“I stood there useless, increasingly covered with snow, becoming all the time immobile.”

The winter setting is an element that renders the doctor confused and impotent. Literally unable to do his job because of the snow, the doctor is unable to move or conduct his business. Because his identity is tied to his profession, not being able to do his job causes existential as well as physical immobility. The doctor doesn’t know how to proceed if he can’t do his duty. The snow also presents not only a physical obstacle that threatens to keep him from accomplishing his goal of getting to his patient, but it also obscures the landscape. The dream-like nature of the story is emphasized by the lack of clear landmarks, with everything being covered and hidden by snow without any visual elements by which to navigate. With nothing to ground him or provide him with a marker of his place in the world, the doctor is disoriented and left with a feeling of purposelessness and impotence.

“In the sick room one can hardly breathe the air. The neglected cooking stove is smoking.”

The conditions in the sick room contribute to the doctor’s disorientation and the nightmarish setting. Like the snowy conditions outside, the smoke in the sick room obscures the doctor’s ability to see and understand his surroundings. Additionally, the cloying smoke emphasizes the doctor’s sense of being trapped. The fact that the stove is untended parallels the state of the patient who seems fine, and then is discovered to have a mortal wound. The patient is likewise neglected, left to die from a wound that he says he has had his entire life. Other things in the home are neglected as well. The parents don’t communicate effectively with the doctor who is confused by their talking, and it is only the sister waving a bloody rag like a red flag who finally signals to the doctor that something is truly wrong with the patient. The entire setting in the sick room is suffocating, mirroring the doctor’s feelings of being stifled and unable to function effectively.

“I want to die too. What am I doing here in this endless winter!”

The winter setting is symbolic of the doctor’s feeling of isolation and the growing realization of his own mortality. The doctor feels a sense of isolation throughout the story. He has no wife or children, and his only human connection is with his servant girl, whom he abandons to be assaulted by the groom. He can’t even communicate effectively with the patient or the patient’s family. Being in the sterile cold of a snowy winter serves to represent the doctor’s isolation within his physical landscape. It also symbolizes the doctor’s age and awareness of his own mortality. The doctor is in the winter of his life, and he has a growing resignation that culminates in the middle of the story when he sees himself in his dying patient and understands that he cannot fight the inevitable. As the story concludes, the doctor is alone in the freezing cold, trying to get home in the snow, yet he understands he will never arrive back to where he started. The aging process only moves forward, and the doctor’s journey in the end can only result in his own inevitable death.