Dark Rivers of the Heart

terrible."
        "What might've caused it?" Roy asked.
        Mondello opened a desk drawer and removed a magnifying glass with a silver handle. He studied the photographs more closely.
        At last he said, "It was more a cut than a tear, so it must have been a relatively sharp instrument."
        "A knife?"
        "Or glass. But it wasn't an entirely even cutting edge. Very sharp but slightly irregular like glass-or a serrated blade. An even blade would produce a cleaner wound and a narrower scar."
        Watching Mondello pore over the photographs, Roy realized that the surgeon's facial features were so refined and so uncannily well proportioned that a talented colleague had been at work on them.
        "It's a cicatricial scar."
        "Excuse me?" Roy said.
        "Connective tissue that's contracted-pinched or wrinkled," Mondello said, without looking up from the photographs. "Though this one is relatively smooth, considering its width." He returned the magnifying glass to the drawer. "I can't tell you much more-except that it's not a recent scar."
        "Could surgery eliminate it, skin grafts?"
        "Not entirely, but it could be made far less visible, just a thin line, a thread of discoloration."
        "Painful?" Roy asked.
        "Yes, but this"-he tapped the photo-"wouldn't require a long series of surgeries over a number of years, as burns might."
        Mondello's face was exceptional because the proportions were so studied, as though the guiding aesthetic behind his surgery had been not merely the intuition of an artist but the logical rigor of a mathematician.
        The doctor had remade himself with the same iron control that great politicians applied to society to transform its imperfect citizens into better people. Roy had long understood that human beings were so deeply flawed that no society could have perfect justice without imposing mathematically rigorous planning and stern guidance from the top. Yet he'd never perceived, until now, that his passion for ideal beauty and his desire for justice were both aspects of the same longing for Utopia.
        Sometimes Roy was amazed by his intellectual complexity.
        "Why," he asked Mondello, "would a man live with that scar if it could be made all but invisible? Aside, that is, from being unable to pay for the surgery."
        "Oh, cost wouldn't be a deterrent. If the patient had no money and the government wouldn't pay, he'd still receive treatment. Most surgeons have always dedicated a portion of their professional time to charity work like this."
        "Then wh?
        Mondello shrugged and pushed the photographs across the desk.
        "Perhaps he's afraid of pain."

    "I don't think so. Not this man."
        "Or afraid of doctors, hospitals, sharp instruments, anesthesia.
        There are countless phobias that prevent people from having surgery."
        "This man's not a phobic personality," Roy said, returning the photos to the manila envelope.
        "Could be guilt. If he lived through an accident in which others were killed, he could have survivor's guilt. Especially if loved ones died.
        He feels he's no better than they were, and he ixonders why he was spared when they were taken. He feels guilty just for living.
        Suffering with the scar is a way of atoning."
        Frowning, Roy got to his feet. "Maybe."
        "I've had patients with that problem. They didn't want surgery because survivor's guilt led them to feel they deserved their scars."
        "That doesn't sound right, either. Not for this guy."
        "If he's not either phobic or suffering from survivor's guilt," said Mondello, coming around the desk and walking Roy to the door, "then you can bet it's guilt over something. He's punishing himself with the scar. Reminding himself of something he would like to forget but feels obligated to remember. I've seen that before as well."
        As the surgeon talked, Roy studied his face, fascinated by the finely honed bone structure. He wondered how much of the effect had been achieved with real bone and how much with plastic implants, but he knew that it would be gauche to ask.
        At the door, he said, "Doctor, do you believe in perfection?"
        Pausing with his hand on the doorknob, Mondello appeared mildly puzzled.
        "Perfection?"
        "Personal and societal perfection. A better world."
        "Well… I believe in always