With their smoothly engineered curves, their expectant lips, and, yes, their eternal willingness, the dolls are—there's no getting around it—hot. They are also, according to the company, resistant to heat, water, staining, and stretching, but there is one "real" aspect of the dolls that doesn't get a lot of play, because it has a tendency to disrupt the fantasy: Every now and then, they get sick.

Just like human beings, RealDolls are vulnerable to maladies, to aging, and to abuse, and thanks to his skills and the nature of his personal obsessions, Slade Fiero has become something of a miracle worker: If a doll falls ill, this part-time tattooist, art collector, and onetime pot dealer who lives alone on a quiet street in Davis may be the only person who can nurse her back to health. Many of Fiero's customers are rich and will pay hundreds or even thousands of dollars for the most minor patch-and-stitch job. One flew him to Las Vegas, put him up for a few days, and bought him tickets to Siegfried & Roy. "Slade has a very important place in the doll world," says Elena Dorfman, a photographer who documented that world in her 2005 book Still Lovers. "People are sending him their beloved—or at least a sex partner that they paid a lot of money for. They're trusting him to fix her. It's like sending someone you love to the doctor and hoping they'll come out all right."

Fiero likes to keep his house dark inside. "I can see better that way," he says. One of the first things you notice, after your eyes have adjusted to the crepuscular gloom, is a display case full of skulls. Several of them are human. Down the hall, at his work station, he points out a thin gash along a doll's right thigh. She's small—just a quarter-scale toy model that Matt McMullen has had on display in his office near San Diego—and the injury is probably the result of nothing more than an unfortunate encounter with office supplies. But Fiero wants to show what his labor entails. First comes the cleaning. There are doll faces scattered all over the floor. Fiero grabs one with ruby-red lips, unscrews a one-gallon can of acetone, dabs some on a sponge, and begins to wipe the grime off the cheekbones. Anytime a full-size doll arrives at his doorstep, the scouring needs to be more thorough. "I hang her in the shower," he says. "I have an attachment on the end of a hose—I shoot steaming-hot water into her body." He also injects acetone into her three orifices with a syringe. "I wear rubber gloves, so it's really not that big of a deal for me," he says. "I don't see gobbles of goop rushing out."

Fiero opens a tub of silicone. It's clear, like gelatinous water. With a tongue depressor he spoons a couple of ounces into a plastic cup and then sprinkles in some flesh-colored powder so that his sealant will match the hue of the doll. He places the cup in what looks like a transparent domed popcorn popper. He flicks a switch. An engine hums. The device is a vacuum pump, and it sucks air bubbles out of the silicone. Then it's time for the silicone to "cure," or solidify. "I want this to be more the consistency of toothpaste," he says. While he waits, he shows off a loop of silicone that's been shaped like a vagina, with a two-inch penis attached at the top. Apparently one doll owner has a thing for she-males, and Abyss asked Fiero to affix the custom attachment. "He wanted a hermaphroditic-vagina type of thing," he says. He goes back to the small doll, which is lying on a foam bed, smears the silicone over the cut with another tongue depressor, and wraps the injury with a tourniquet fashioned from a yellowish strip of vinyl.