The Surgeon

The irregular red birthmark, which resembles a wine stain, symbolizes the indelible nature of past trauma and evil. It physically manifests a sin that can’t be washed away, becoming the inescapable trigger for the novel’s central conflict. For years, Anne’s memory of this unique birthmark was inextricably linked to her unresolved grief and the suffering of her adoptive sister, Melanie.

When Anne sees the birthmark in the operating room, the patient is no longer an anonymous body whose heart she must save; he becomes the monster from her past. The sight of the birthmark collapses time, forcing a long-buried trauma into the sterile, controlled environment of the present and confronting Anne with an impossible choice between her professional oath and her desire for vengeance. The text notes the birthmark’s haunting power, describing it as “[t]he port-wine stain that haunted [Anne’s] nightmares for years” (25). This description solidifies the mark as not just a physical feature but also an active agent of psychological torment.

The birthmark’s symbolism deepens via Donaghy’s attempts to conceal it with a beard and a baseball cap, mirroring the broader idea of festering secrets. Its eventual reveal is a moment of