In context, life and death (symbolic death) is vividly portrayed theough the character of Sofia. Sofia's life is on hold, as she cares for her ailing mother... she doesn't really live, and she is resentful of her mother's needs whether they are real or imaginary because she, herself, is stagnating.
Sofia has put aside her dreams to care for her mother, and in return, her mother barrages her negatives and insults. Note, Sofia's mother, Rose, faces her own battles. Confined to a wheelchair, she seems to have given up because though she is weak, she is still able to walk... she simply refuses to do so, and in turn, she gains no strength. She has given up, and she is almost forcing her daughter to do the same.
In essence, the novel is centered around wants and needs... what Rose wants in not necessarily what she needs, and what Sofia wants has been set aside in order to care for her mother's perceived needs, whether they are real, or whether they are in her mind. Hopelessness creates a kind of living death, and it kills the desire to really live.
"My mother’s words are my mirror.” (Chapter Six)
"You are using your mother like a shield to protect yourself from making a life.'” (Chapter 12)
"While he takes the tiny sliver of glass out of the skin above my eyebrow, I confess that I am often lost in all the dimensions of time, that the past sometimes feels nearer than the present and I often fear the future has already happened.” (Chapter 24)
“I wanted my whole life so far to slip away with the rolling waves, to begin a different kind of life. But I didn't know what that meant or how to get to it.”