Yeah the lighthouse in the background as well...he looked at it twice..."follow the light" was the theme but he seems to be doing his own thing...the costa mesa fire on TV representing hell and asking the bartender later..."so what's it like in costa mesa?" and the bartender says "it's dead in costa mesa".
The doubters need to realize the importance of tonight's show and look at the big picture...it was a very telling and moving performance which is doing nothing but setting you up for usually something huge in the next 2-3 episodes.
This is a mafia family and the mafia in general here. This big deal about Tony's health is really for the viewers...the actual characters don't care. They have all feared Tony all along and loved him for what he could get them material wise.
The kids are embarassed by him, AJ didn't give a crap until he sat in the room with him and talked and then all of a sudden grew angry,Carm wouldn't call him a good husband or man...just a good father and friend and that he wasn't going to hell...she has hated him for years,and his crew is lining up their moves and money for what they will do as soon as Tony goes to the light.
They joke at funerals and make their deals and move on.
Tony has always been afraid of being alone and being himself...hence what is happening to him in the dream sequence....he is on his own and nobody cares what his name is.
In that thought then yes, the writers have introduced something interesting and revealing. Right now he is caught in a form of pergatory because of his choice in briefcases (aka, his life). He cannot escape and he can see the light from above or the fires of hell on the TV set. He is also a nobody and for a wise guy, that is a form of hell for him. The stairway scene is representative of his life in that he sought short cuts and hurt himself by doing so. But, it was that short cut on the stairs that allowed him to see that he was dying.
I don't know if it was really necessary for Chase and company to have to lay it on so thick with his family though. Yes, we have seen Carmella in all her vanity and shallowness but it is a road we have travelled far too often in the past. AJ is also shallow and vain and again, it is wasted time.
The seeds have been planted for the mafia family to come apart and that seems to be where the good action will be found.