Dr. Sheppard (symbol)
Dr. Sheppard is a symbol of Christ. Note the similarities between names: Christ is 'the Good Shepherd'; Dr. Sheppard shares the same name. When Dr. Sheppard first sees Sister John, he tests her feet--reminding Sister John of Jesus washing the feet of his disciples and of Mother Mary washing the nuns' feet. She realizes that he kneels before patients every day, seeking to cure their diseases just as Christ did.
birds (motif)
Several times throughout the book, Salzman uses birds. Sister Miriam is described as a bird in adolescent plumage. Young Helen thinks if she could only fly as unerringly as a blackbird through the marshes, she would pluck out the eyes of the people who teased her. During Christmas mass, Helen feels confused, like a bird that has flown into a windowpane. Helen also sees herself as savior of the chickens, hating the trips to the farm where the birds were imprisoned and abused. Sister Bernadette sprays a blackbird that is bullying other birds and not allowing them to drink water. When Sister John is in the infirmary, she sees a red-tailed hawk being chased off by a pair of mockingbirds.
silence (motif)
Silence is a big part of monastery life. Not only are the nuns prohibited from speaking except during certain times and in certain places in the monastery, the silence is at times vast and mysterious, at times friendly, and at times terribly isolating. The nuns celebrate silence as the means through which they hear God speak, but when he is absent (as in the case of the 20+ years Sister John waited to experience God) is depressing and isolating.
drought/desert (motif)
After the initial six years at the monastery wore off, Sister John undergoes over two decades of what she describes as "The Desert": she does not experience God and struggles to fulfill her duties and obligations as a nun. Though she does not leave the monastery, she does consider it and decides to stay to fulfill the work she has been given and to seek God's will anyway. Part of the fear of doing the surgery is returning to that desert, where she feels parched and dry, and the thought of returning to it causes her to question deeply if her faith had ever been real.
Sister John's visions (symbol)
One could see Sister John's visions as symbolic of 'proof of faith': evidence of her connection with God. In order to fully realize her faith, she must ultimately transcend this evidentiary crutch.
