Richard is a doctor living on the West Coast of the United States. Due to substance abuse issues, he is no longer able to practice medicine in the US, so he spends extended periods of time treating people in Africa. One winter night, he’s in the middle of a manic episode, so he goes to Safeway and gets some antifreeze for his car but ends up cutting his thumb and going to the hospital. At the hospital, he remembers past times he’s been at the hospital with his sister, Susan. Susan also has psychological difficulties. At one point, she tried to shoot herself in the head, but she managed to aim perfectly and gave herself a lobotomy that cured her entirely. Whenever she’s with Richard, they talk about the possibility of going to Africa together, although Richard hides the truth about his experiences on the continent so as not to ruin her idealistic vision of the place. When he’s feeling low, he remembers how he promised Susan he would stick it out. Suddenly, the world seems brighter and more beautiful.