Hektoen International

A Journal of Medical Humanities

Dr. Blockhead’s victory: Up there, down here

Angela Belli
Queens, New York, United States

The iconic image of the prizefighter raising his hands above his head in a gesture of victory is given life in Flannery O’Connor’s The Enduring Chill.1 He appears not as a heavyweight champion of the world but as a country doctor. The main character in the story is a 25-year-old Southerner, Asbury Fox, who returns home to his mother’s dairy farm in the deep South after spending some time in New York City in a vain effort to achieve recognition as a writer. In that city he inhabited a freezing flat where he had to sleep under two blankets, one overcoat, and, in between, three layers of the New York Times. One night he experienced a severe chill which, coupled with other disquieting symptoms, convinced him that he was seriously ill—at death’s door in fact.

Having lost his job in a bookstore for excessive absences and with dwindling funds, he has no recourse other than to return to his roots. Physical distress apart, he is also demoralized by his need to abandon the environment that he considers superior for the development of his superior artistic gifts. Picking up her son at the rail stop, his widowed mother, Mrs. Fox, is aghast at his wasted appearance. Nevertheless, as she drives him back to their farm she maintains an optimistic air as she provides Asbury with an instant diagnosis—his illness is due to the cold he has experienced “up there” and she prescribes a cure, a generous dose of warm Southern air. He soon receives a second opinion, this time from his older sister, Mary George, described as the principal of the county elementary school and “an expert in all things” (363). She has concluded that his health issues are purely psychosomatic due to his failure as a writer. Her prescription? Two or three shock treatments to rid his head of the notion of being an artist.

Throughout the tale the “up there” “down here” duality is used to connote the North and the South, contrasting social, philosophical, and spiritual attitudes. A master of the short story form, O’Connor sketches in concise detail the inhabitants and scenery of her native Georgia. Her style is marked by a keen ear for regional dialect and a rich sense of humor, all effective in recreating the milieu in which the tale is set.

Mrs. Fox decides that Asbury should see a local practitioner, Dr. Block. Her son rejects the notion instantly, declaring that if he had wanted to go to a doctor he would have “gone up there where they have some good ones.” He adds, “Don’t you know they have better doctors in New York?” (359). His mother counters that, unlike Block, the doctors “up there” would not take a personal interest in him. She takes a dismal view of the city. On one occasion she had paid her son a visit and found his apartment to be a “terrible” place, five flights up “past open garbage cans on every landing” (362). However, she fails to convince him. As does Mary George, Ashbury regards Block as an “idiot.” Undoubtedly, O’Connor uses the doctor’s name ironically to suggest “blockhead.”

Waking from a troubled sleep, Asbury finds a pink, open-mouthed face, senseless as a baby’s, hanging over him and making faces as a stethoscope extends above his chest. Dr. Block has responded to Mrs. Fox’s summons. As he continues his examination, the doctor questions his patient about what he could have been doing in New York to reduce him to such a sorry state. He shares Mrs. Fox’s views of life in the city, adding to her assessment “I went up there once myself … and came straight on back home” (366). He orders his patient to open his mouth, all the while wiggling his ears as he proceeds. Dr. Block, we are told, is “irresistible” to children. “For miles around they vomited and went into fevers to have a visit from him” (366). Block resembles them, identifies with them and plays with them. By contrast, Asbury is less intrigued and wishes him out of the room. Unperturbed, the doctor continues to examine him murmuring, “You sho do look bad, Azzberry” (366). His patient continues to insult him, declaring “What’s wrong with me is way beyond you.” (367) indicating that the expertise of country doctors is negligible. To Asbury’s charges, Block responds calmly, admitting that many things are beyond him. He admits “I ain’t found anything yet that I thoroughly understand” (367). Nothing about the doctor gives any sign of intelligence—except for his unusual eyes which are “cold clinical nickel-colored” and reveal a curiosity over whatever he looked at (366).

In The Enduring Chill O’Connor invites us to view the ancient and unique encounter of physician and patient. The interaction is essential to the healing process and lies at the foundation of effective treatment. Of a number of models analyzing the relationship, O’Connor represents one, the paternalistic model. Dr. Block assumes a paternalistic role, which explains his popularity with children. Unlike the children, Asbury does not relate to a father figure nor does he consent to Block’s determining what is in his best interests or regulating his participation in his treatment. In a relationship marked by mutual consent, Asbury refuses to cooperate. Upon the death of Asbury’s father, his mother had assumed the role of both parents, thereby frustrating further her son’s longing for independence. In his new circumstances he must submit anew to his mother’s will. Only the thought of his imminent death and release consoles him. Upon leaving Asbury’s room, Mrs. Fox implores Block, “I want you to come back every day until you get him well” (366).

