In Debenham, a village in the Suffolk district of England, the story begins with four men drinking in an inn called the George. There’s an undertaker, a landlord, a man named Fettes, and the unnamed narrator who describes Fettes. Fettes is known as “the Doctor” because he’s educated and has performed first aid from time to time when needed, but he’s never been known to actually practice medicine. Fettes is a heavy drinker, and little of his past is known to his companions until one night when a stranger comes to the George to provide medical service to a guest. Fettes is interested when the landlord mentions the visiting doctor’s name is Wolfe Macfarlane. Fettes’s comments suggest he knows someone by that name, and he asks the landlord to describe him. After the landlord says the man is not a young man but looks younger than him, Fettes says he wants to see the doctor. 

The four men go into the lobby of the George to wait for a glimpse of Macfarlane. Fettes immediately recognizes the man even though he’s older with white hair and dressed richly. When Fettes calls out his name, Macfarlane is shocked, but he recovers quickly and says he’s happy to see Fettes but can’t stay to talk. He says he’ll give Fettes his address and help him financially since he appears down on his luck. Fettes says he’ll never take anything from Macfarlane and doesn’t ever want to see him again. Even though Macfarlane’s expression turns ugly, he maintains his jolly demeanor when he realizes there are witnesses around. He moves to leave, but Fettes grabs his arm and asks him if he’s “seen it again.” Macfarlane cries out and flees the building, leaving Fettes to warn his companions to never cross paths with the doctor if they can help it. Fettes goes home, leaving his friends to wonder what happened between Fettes and Macfarlane. The narrator reveals that he eventually gets the tale from Fettes, and the remainder of the story is his account of events from Fettes’s time in medical school. 

Fettes is a promising student. He has an excellent memory and distinguishes himself with his professors even though he is a heavy drinker and partier outside of school. He believes if he can get the favor of a popular professor named Mr. K— and get him to become his mentor, he would get ahead in his academic and professional goals. He starts working for Mr. K—, maintaining the medical theater where dissections are demonstrated. Eventually, he is given lodging by Mr. K— in the same building with the dissecting rooms and is responsible for accepting deliveries of bodies during the night. Fettes suspects the men who deliver the bodies are unsavory people, but he does his job without question, paying the men and intaking the bodies. 

Fettes is selfish and apathetic to the plights of others around him, and he’s immune to his own conscience. He doesn’t concern himself with the origin of the bodies delivered in the night. Instead, he enjoys satisfying his own desires through drink and women but always makes sure to maintain a clear boundary so he doesn’t risk getting in trouble or losing the good opinion of his classmates and professors. Meanwhile, there is a shortage of bodies available. Mr. K— has a policy of never asking questions about how the bodies are provided, and he encourages Fettes and the other assistants not to ask questions either. Any suspicions Fettes has that crimes are being committed, including murder, are ignored. However, Fettes is eventually faced with the fact that he has been involved in criminal behavior when men bring the body of a woman Fettes recognizes.  

When Fettes recognizes Jane Galbraith, a woman he saw alive and well just the day before, he states to the two men delivering her that he suspects foul play. The men look at him threateningly, tell him he’s mistaken, and demand payment. Because he’s scared by the men’s implied threats, Fettes pays them and is relieved when they leave. However, he examines the body and finds marks that lead him to conclude that Jane was murdered. He waits to talk to the head assistant, Wolfe Macfarlane. While waiting, Fettes reflects on Macfarlane’s popularity and how the two of them went graverobbing on occasion when dissection cadavers weren’t readily available. As soon as Macfarlane arrives, Fettes tells him his suspicions and shows him the marks on Jane’s body. Macfarlane acknowledges that Fettes’s suspicions are well-founded but tells him to do nothing except maintain his silence. 

Fettes is horrified, but Macfarlane convinces him to keep his mouth shut. He even implies that Mr. K—chose them for their work because he knew they wouldn’t take issue with the lengths and means necessary to obtain bodies. Fettes continues to go about his work. Some time later, Fettes meets up with Macfarlane in a tavern with a man named Gray who Fettes finds to be ignorant, crass, and obnoxious. Gray has some kind of control over Macfarlane and treats him with disrespect but seems to like Fettes. Gray acknowledges that he’s a bad man, but he says Macfarlane is worse, referring to him as “Toddy” which angers Macfarlane. Gray jokes that Macfarlane would like to cut him with a knife, and Fettes jokes in return that medical students dissect people they don’t like. The three have an expensive dinner, and Gray leaves Macfarlane to pay the bill. Fettes leaves and doesn’t think much about it when Macfarlane misses class the next day. He looks for Macfarlane and Gray after classes, but he never finds them.

At four o’clock in the morning, however, Macfarlane knocks on the door with the freshly dead body of Gray. Fettes is horrified. Macfarlane says Fettes must pay him to maintain accurate record-keeping and avoid suspicion. Fettes hesitates but ultimately pays, rationalizing that his most immediate need is to get Macfarlane to leave with no trouble. Before leaving, however, Macfarlane tells Fettes that Gray is just like Jane Galbraith. The only difference between those two bodies and all the others Fettes has seen is that he recognized Gray and Jane. He tells Fettes to be a lion and not a lamb in the world, to take what he needs to live a rich life. He says within three days, Fettes will no longer suffer any pangs from his conscience. Macfarlane leaves, and several days later, his prediction comes true. Fettes stops worrying and lives his life as normal without any guilt or fear.

Although Macfarlane avoids Fettes and is unwilling to talk at all about their co-conspiracy, a shortage of bodies leads to the two of them going on a graverobbing trip. While they wait for the dark of night, they have an expensive dinner. Macfarlane gives Fettes extra money, and Fettes boasts about how Macfarlane changed his life for the better. He says he no longer feels fear or concern for right or wrong. He only wants to take care of himself and satisfy his own desires. Later than night, they go to the graveyard and dig up a woman. During the digging, Macfarlane throws a rock that accidentally breaks the lantern they were using. They finish in the dark, break open the coffin, remove the wrapped body, and climb into the carriage with the body between them. As they travel back, the body shifts from its former position. Fettes observes that it seems larger, and he tells Macfarlane to stop the horse and light the remaining lamp. Macfarlane observes that the body isn’t that of a woman, so they unwrap the face and find that it’s Gray under the shroud. Both men scream, Macfarlane drops the lamp and scares the horse into running away with the body in it, leaving Fettes and Macfarlane behind in the road.

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