The old marriage photo used for the comatosed patient is that of Andy Griffith.
The sentence "All happy families are alike" which Dexter repeats throughout the episode is the first sentence in Leo Tolstoy's famous novel Anna Karenina from 1877. It continues: "...every unhappy family is unhappy in its own way."
Actress Vanessa Marano's ( as Rebecca Mitchell) second appearance with actor Michael C. Hall (Dexter Morgan). The first was in Six Feet Under (2001).