Health and safety
The imagery that starts the novel is that of health concerns and urgency, even perhaps desperation. We see the mother right in the middle of a crisis, showing her character dynamic in the imagery of a hospital visit and an attempt to save her son's life. Within this imagery, we learn that her efforts are often thwarted by chance or by circumstances outside her control. She is able to bring her boy to the doctor, but the son's own shyness kicks him into high gear, giving the appearance of wellness which the mother knows is only temporary, but getting him to the doctor was such a fiasco that this just leads her to feelings of hopelessness. How can she keep the kids safe when the world seems specifically shaped to prevent that?
Idealism and fantasy
The frustration that the mother feels in relationship to her children has a tremendous weight that she carries all alone, without community support. Without someone to talk to daily, since her brother dies—without someone to talk to ever, really, her mental health starts to be in crisis. In response, we see an explosion of her fantasy for a hopeful future. She is trying to talk herself into hope by imagining an imagery of life that could be better. She fantasizes about the Tipton house.
Detroit
Because of her speculative, calculating nature, Gertie decides to move to Detroit in hopes of a better life. But what she learns is that her speculation and wishes were far off the mark. She basically just moved to a town that is filled with people in as dire of straights as she is. Detroit is no home for her children. The scrappy, competitive personality of the city is not friendly to them as newcomers, and her daughter ends up dead for the strategic misstep.
Death and motherhood
That isn't to say that Gertie is a bad mother. She experiences that emotional shame in herself, but the reader sees very clearly that she does what she thinks is best. She loses a fight she was never going to be able to win. Although she has her Bible handy, that does not seem to insulate her from fate and the glorious tragedy of life. The imagery of death comes into her world without her permission, though she kicks and screams against it. Death swallows up her family one by one, until she realizes that nothing she does with her hands can give her children immortal life. She quits her efforts at sculpture, which is for all intents and purposes "artistic manipulation," or as her Bible might call it, "the work of her hands."
