In Adam Haslett’s short story, “The Good Doctor,” setting is both an historical and a geographical context, the decades-long persistent local economic depression and a history of failure of the federally funded medical outreach program, sponsored by the National Health Service Corps, to respond effectively to local substance abuse needs. The chronic poverty and the inadequate federal program attempting to address its effects, taken together, create an insidious, deterministic context, an inertia as unnoticed as the height of the grass growing through the rusted “skeleton of a Chevy Nova,” on the Buckholdt property. Here is a story of a story of a story: a problem within a problem within a problem. It might be schematized this way: first comes the story of the interview between Dr. Frank Briggs and his patient, Mrs. Buckholdt; next is her story of her son’s addiction to methamphetamine, his attack on her, and his death; and last is the economic story of chronic poverty in a remote landscape that stretches back through the history of this family and the history of the parents of this family, all in a place beyond the effective reach of professional assistance. The first two stories are symptoms of the third problem, which in this case, the patient appears to understand better than the doctor.
Chronic poverty is presented first in “The Good Doctor” in the image of the half-buried Chevy Nova, rusting on the Buckholdt property. This car, whose name means “no go” in Spanish, signals no means of escape from this “empty prairie.” The sagging “fifties prefab,” the “dilapidated barn,” the “air heated thick as the fumes of gasoline,” all make up the immediate setting or backdrop, the barren, dusty landscape, in which Mrs. Buckholdt, her alcoholic husband, Jack, and their two children exist. What is wrong with this place and these people has been wrong a long time.
Waiting for Mrs. Buckholdt in the living room, Dr. Briggs examines her chart only to see “how shoddily her case had been managed.” The problem of this family, summarized in the facts about Mrs. Buckholdt, go back four years, when she first came into the clinic complaining of depression after her son died. The chart provides only brief notes; she received antidepressants then sedatives and no therapy. In this rotating-door, federally funded agency, presumably one psychiatrist after another dealt with Mrs. Buckholdt over the past four years. The last one phoned in her refills rather than investing the time in driving out to her place to see her; Dr. Briggs, the new person handling her case, takes the trouble to visit her house in the hopes that talking with her will help. The chart does not clue him in on the background. In the margin, Dr. Briggs sees “a cryptic line,” that “ Injury may be a factor ,” a line that may be a warning but certainly is not all that informative and leads him to suspect incorrectly some kind of farm accident.
Immediately, however, readers are given reason to wonder if this clinic and Dr. Briggs’s good intention are capable in any way of addressing Mrs. Buckholdt’s case. In fact, “The Good Doctor” begins the morning after Dr. Frank Briggs gets some bad news. A volunteer with the National Health Service Corps, Dr. Briggs has agreed to work for three years for “a paltry salary” in the northeast Nebraska boondocks in exchange for repayment of his medical school debt. The news is that agreement is about to change: Congress is cutting funding to the agency, and Dr. Briggs is being left with “the full burden of his debt.” As Mrs. Buckholdt’s chart shows, the program has been ineffective for some years already, and now as Dr. Briggs begins his second year of working in it, the program faces budget cuts which may make it infeasible for Dr. Briggs to continue practicing in this location. Connected to money issues is a question about methodology.
Dr. Briggs was trained in a residency program dominated by “biological psychiatry”; drugs were the preferred method for treating psychological and behavioral problems. However, though he is a medical physician and trained in physiological diagnosis, Dr. Briggs clings “to an old myth about the value of talk.” Young and idealistic, he believes patients need “someone to acknowledge what they were experiencing.” Frank Briggs has not developed the “numbing” his fellow doctors acquired during their training. He knows himself to be “a sponge, absorbing the pain,” and he puts his faith in the healing effect of empathy. That position is fine, but how can it be applied effectively within a program which faces budget cuts in an area so remote some of the clients are hours away? In other words, reduced funding for the program constricts its reach and effectiveness and undermines the workers who face unexpected financial worries themselves. In addition, treatment method is called into question given the mission of this program to serve populations in remote areas where frequent consultation is impractical and drug addiction widespread. Mrs. Buckholdt’s case has gone unmanaged for years, and given internal difficulties in the agency and Dr. Briggs’s own financial burden, how likely is it that Mrs. Buckholdt’s best interests can be served in this place and at this time? Unlike the previous psychiatrist, Dr. Briggs wants to extend himself to his patient. He is willing to drive the five-hour round-trip to her house to see for himself how she is doing and to evaluate her medications. But in their interview, Dr. Briggs encounters some surprises. The contrast between the chart and Mrs. Buckholdt herself is immediately apparent. Her first response to Dr. Briggs is refined, gracious, so unlike this most ungracious “fifties prefab” out in the middle of nowhere. She appears in good health, is nicely dressed, and has “a self-possessed demeanor.” Older and in some ways in better shape on this afternoon than the doctor, who is himself suffering from a hangover, Mrs. Buckholdt takes charge of the interview.
