Amis's use of these techniques is aimed to create an unsettling and irrational aura for the reader; indeed, one of the recurrent themes in the novel is the narrator's persistent misinterpretation of events.

The reverse narrative begins in America, where the doctor is first living in retirement and then practicing medicine.

The doctor, Odilo Unverdorben, assists "Uncle Pepi" (modelled on Josef Mengele) in his torture and murder of Jews.

While at Auschwitz, the reverse chronology means that he creates life and heals the sick, rather than the opposite.

Not for its elegance did I come to love the evening sky above the Vistula, hellish red with the gathering souls.

[clarification needed] Amis first thought up the idea of telling a man's life backwards in time two years before the novel was published.

He found a fertile ground for that structure when his friend Robert Jay Lifton gave him a copy of his book, The Nazi Doctors, about the involvement of German doctors in World War II, from Action T4 to the extermination camps.

The alternative title for the novel is taken from Primo Levi's The Truce: So for us even the hour of liberty rang out grave and muffled, and filled our souls with joy and yet with a painful sense of pudency, so that we would have liked to wash our consciences and our memories clean from the foulness that lay upon them; and also with anguish, because we felt that this should never happen, that now nothing could ever happen good and pure enough to rub out our past, and that the scars of the outrage would remain within us forever... Because, and this is the awful privilege of our generation and of my people, no one better than us has ever been able to grasp the incurable nature of the offense, that spreads like a contagion.

[1]Amis also mentioned the critical influence of If This Is a Man, The Drowned and the Saved, and Moments of Reprieve.

And Amis's Afterword to this novel acknowledges his debt to a famous paragraph in Kurt Vonnegut's Slaughterhouse Five: the Dresden firebombing passage in which Billy Pilgrim watches, backwards, a late-night movie of American bombers recovering their bombs from a German city in flames.