Yes, every one of those little circles above and all the crosshatching below is done by hand. Marion says it took her 6 years, but it's for her one of her special grandson's. (I don't know if she has more than one, but I'm sure they are all very special.)
I only finished the binding on this quilt for her, and will be making a label as soon as my machine comes back from the repair shop. After 6 years, Marion said that she was "through with this quilt", and that's how I got to meet her and work on her beautiful project.