Like other Updike fictions, this story transforms a realistic portrayal of the social behaviors and dynamics of the affluent and educated classes into a moral tale with a tinge of gothic and more than a tinge of irony. As well as exploring the blurry line between "reconstruction" and "enhancement" and the general desires of patient and surgeon that can fuel surgical interventions (transference, for example, and the challenge of mastering a complex procedure), Updike explores the complex and interconnected desires this specific protagonist has towards this particular surgeon and procedure. These include the desire to be beloved by Dr, Kim (as baby or husband) and the desire to be Dr. Kim, and both desires are variously inflected by Dr. Kim's multiple identities as woman, young person, Asian-American, beautiful and "smooth" person, surgeon, and mother.

A particularly strong thread is Anderson's Orientalist view of Dr. Kim--he exoticizes and stereotypes her (see Edward Said's book, Orientalism). Another is Anderson's distaste for his "stale" aging body and desire to be as fresh as his surgeon can make him, which in his mind becomes equivalent to becoming as fresh (and fertile) as the surgeon herself. In one of the funniest scenes Anderson attempts repeatedly and unsuccessfully to become "one of the girls" by entering the conversation among the women conducting his surgery. An interesting question for this story, however, is the degree to which the narrative frame looks critically and ironically at each of the "not-self" identities for which Anderson longs and how his imagination constructs various cultural "others."

While Anderson is in some ways a familiar character in the Updike corpus, which often explores the inner life of the affluent, literate male of a certain age, the story has richer connections to his story, From the Journal of a Leper (see this database) and memoir, At War with My Skin. The title obviously invokes Kafka's exploration of illness and alienation in The Metamorphosis (see this database), but the tone and content of the story bring it closer to Ovid's Metamorphoses.

There are productive connections to other literary works including Weldon's The Life and Loves of a She-Devil (see this database) and to cultural histories of aesthetic surgery such as Sander Gilman's Making the Body Beautiful. The story is a very useful teaching text in the contexts of surgery and ethics; the cultural construction of desires for beauty, youth, and other "differences" of gender, "race," age, and ethnicity; and the dynamics of Orientalism in contemporary Western culture.