“A man huddled down in the stall below showed his open blue-eyed face…crawling out on all fours.”

The inciting incident is the emergence of the groom which sets the rising action of the story in motion and introduces the first elements of surrealism. When the groom magically emerges from the pigsty and supplies the horses the doctor needs, it’s clear that there is more going on than what literally appears. The doctor’s struggle with his feelings about the groom’s behavior reveals his internal conflict. He must confront his sense of duty in opposition to his feeling of responsibility to his servant girl Rosa. The fact that that groom, a man the doctor acknowledges is a mysterious stranger, initially walks on all fours and attacks Rosa by biting her in the face establishes the doctor as a beast himself. That comparison initiates the establishment of the groom as an allegorical figure who represents the doctor’s inner animal nature, struggling under the surface to break free from the restraints of duty and decorum.

“[M]y eyes and ears are filled with a roaring sound which overwhelms all my senses at once. But only for a moment. Then I am already there.”

The rising action of the doctor’s journey establishes him as helpless against the powers working against him. Just as an object caught in a river cannot do anything but move where the current takes it, so too is the doctor impotent against the forces that propel him within the story. The journey foreshadows how the doctor will be even more powerless once he reaches his destination and is confronted with his patient. The scene in the carriage also serves to create the dreamlike, or even nightmarish, feeling in the story. The horses are active agents, moving of their own accord without any direction from the doctor. Additionally, the doctor is able to magically hear the groom tearing about the doctor’s house to get to Rosa, showing how he is helpless to rescue his servant girl as well as the fantastical world in which the doctor exists. Likewise, the journey of ten miles is accomplished in what seems like a moment for the doctor, indicating how the natural laws of time and distance do not function in a realistic way.

“But now it was time to think about my escape. The horses were still standing loyally in place. Clothes, fur coat, and bag were quickly snatched up.”

The story rises to its climax when the doctor crawls out the window and escapes from his patient’s sickroom. He is only able to achieve his escape because he lies to his patient, promising that the man will be absolutely fine despite an obviously mortal wound. Despite his stated concern about doing his duty and his fears about not meeting the expectations of the community members who depend on his service as a physician, the doctor’s lies and his escape are the only things he does to show any agency. Prior to this moment, the doctor is utterly powerless against the groom, unable to direct the horses on the journey to the patient, and completely ineffectual in his job as a doctor. Ironically, taking action and fleeing the sickroom leads to the doctor’s death since he is out in the freezing cold of a blizzard, naked, traveling with horses that are moving too slowly.

“I’ll never come home at this rate…Once one responds to a false alarm on the night bell, there’s no making it good again—not ever.”

In the falling action and resolution of the story, the doctor is resigned to his own death. He does not stop to dress himself, and he can see but does not fetch his fur coat which trails behind him in the snow, signifying complete and utter hopelessness. Whether he is physically able to get his clothes and coat is ambiguous, further emphasizing the dreamlike state the doctor is in and indicating that the truths the doctor is now aware of are only accessible to him in his own subconscious state. His loss of faith in his abilities, the community’s expectations of him, and his own impending death are clear within the nightmarish setting. In the end, the night bell can be seen as a death knell, and the false alarm as the awareness of mortality but not an actual experience with death. The doctor has grasped his own inevitable demise as imminent, and he cannot come back from the knowledge. Nothing will ever be the same again, and he can never un-know the knowledge of his own mortality.