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The story opens in the home of Ivan Yakovlevich in St. Petersburg, Russia. Ivan, a barber, has awoken to find that his wife, Praskovya Osipovna, has prepared coffee and hot bread. After cutting the loaves, he realizes that there’s something inside it. He pulls the object out and sees that it is someone’s nose. Ivan immediately recognizes the nose, which fills him with horror. Praskovya Osipovna accuses Ivan of having cut someone's nose off, calling him a scoundrel and drunkard, and threatening to report him to the police. This makes little impression on Ivan, as he’s preoccupied with the realization that the nose belongs to Collegiate Assessor Kovalyov, a high-ranking client at his barbershop. Praskovya Osipovna yells at Ivan that he needs to get the nose out of her house, and Ivan puzzles over how the nose came to be in his bread. He can’t remember if he came home drunk the night before, but even if he had done something while drunk, it still doesn’t explain how the nose was baked into his bread.

Terrified that he might be charged with a crime, especially because the nose belongs to a high-status official, Ivan wraps up the nose in cloth and carries it outside to look for a place to dispose of it. His efforts are hindered by the many friends he meets on the street, which only increases his anxiety. Ivan knows that he needs to get rid of the nose soon, as the area is becoming crowded as shop owners open their stalls. He heads to St. Isaac’s Bridge with the intention of throwing the nose into the river Neva. Here, the story’s first-person narrator suddenly makes their initial appearance, telling the reader that they’ve forgotten to supply the necessary context on Ivan Yakovlevich. The narrator reveals that Ivan is a drunk who wears messy and stained clothes, but that he is an unflappable man who does not become angry even when Kovalyov rudely remarks during his weekly shaves that Ivan’s hands stink. He retaliates only by giving Kovalyov an extra strong lathering with shaving cream.

Back at the bridge, Ivan drops the nose into the river and feels a weight lift off his shoulders once the strange object has been disposed of. However, as he attempts to make his way to a nearby restaurant, he’s immediately apprehended by a police officer who saw the act, and who begins to question Ivan about what he was doing on the bridge. Ivan tries to avoid the questioning by bribing the police officer with free shaves, but the officer declines the bribe and continues to interrogate Ivan. Then, the narrator remarks that the scene becomes covered in mist, and they cannot tell what happens next.

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