Dr. Briggs wants to focus on her present condition, inviting her to describe her symptoms. It registers on him as off the subject when she chooses instead to question him about where he grew up and went to school, eliciting the fact that he comes from an affluent Boston suburb. The subject is germane, however, from her point of view, for she went to college back East, and she knows the difference between affluence and poverty, between being cultivated and not having a clue about how to survive in a place that offers no hope of a better life. Mrs. Buckholdt, in asking about the doctor, excuses herself for seeking personal information: “I just like having a sense of who I’m talking with. You are from the East I take it.” It is not professional for the conversation to focus on the doctor rather than the patient, yet given the story Mrs. Buckholdt has to narrate, a sense of place is relevant. She knows where Dr. Briggs is coming from, both literally and professionally, and she wants him to know she can imagine the town where he grew up: “a rich town, isn’t it? Tidy lawns. A country club. Kids going to college. Am I right?” These details of setting signify the context for Dr. Briggs’s own development and suggest the factors that supported his becoming the psychiatrist he is. When he asks about her depression, she looks over his shoulder to a Brueghel print on the wall.
The case at hand, from this patient’s point of view, is a matter of setting. It matters that she was sent back East to college, that she studied art history, that she was cultivated and saw how rich kids live in eastern cities. It also signifies much that the death of her father called her back to Nebraska without allowing her to complete her bachelor’s degree, back to a mother who thought the cost of education for a daughter was a waste of money. In this way, Mrs. Buckholdt learned what she could not find in northeast Nebraska. She married and bought into her husband’s dream of escape. Investing more than she knew in the hope of a change in real estate, she and her husband bought a house in Nebraska, theoretically to save up for the move, and then they had children, the first one born quickly. Thus, the factors were in place for their remaining where they were longer than they envisioned. Perhaps imperceptibly at first, economic depression made the inertia of this place more adhesive. Mr. Buckholdt’s job became one of managing foreclosures; then the bank folded, and he lost his job and began to drink. Some years later, what chance of leaving existed? Disillusioned for herself, Mrs. Buckholdt nonetheless perpetuated the narrative of escape for her son, Jason.
In her story about Jason, Mrs. Buckholdt asks Dr. Briggs: “You’re a doctor in these parts . . . You must know all about methamphetamine.” Dr. Briggs agrees; cases of this addiction appear in his clinic; “It had become the drug of choice for kids out here, cheaper than coke.” Existing in poverty-stricken rural Nebraska, seventeen-year-old Jason Buckholdt had perhaps as high as a one in four chance of exposure to this drug. On the day of his psychotic episode, Mrs. Buckholdt had gone to his room when she heard him crying in the same tone of voice he had had as a little child; now describing that scene to Dr. Briggs, she recalls years earlier when Jason was a little boy, how she would comfort him. Significantly, she consoled him with an escape narrative: “I’d tell him how one day we’d take at trip on a boat all the way across the Atlantic and he’d see Athens and Rome and all the places where the stories I’d read him took place.” Mrs. Buckholdt used the myth of eastbound travel, a fantasy of entering the setting created in fiction, to appease her little boy. She might have taught him how to deal with school or kids who made fun of his studying the violin, but instead, she gave him the myth of escape.
