through subtle implication all the ways that racial prejudice affects the family. Birju's healthcare is a symbol in this motif. When Ajay finally discovers a path to wealth, he seizes the moment and succeeds, but against serious odds of failure.
Health and healthcare
This subtle motif works in the background as a limiter. There are two main currencies in the story: money and health. The father spends both, becoming unhealthy by drinking excessively, draining his money and health for unwise purposes. The son, Ajay, sees his brother succumb to apparently perfect ill health, and he realizes that part of success is becoming healthy and powerful. This goal of health as well as prosperity creates a new ethic where desire used to be.