Simon worships at the altar of sanitation.
Everyday; often over ten times a day, he walks to that altar and spends up to five minutes (though he feels like fifteen would do better) going through his own private ritual.
He carefully works through the techniques he was taught at the MediCad on Osiris, the movements he is sure he refined to perfection whilst working at the hospital, and then his mind is somewhere else as he continues the ritual with fervour – no longer following any written rules or memorized speech.
Simon's brilliance as a trauma surgeon is only surpassed by his love for River, only matched by his dedication to this worship.
Sometimes Simon is caught in the act. Ever the cool, collected doctor he smiles and says he is just taking precautionary measures, being careful, that it benefits everyone and maybe certain crew members ought to follow his example more devoutly than they do.
River interrupts his routine often, but he can never bring himself to be angry with her. Not when she's blissfully lucid and asks him to partner her for a dance, not when she's crying and clinging and begging him to understand her mixed up words.
He goes straight back to the altar once she's playing with Kaylee or mercifully sedated, though. Tear-tracks glisten on his cheeks and his jaw clenches tightly shut as he renews the ritual with desperation, once twice many times he follows through every step with almost painful precision. Confessing his guilt over River's suffering, the crew's suffering, his own suffering as he washes off the blood, vomit, chemicals, memories; praying to every deity and none as he lathers his hands and forearms in soap; wishing, hoping, pretending the water would wash away his sins, her sins, their sins.
Simon knows that he will worship at this altar for the rest of his life, going through the same ritual day after day for many years to come as he has for many years before. He wonders if his martyrdom because of his absolute devotion to River will mean he is truly redeemed with his death. He buckles under the weight of his guilt, fear, love, secrets.
He reaches for the sanitizer, and he repeats.