He opened the case and gazed earnestly at the medal inside, the Hunter Gold Medal, awarded annually at St. Andrews to the best student in clinical medicine. He, Andrew Manson, had won it. He prized it beyond everything, had come to regard it as his talisman, his inspiration for the future. But this morning he viewed it with less pride than with a queer, secret entreaty, trying to restore his confidence in himself.

At the beginning of the novel, Andrew Manson is a romantic about medicine. He has done well at his studies in medicine in Scotland, in spite of being without parents, and he has come to Wales to be an apprentice to a doctor. When he arrives, he finds that the doctor he has come to assist is disabled and that he, Andrew, must do all the work. Andrew is thrown into consulting with patients and feels insecure. The medal stands for his ambitions for excellence in medicine, but he is suddenly worried that he will not be able to live up to the lofty, romantic ambitions he has about medicine.

He did not ask himself if she were pretty. It was enough that she stood, spare and living, before the screen of his sight. And his heart would turn unwillingly, with a kind of sweet oppression he had never known before.

When Andrew first meets his future wife, Christine Barlow, she is a teacher. He confronts her about having a boy in her class whose brother has measles and says that the boy should be at home. However, she refuses, as the boy needs the milk he receives at school, so she does not want to keep him at home. Andrew is touchy and proud, and he is struck by the way in which Christine does not give into him. He starts falling in love with her without really wanting to, as he is usually shy with women. Christine is a more realistic person whose sense of what is practical is in contrast with Andrew's rigid ideals.

He sensed that they were drifting away from each other, losing that mysterious unity, that hidden bond of comradeship which had always existed between them. Well! It was not his fault. He was doing his best, his utmost. He thought angrily, my getting on means nothing to her. Nothing.

Andrew and Christine leave the mining town where they are working to help coal miners, and he sets up a private practice instead. For the first time, he is making a good living, and he constantly trots to the bank to deposit the money he collects from wealthy patients. He even proudly tells his wife to remodel the house, thinking that she will be happy. Instead, she treats the news with a sense of dismissal. She misses the emotional closeness that they used to share, and she is indifferent to the material gains her husband is making. He is moving away from his ideals, and she remains true to them. Christine stands for the ideals that Andrew once had but that he loses when he is tempted only to make money in his medical practice.