Dimly conscious of his mother’s love for him, Asbury regards her as provincial and naïve. He holds her responsible for shackling him and stifling his creativity; she has kept his imagination imprisoned as one would a caged bird. Her attempts to communicate with him on matters of interest to him all fail. In a further effort to bond with him, she ventures a discussion on writing, suggesting that when he recovers it would be nice if he wrote another book about “down here.” She specifies that what is needed is another Gone With The Wind. She advises him “to put the war in it. … That always makes a long book” (370). Asbury feels the muscles in his stomach tightening.

During his visit the previous year, Asbury had worked on a play about “the Negro.” To gather material for his project he attempted to establish rapport with the two black farm hands who worked in the dairy. Sensitive to the social changes of the moment, he encouraged the workers to assert themselves, even to overtly rebel against his mother’s rules—particularly her prohibition against smoking and drinking the fresh milk. Despite knowing better, they yield to Asbury’s offer to share his cigarettes. The following day the creamery returned the milk for having absorbed the odor of tobacco. The next afternoon the workers remain steadfast in refusing to violate the second rule. “That’s the thing she don’t ‘low” and further “She don’t ‘low noner us to drink noner this here milk” (369). The second rule is violated only by Asbury, who drinks the milk daily in an attempt to break down the men’s reserve. The only result of the second disobedience is the nausea that Asbury experiences from drinking the warm milk.

In the North Asbury had found intellectual stimulation by becoming part of a group of pseudo intellectuals who devoted their time to debating the meaning of existence. In their company he meets a Jesuit priest, Ignatius Vogle, S.J. whom he admires as a rare individual who could well have understood the meaning of his death. However, no further meetings occur between them as Asbury must return home. Before leaving his apartment for the last time, he burns all his manuscripts, destroying all his writing, except for a long letter—in imitation of Kafka—addressed to his mother in which he blames her and forgives her for the unconscious role she played in the tragedy of his life. Not to be opened until after his death, the letter will reveal the pain she has caused him. Once home Asbury seeks the counterpart to Fr. Vogle. The priest who arrives to see him, Fr. Finn, bears no resemblance to Fr. Vogle. He is elderly, infirm, and unable to converse on literary topics. When questioned about James Joyce, Fr. Finn states that he has never met him. Changing the topic, Asbury wants to discuss a favorite subject, “the myth of the dying god,” but he is equally unsuccessful. The priest proceeds to question the younger man on questions of dogma, none of which interests him. On leaving the bedside, Fr. Finn shouts a warning to Asbury to accept the Holy Ghost, who will come to him only when he rids himself of the hubris that fills his being. Anticipating the quick ending of his life, Asbury gives his mother the key to the desk drawer containing the letter. Not understanding, she places the key on the bedside table and leaves him to sleep. Shaken by her son’s rapid deterioration, Mrs. Fox accepts the fact that her son’s illness is real and realizes that Block, too, has a similar opinion.

When Mrs. Fox reappears, it is in the company of Dr. Block. Block comes in making faces while Mrs. Fox beams as she announces, “Guess what you’ve got, Sugar pie!” Block intervenes, “Found theter ol’ bug, did ol’ Block” (381). At that moment he signals victory. The gesture exhausts him and he lets his hands collapse in his lap. He proceeds to wipe his face vigorously with the red bandana he always carries, the face bearing a different expression each time it emerges from behind the rag. With the pride of a conqueror he tells his patient, “You ain’t going to die” (381). “Asbury,” Mrs. Fox explains, “you have undulant fever. It’ll keep coming back but it won’t kill you!” (381). To clarify matters, Dr. Block makes reference to the culture they both share: “Undulant fever ain’t so bad, Azzberry…it’s the same as Bang’s in a cow” (381). It appears that Asbury has been mistaken in assuming that his illness is “way beyond” his doctor’s understanding. Mrs. Fox, in fact, is also quite knowledgeable. She informs Block, “He must have drunk some unpasteurized milk up there” (381). Any New Yorker who shares Mrs. Fox’s joy must grant her license in concluding that cows providing fresh milk can be found in the midst of the city. As the doctor and Mrs. Fox leave the room, Asbury’s hand shoots out and he retrieves the key from the table and places it in his pocket.

