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Chapter 1
Tell the Truth

You may have seen us in "Vows" in The New York Times: me, alone, smoking a cigarette and contemplating my crossed ankles, and a larger blurry shot of us, postceremony, ducking and squinting through a hail of birdseed. We didn't have pretty faces or interesting demographics, but we had met and married in a manner that was right for SundayStyles: Ray Russo came to my department for a consultation. I said what I always said to a man seeking rhinoplasty: Your nose is noble, even majestic. It has character. It gives you character. Have you thought this through?

The Times had its facts right: We met as doctor and patient. I digitally enhanced him, capped his rugged, haunted face with a perfect nose and symmetrical, movie-star nostrils—and he didn't like what he saw on the screen. "Why did I come?" he wondered aloud, in a manner that suggested depth. "Did I expect this would make me handsome?"

"It's the way we've been socialized," I said.

"It's not like I have a deviated septum or anything. It's not like my insurance is going to pick up the tab."

Vanitas vanitatum: elective surgery, in other words.

He asked for my professional opinion. I said, "There's no turning back once we do this, so take some time and think it over. There's no rush. I don't like to play God. I'm only an intern doing a rotation here."

"But you must see a lot of noses in life, on the street, and you must have an artistic opinion," said Ray.

"If it were I, I wouldn't," I said for reasons that had nothing to do with aesthetics and everything to do with the nauseating sound of bones cracking under mallets in the OR.

"Really? You think the one I have is okay?"

"May I ask why you want to do this now, Mr. Russo?" I asked, glancing at the chart that told me he'd turn forty in a month.

"Let's be honest: Women like handsome men," he said, voice wistful, eyes downcast.

What could I say except a polite "And you don't think you're handsome enough? Do you think women judge you by the dimensions of your nose?"

Next to me he smiled. The camera mounted above the monitor played it back. He had good teeth.

"I haven't been very lucky in love," he added. "I'm forty-five and I don't have a girlfriend."

"Is your date of birth wrong?" I asked, pointing to the clipboard.

"Oh, that," he said. "I knock five years off when I'm filling out a job application because of age discrimination, even at forty-five. Bad habit. I forgot you should always tell the truth on medical forms."

"And what is your field?"

"I'm in business, self-employed."

I asked what field.

"Concessions. Which puts me before the public. Wouldn't you think that if everything was okay in the looks department, I'd have met someone by now?"

I hated this part—the psychiatry, the talking. So instead of asserting what is hard to practice and even harder to preach in my chosen field—that beauty's only skin deep and vastly overrated—I pecked at some keys and moved the mouse. We were back to Ray's original face, bones jutting, cartilage flaring, nose upstaging, a face that my less scrupulous attending physicians would have loved to pin to their drawing boards. If it sounds as if I saw something there, some goodness, some quality of mercy or masculinity that overrode the physical, I didn't. I was flattering him to serve my own principles, my own anti–plastic surgery animus. Ray Russo thought my silence meant I wouldn't change a hair.

"Vows" would reconstruct our consultation, with Ray remembering, "I heard something in her voice. Not that there was a single unprofessional moment between us, but I had an inkling she may have been saying ‘No, don't fix it' in order to terminate our doctor-patient relationship and embark on a personal one."

Excerpted from The Pursuit of Alice Thrift by Elinor Lipman Copyright© 2003 by Elinor Lipman. Excerpted by permission of Random House, a division of Random House, Inc. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.