Gerald Wilcox is an otolaryngologist who lives with his wife and daughter in a small town in Montana in 1959. Dr. Wilcox has a weakness for women, alcohol, and, lately, morphine (with which he injects himself about once every six weeks). He enjoys writing in his journal almost every evening yet rarely reviews what he has previously written.

Although high on morphine, Dr. Wilcox repays a debt by making a house call late one night to treat a young boy with mastoiditis. On returning home, the doctor decides to bake a coffee cake for his wife at 5 o'clock in the morning while musing on what will happen to his journals after he dies.