Set in the barren prairie of northeast Nebraska, “The Good Doctor” tells the story of an at-home interview between psychiatrist Frank Briggs and Mrs. Buckholdt, a patient who has been using sedatives and antidepressants for four years and who has recently missed several of her clinic appointments with her regular doctor. Young and somewhat idealistic about how much he can help, Dr. Briggs drives two hours to visit Mrs. Buckholdt because he wants to evaluate her case directly. He does not believe it is healthy to continue to prescribe medication for her over the phone. Though he is trained in “biological psychiatry,” a physiological method of treating psychological problems with drugs, Dr. Briggs subscribes more to the value of talk therapy. He believes that a patient needs to experience empathy from the therapist, a sense of connection and caring. He takes the trouble to drive out to the Buckholdt house because he wants to understand Mrs. Buckholdt better, to hear her story firsthand. However, when he arrives at the sagging “fifties prefab” in the middle of nowhere, he confronts a family of alienated, hardened individuals and a client more in charge of the situation than he anticipated.
The night before this interview, Dr. Briggs learned that Congress was reducing funds for the National Health Service Corps, the organization for which he works as a volunteer in exchange for his medical school debt being repaid. One year into his three-year contract, Dr. Briggs is suddenly aware that his career may be on hold and that he may come away from his current work in rural Nebraska with debt he hoped to have eliminated. At the age of thirty-two, Frank Briggs has recently ended his six-month relationship with his girlfriend, and he offers himself the dubious consolation that his patients have “romantic lives more desperate than his own.” He has a headache from having drunk too much alcohol the previous night, is worried about his future, and exhausted by the one-hundred-degree heat as he pulls into the Buckholdt property.
In turn, Frank meets each of the four f-amily members. They are separated spatially from each other and not inclined to talk. The daughter appears in the driveway, but she turns and walks away in response to his greeting. After a few knocks at the door, Jack Buckholdt opens up. Jack says the daughter “ain’t a bigger talker,” an understatement that clearly applies to the whole family. Dr. Briggs notes that Jack evinces some physical signs of “Hepatitis C . . . or the end of a serious drinking habit.” Jack’s second comment begins a pattern that characterizes the interview between Frank and Mrs. Buckholdt; Jack minimizes Frank’s authority by commenting on his age. He is “young to be a doctor” and appears to be running an errand for the clinic, “the one they sent up.” Jack says his wife is inside and then edges past the doctor and disappears into the yard. Dr. Briggs adjusts to the dark interior and notes the back of the son’s head in the kitchen. The boy is watching an animal chase on “a muted television.” While he waits for Mrs. Buckholdt, Frank looks over her record. He thinks about his ex-girlfriend Anne and how they disagreed in their residency program about the emphasis on drug therapy for psychological problems.
While other residents “joked about the numbing” that insulated them from patients’ problems, Frank knew he was not adapting similarly. In fact, “he still felt like a sponge, absorbing the pain of the people he listened to.” Now he reviews Mrs. Buckholdt’s chart, which contains an assessment by an internist. He finds her case mismanaged. What he learns is that she first appeared at the clinic four years earlier, complaining of depression following the death of her son, Jason. She had been given antidepressants followed by benzodiazepines, “written as needed.” There was no therapy, and the previous psychiatrist would not have considered making a five-hour round-trip just to check on his patient, “so he’d just kept calling in her refills.” In the margin of the chart, Frank sees a little note, “ Injury may be a factor Mrs. Buckholdt’s first sentence is remarkably refined: “My apologies for not greeting you at the door.”
She is attractive, in apparently good health, nicely dressed. Frank had expected “a disorganized person,” but Mrs. Buckholdt seems “out of place here, in this house out in the middle of nowhere.” She locks the door to the kitchen and sits down, facing Dr. Briggs. He begins conventionally; the director wanted him to check in on her in person. She denies eye contact, looking over his shoulder. Her response is a non sequitur: “I take it you’re childless.” Clearly, Dr. Briggs wants to conduct a typical assessment interview: he asks the relevant questions, and the patient answers them. But Mrs. Buckholdt asserts control, asks personal questions, chooses the subjects she discusses. She is not a weakling, a victim; rather, she is “self-possessed” with “powerful” eyes and “a strong, almost male jawline.” Then she moves a certain way, and Frank sees that her four fingers have been cut off her right hand. He focuses on her face, and then he decides he will accept a glass of water.