Unfortunately, the effectiveness of this anodyne wore off by the time Jason was fourteen. Mrs. Buckholdt states, “this place, it started doing its work on him somehow.” Just as Jason entered puberty, “His father had started drinking . . . Everything was going to hell around here, prices dropping through the floor . . . And as for symptoms, yes, to tell you the truth, I was depressed. . . . Things hadn’t gone like we’d planned.” Given her own shrinking circumstances, she thought about the contrast between her life and the young women who attended college with her, “visiting Europe, standing in front of those pictures.” The reality is that increasingly in the late 1980s and throughout the 1990s, methamphetamine was cheap and easily available in the rural Midwest. Jason and his friend Jimmy Green were caught buying some in a parking lot in Ewing Falls, Nebraska. Jason was sent for three months to a juvenile detention center in nearby Atkinson; when he came home he was “angrier, more confused.” Mrs. Buckholdt theorizes that he procured meth even while incarcerated; she asks, “how they can run a jail where children can get drugs?” Some time later, when she was home alone with Jason, who had been awake for several days and nights, a terrifying psychotic episode occurred. He was naked, sobbing, and had rubbed his flesh raw. She says, “he looked at me like I’d severed a rope he’d been clinging to for dear life, just like that, like I’d sent him down somewhere to die.” She adds, “I was his mother . . . What was I supposed to do?” She wrapped him in a towel and applied ointment to his wounds. Later, in the kitchen, he grabbed a meat cleaver and “chopped [her] fingers off, the fingers [she’d] touched him with.” Dr. Briggs is silent as he listens to the story, and after she finishes speaking, he remains quiet. With the truth out in the room, Mrs. Buckholdt seems “smaller and more frail, her earlier, imposing demeanor exhausted.” Significantly, when he died, Jason was heading west on the interstate; the borrowed truck hit a cement wall.
Hearing her story, Dr. Briggs feels “a familiar comfort being in the presence of another person’s unknowable pain.” He acknowledges to himself that “More than any landscape, this place felt like home.” Able to attend, to pay attention to her story, Dr. Briggs still responds clinically, mentally composing a statement for her chart as he watches her: “intrusive recall . . . hyper-vigilance, and generalized anxiety. Diagnosis: post-traumatic stress disorder. Treatment: a course of sertraline, one hundred milligrams daily, recommendation for psychotherapy, eventual titration off clonazepam.” Sitting quietly, he has to wonder if “the power to describe the people they listened to save [doctors] from what they heard.” He thinks about the psychological vacancy of some patients, the denial of others, “the unsaid visible in their gestures, filling the air around them.” Musing about his patients, thinking now about Mrs. Buckholdt’s story, Dr. Briggs realizes why “he’d become a doctor: to organize his involuntary proximity to human pain.” But the illusion of being able to organize pain is immediately shattered by Mrs. Buckholdt’s resolute dismissal of him. They look again at the Brueghel print, The Fight between Carnival and , Jason’s favorite work of art. The painting depicts a village square with lots of peasants engaged in various activities and at its center the “contending forces” of self-indulgence and abstinence. It is not the “lush landscapes” Mrs. Buckholdt loved; it is a painting, though, full of life. Mrs. Buckholdt is ready for Dr. Briggs to leave; she is taking her surviving son for his violin lesson. In response to the idea of leaving the house, Frank Briggs feels a visceral tightening: “the panic beginning before his mind could form the thought: he didn’t want to lose her, he didn’t want the telling to end.” But the stories have all come to an end: he can recommend drugs and therapy, but she already knows there is no escape from the setting that controls this plot. When he demurs, she holds the door for him, asking him, “didn’t you hear what I said?” Dr. Briggs has, in fact, not heard her, if he continues to think that his remedy of drugs and talk can extricate her from the place and time that controls her life. Evidence provided at the outset also suggests that neither Dr. Briggs nor the more distant National Health Service Corps which he represents can in any way transform the remote regions in which cases such as that of Mrs. Buckholdt occur. They cannot undo the past, shift the decades’ long downward spiral of economic depression, or make the barrenness in her life as lush as a painting or the California fantasy she once loved. The story proves the lie of its title; here is a case of chronic poverty and drug addiction, of trauma, grief, and loss, which the “good” doctor cannot even begin to fix.
Melodie Monahan, Ira Mark Milne – Short Stories for Students – Presenting Analysis, Context & Criticism on Commonly Studied Short Stories, vol. 24, Adam Haslett, Published by Gale Group, 2006