Aging and death are prominent concepts that first emerge in full form upon the death of Jeremiah Saint-Amour and are explored throughout the novel. When Dr. Urbino, a well-respected man of great wealth and power, is forced by his age and debilitated physical condition to use the toilet like a woman, he is degraded, belittled by his wife and by his own morose maturity. A man once so capable, so authoritative, and so intimidating that the mere sound of his urine stream was enough to frighten his newlywed wife, is now pathetic and dependent, enfeebled by old age and its merciless attack on his body and mind.
The Doctor is distraught by Saint-Amour's death not only because of his old friend's deceit in keeping from him his life's secrets, but because he realizes, upon seeing Saint-Amour's body, that death is not a "permanent probability," as he has always imagined—an intangible, distant, untouchable fate. Upon seeing the body of his friend, the Doctor, for the first time in his long life, truly and fully understands that death is not simply some imaginary, obscure human idea, but a tangible destiny. Despite his debilitation, it is in this moment that Dr. Urbino realizes he has grown old and can never reclaim his youth. Similarly, his sad realization that he is living his last days is so overwhelmingly powerful that it forces him awake, literally waking him to the reality of his fast-approaching death, and foreboding his fatal fall from the mango tree. Dr. Urbino, a man who lives life with religious regularity, is described as having acted out of character only twice; once when moving from an old, stately home to a new house in a nouveaux riche community, and once more when he had married Fermina, who had been considered a member of the lower class. This decision to resettle in a nouveau riche neighborhood is considered out of character in part because the Doctor is a very predictable man, but primarily because he is the product of a well-respected, blue-blooded family, a family that stems from a long line of old money. However, as of yet, the Doctor's reasons for choosing Fermina as his bride are unexplained. Surely, as an esteemed, wealthy, young physician of high family class, Dr. Urbino could have chosen from many willing, equally wealthy brides. Why, then, the text probes the reader, does the Doctor choose a girl from the lower class? Once more, the author poses a question with the intent of intensifying the reader's curiosity; these questions act as cliffhangers, encouraging the reader to continue through the text and discover the outcome, which is not revealed until later in the novel.
Ironically, Dr. Urbino's parrot, in which he has invested more time and effort than in his children, is ultimately responsible for his death. The bird is to blame for enormous disaster: the distress of the servants, the destruction of the house by the fire department, and, most seriously, the accidental death of Dr. Urbino. Throughout the novel, birds, like flowers, develop a deeper meaning in relation to the events which have occurred earlier in the text, and are responsible for further disaster and anguish.