In the kitchen, Frank greets the boy, but the boy only looks vacantly at him and then back to the television, where an animal feeds on the stomach of a deer. As he leaves the kitchen, he turns the key in the lock as Mrs. Buckholdt had and rejoins his patient. He begins again, asking her if she is still troubled by the depression she had four years before when she first came to the clinic. Again, she responds with a non sequitur: “Where is it that you grew up?” When he brings her back to the subject, gently reminding her that it would be good to use their time together to understand her situation, she still pursues personal questions about him. She explains that she likes to have “a sense of who [she’s] talking with.” Thus, she draws the conversation off her and onto him. Frank tells her he grew up outside Boston. Again, he tries to pull the discussion back to her depression, inquiring if it is a current problem. She directs his attention to a print of a Brueghel painting on the wall.
Then Mrs. Buckholdt begins to talk about her past, and Dr. Briggs decides to acquiesce to her choice of subjects. Mrs. Buckholdt went to college out East, where she studied art history. She loved paintings and hoped to have a better life than smalltown Nebraska offered her. But her father died as she began her senior year, and she had to return home. She married Jack Buckholdt, a handsome young man who read books and had a promising job at the bank. She believed him when he talked about saving up for a couple years and then moving to California. But years went by, and they did not move. They had three children instead; the area suffered an economic depression during which the bank closed, and Mr. Buckholdt took up drinking and then lost his job.
Dr. Briggs asks Mrs. Buckholdt to describe her symptoms. She says some mornings she is afraid to get out of bed. She takes medication to help her get up and serve her children their breakfast. She admits being afraid of her son. When he asks why, she answers that taking the pills helps her. Then she returns to talking about her past. Building some kind of rapport with Dr. Briggs, she asks if he is married or if he intends to marry. Then she goes on about her plans for her first son, Jason. If she could not escape this barren place, then she was committed to helping Jason do so. She read him her art books, bought him a violin, and gave him lessons. All went well until he hit fourteen, got criticized by children at school, and destroyed his instrument. She says, “this place . . . started doing its work on him somehow. . . . The little tough guy stance, afraid of anything that wouldn’t make him popular.” She was depressed, feeling that she was not “really there in the room” with her own children. Then Jason and his friend Jimmy Green got hooked on methamphetamine, “the drug of choice for kids out here.” Now Mrs. Buckholdt closes in on a certain Sunday when her husband and the other two children were away, and Jason was up in his room, having gone several days and nights without sleep.
He began crying; she went upstairs to discover her son, now seventeen, naked and rubbed raw and bleeding. He looked at her like she had “severed a rope he’d been clinging to for dear life.” She got gauze, ointment, and Band-Aids, and tried to take care of his skin. Downstairs, she was in the kitchen chopping vegetables for soup; he came in and chopped off her fingers with a meat cleaver. Then he went out of the house, naked, and never returned. Frank listens and waits, feeling “a familiar comfort being in the presence of another person’s unknowable pain.” A few days later, Jason and his friend Jimmy crashed someone’s truck into the wall of an overpass on the interstate. Jimmy was burned; Jason was killed. Dr. Briggs listens, mentally writing his own note into her chart: “intrusive recall . . . hyper-vigilence, and generalized anxiety.” He thinks she has post-traumatic stress disorder. Facing Mrs. Buckholdt, “this oddly compelling woman,” Frank realizes why he became a doctor: “to organize his involuntary proximity to human pain.” It served him as a way to control “this opening in him” to pain in others. He seems to benefit more from the interview than she does. Earlier, Mrs. Buckholdt discussed a Brueghel painting in the room; now, having told her story, she returns to it. It was Jason’s favorite work. She recalls learning that Brueghel “was a moralizer, his paintings full of parables.” She takes charge of the conclusion of the interview. She does not want Dr. Briggs to return; she will not go to the clinic. It is better when she does not think of the past. She can use the pills, but she can get along without them. As she rises and alerts her son that they must soon leave for his violin lesson, Dr. Briggs feels panic at the thought that it is over between them: “he didn’t want to lose her, he didn’t want the telling to end.” He tries to hold on by asserting that therapy is advisable, but she cuts him off: “didn’t you hear what I said?” she asks him. She has the last word. She does not need him, but he knows how much he needs her.
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