The Struggle to Live is a central theme in this story. There are two main aspects to the book's many manifestations of this theme. The first is literal, in that many of the characters (particularly those whose lengthy, detailed stories serve as narrative diversions from the main plot, i.e. the apothecary, Luka, Darisa the Bear, the Galina tiger) struggle simply to stay alive. Their determination to do so gets them through painful, difficult, extraordinarily challenging circumstances, said determination mirroring and/or complimenting that of Natalia and her grandfather, perhaps inspiring both.