 Twice Through the Heart lasts for approximately 30 minutes. It consists of nine musical numbers arranged in three sections. It is narrated by a woman in the prison cell where she has been sent for the murder of her husband. To express the woman's feelings, Kay deliberately chose a voice that was unpoetic: "I wanted the voice to be so everyday, it would be banal." Turnage's music too includes similarly basic material, what critic Tom Service describes as "simple hummable tunes", but these are transformed and distorted, a metaphor for how initial loving intimacy is destroyed and distorted by years of violence and abuse. Turnage's musical language is modernist but influenced by jazz, an area of musical interest he shared with Kay.
