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Fettes was far through his third tumbler, stupidly fuddled, now nodding over, now staring mazily around him; but at the last word he seemed to awaken, and repeated the name “Macfarlane” twice, quietly enough the first time, but with sudden emotion at the second.

The opening scene at the George presents the inciting incident of the story. Fettes is established as a man with a past. He is a heavy drinker, suggesting that he has inner demons to drown. Information is also presented about how Fettes came to Debenham as a young man which connects to the end of the story and implies that the night in the graveyard signaled the end of his aspirations for a career in medicine. It’s at the George that Fettes is confronted with the presence of Macfarlane. This meeting also introduces the story within the story that is told second-hand by the unnamed narrator who takes pride in being able to gain Fettes’s confidence and get him to unpack the tale. The confrontation between Fettes and Macfarlane establishes the protagonist and antagonist, respectively, and foreshadows the central conflict. Fettes is shaken by his old friend’s name, and once the story from the past unfolds, the cause of his shock becomes clear.

[A]fter a night of turbulent pleasures, his hand still tottering, his sight still misty and confused, he would be called out of bed in the black hours before the winter dawn by the unclean and desperate interlopers who supplied the table.

In the story within the story, the rising action is established with Fettes’s activities as a young medical student. He is described as a young man who drinks and parties. Although no specifics are provided, it’s clear that Fettes places his own selfish pleasures above all else. He is more concerned with maintaining appearances in front of his peers and professors than he is with being sincere in his manners and morals. Although he recognizes that the men who supply bodies are dirty and dangerous, it’s at least somewhat reasonable to accept that he is not yet aware of how despicable they are or what he himself is involved in. As the tension continues to rise, Fettes’s character is tested through conflicts with his situation, Macfarlane, and his own conscience. The establishment of Fettes as a dissolute young man to begin with makes the struggle with his later choices more believable because if he was always good and principled, the choices would be much simpler.

The next few seconds were for Fettes an agony of thought; but in balancing his terrors it was the most immediate that triumphed.  Any future difficulty seemed almost welcome if he could avoid a present quarrel with Macfarlane.

As narrative tension continues to rise and Fettes is confronted with increasing proof that he is involved in activities both criminal and immoral, his character is developed further. He is first persuaded by Macfarlane to ignore the indications that Jane Galbraith was murdered. When Macfarlane mocks him for being foolish enough not to understand already that the bodies that end up on the dissecting tables are murder victims and challenges his manhood, Fettes is revealed as inherently weak and motivated by his own selfish desires. He maintains his silence and complicity but is still horrified and ambivalent about his next course of action when Macfarlane shows up with the murdered corpse of Gray. When he balances his choices and decides to choose what he perceives to be the easier path and avoid an immediate battle with Macfarlane, Fettes’s transformation is achieved. His complicity is assured, and the story moves to the next phase of determining whether Fettes will rise or fall as a result of his choice.

For some time Macfarlane stood motionless, holding up the lamp.  A nameless dread was swathed, like a wet sheet, about the body, and tightened the white skin upon the face of Fettes; a fear that was meaningless, a horror of what could not be, kept mounting to his brain.

The story moves to its climax after Fettes and Macfarlane have completed their task of digging up the body of the farmer’s wife and head back to Edinburgh. Tensions continue to rise since both men are filthy, soaked from the rain, and forced to travel in pitch darkness without the benefit of their lanterns. The body is bulky and burdensome, and both men’s nerves are fraying. To heighten the tension of the last moments of the rising action, dogs begin to howl tragically. Fettes senses that there are supernatural forces at work when he asks for a light. After Macfarlane obliges by stopping the wagon and lighting the lantern, they both gaze on the inexplicable presence of Gray’s corpse instead of the one they dug up, and the story reaches its climax. The falling action ensues as Fettes drops the lamp, and the horse runs away. Both Fettes and Macfarlane are left alone in the dark to make their own choices of how to proceed from the horror they’ve seen and done.

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