At the conclusion of the tale, Asbury experiences a rebirth of spirit. Previously adopting the pose of an intellectual, he had been guilty of hubris, forsaking the Christian God for the God of Art. Having survived a health crisis, he accepts the coming of new life. A water stain on his bedroom ceiling in the form of a fierce bird with spread wings had been in place since his childhood. It had alternately annoyed and frightened him. Now, with eyes shocked clean by self-awareness, he accepts the responsibility for his illness and the forecast of a life frail, racked, but enduring in the face of a purifying terror” (382). Newly discovered self-awareness strips him of all illusions. The water stain on his wall suddenly takes on life, appearing to descend on him. Its movement symbolizes the descent of the Holy Ghost.

In pondering the successful physician-patient interaction, O’Connor sets down the factors that lead to fulfillment. With Dr. Block we find a skilled professional. Very much a part of the rural setting in which he is at ease, he is committed to serving the needs of the local inhabitants. At home in Timberboro, a small town ringed by farms, he has no desire to leave. His patients, of which Mrs. Fox is one, maintain their faith in him. When matters appear bleak for Asbury, his mother suppresses her doubts and declares, “Nowadays doctors don’t let young people die” (372).

Again, we must grant Mrs. Fox license for being illogical, except that this time she trumps the reader. At the end of the story when Block comes in to announce his success she cries out, justifying her unquestioning certitude, “I think you’re just as smart as you can be” (381). His dedication to his patient, despite the latter’s rudeness, has been borne out by his frequent visits and long, hushed conversations with Mrs. Fox and Mary George, all out of Asbury’s hearing. The happiness of the mother upon being reassured that Asbury’s disease is not life-threatening is conveyed in her description. “Her smile was as bright and intense as a lightbulb without a shade” (381), leaving one critic to observe that she “experiences the only smile of unqualified joy in all of O’Connor’s fiction.”2 Another example of mutual trust as a value in the community has been referred to earlier. Involved in the unprecedented social changes occurring about them, Mrs. Fox’s farm workers accept, without question, the taboos she imposes on them. The result? Not one of them drinks the forbidden fresh milk and not one of them falls ill.

Dr. Block’s cure is not confined to Asbury’s body. No small part of the younger man’s dis-ease has been occasioned by his spiritual malaise. In this regard, neither Fr. Vogle nor Fr. Finn has offered any comfort. During a visit from Dr. Block on one occasion when he draws Asbury’s blood, the doctor is described as humming a hymn as he pressed the needle in. “Oh slowly Lord but sure,” he prays (367). Block calls for divine assistance as he goes about his work. With the restoration of his physical health, Asbury achieves the spiritual renewal he sought, the two being linked. And Block succeeds where the clerics have not.

Flannery O’Connor was fully aware that not all readers shared her religious views, though her fiction repeatedly centered on themes calling for religious faith and redemption in a spiritually arid society. Yet, as with all great writers she sought to explore the universal in all human experience. That she succeeded in doing so has been recognized by many. No one paid her greater tribute than Thomas Merton in his prose elegy. Writing shortly after her early death, he said that “she probed our very life—the conflicts, the falsities, the obsessions, the vanities.”3 He celebrated her penetrating appraisal of life in the South and in the North. Thinking of her he thought not of Hemingway, or Porter, or Sartre but of Sophocles. At the beginning and at the end of the essay he tells her that he writes her name with honor.

Sophocles endures. Flannery O’Connor endures. And Dr. Block endures—in art and in life.


  1. Flannery O’Connor, The Complete Stories (New York: Farrar, Straus and Giroux, 1946).
  2. Edward Kessler, Flannery O’Connor and the Language of Apocalypse (Princeton: Princeton University Press, 1986).
  3. Thomas Merton, Flannery O’Connor: A Prose Elegy in The Literary Essays of Thomas Merton (New York: New Directions, 1981) 159-161.


  1. Kessler, Edward. Flannery O’Connor and the Language of Apocalypse. Princeton: Princeton University Press, 1986.
  2. Merton, Thomas. The Literary Essays of Thomas Merton. New York: New Directions, 1981: 159-161.
  3. O’Connor, Flannery. The Complete Stories. New York: Farrar, Straus and Giroux, 1972.

ANGELA BELLI, PhD, is professor of English at St. John’s University in New York. She has served as Chair of the English department and as President of the New York College English Association. She is the author of Ancient Greek Myths and Modern Drama: A Study in Continuity, New York University Press and coeditor of Blood and Bone: Poems by Physicians and Primary Care: More Poems by Physicians, University of Iowa Press. She is the editor of Bodies and Barriers: Dramas of Dis-Ease, The Kent State University Press. Her participation in the meetings of professional organizations has been devoted to exploring issues in modern drama and literature and medicine. Her many contributions to literary and medical publications have had a similar focus.

Highlighted in Frontispiece Volume 5, Issue 3 – Summer 2013

Summer 2013



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