Throughout the novel there are multiple instances of people who are hesitant to shake Willie's hand but do so anyway. The first instance of this motif is early in Chapter 1, in Mason City, when Jack describes how Malaciah, the soda jerk at the drugstore in town, was reluctant to accept Willie's advances:

The Boss started toward him and put out his hand. Old Leather-Face didn't show. Maybe he shuffled one of his broken brogans on the tiles, and his Adam's apple jerked once or twice, and the eyes were watchful out of that face which resembled the seat of an old saddle left out in the weather, but when the Boss got close, his hand came up from the elbow, like it didn't belong to Old Leather-Face but was operating on its own, and the Boss took it.

At first, Malaciah does not want to shake Willie's hand but eventually relents. Later in the same chapter, Willie and his team go to the Stark family home. There they meet Willie's father, who shook his son's hand "with that same motion from the elbow which Old Leather-Face had had in the drugstore back in Mason City." Old Man Stark, too, is reluctant to shake Willie's hand and weakly assents like Malaciah.

Later, Willie tries to convince Adam to lead the medical staff at the governor's new hospital. In Chapter 6, Jack describes how Adam was similarly hesitant with Willie:

The Boss took a step forward and put out his right hand. Perhaps I imagined it, but I thought I noticed a shade of hesitation before Adam took it. And the boss must have noticed it, too, for when Adam did put out his hand, the Boss, in the middle of the shake, before any word had been spoken, grinned suddenly, and said, "See, boy, it's not as bad as you thought, it won't kill you."

The imagery here, as with Malaciah and Old Man Stark, show how these characters begin with some doubt or distaste toward Willie, reluctant to shake his hand, but the Boss's overwhelming charisma causes them to give in and shake. In the case of Adam, though, his distrust of Willie never fully goes away. The motif of the spurned handshake runs right up to the climactic scene of the novel. Adam is in a murderous rage after learning of Anne's affair with Willie. Jack frantically describes the moment just before Adam and Willie's double murder, including yet another handshake:

For an instant Adam stood there immobile, as though about to refuse to shake the hand of the man approaching him. Then he put out his hand, and as he did so I felt a surge of relief and thought: He's shaking hands with him, he's all right now, he's all right.

Adam, in his delusional fury at the end of the novel, raises his hand, apparently to shake, and attacks Willie in a final act of hatred. Willie's earlier comment to Adam over a handshake—"it won't kill you"—becomes darkly ironic as Sugar-Boy immediately shoots and kills Adam in response. The progression of these similar images, of men who try to avoid shaking Willie's hand, builds toward this climax of the novel, where Adam shoots Willie in a gesture which, at first, appears to be a handshake. The motif, throughout the novel, is a demonstration of how Willie's charisma can convince almost everyone. The repeated image of the handshake reverses, though, as Adam's opinion on Willie reverses after the revelations of his affairs.