As one of his more programmatic works, Nikolai Medtner’s Sonata-Ballade, Op. 27 exemplifies the composer’s structural mastery of form in framing an expressive narrative. In accounts given by Medtner’s students, the sonata was partly conceived in connection to a religious poem by Fet detailing Christ’s temptation in the desert. His pupils additionally recall an underpinning theme of inner conflict between light and darkness in the human soul. Medtner’s program is indeed a sort of two-tiered narrative, incorporating Fet’s biblical drama within a larger narrative of personal struggle and redemption. In the music, this manifests itself in the form of a variable subjectivity that alternates between a virtual, human protagonist and a scriptural drama. My analysis of the Sonata-Ballade uncovers implicit meanings in Medtner’s use of musical gestures, intertexts, topics, and his employment of genre. In addition, I survey the composer’s symbolic conception of his ‘muse’ to better contextualize the use of an associated leitmotif in the sonata. In these discussions, I support the ongoing reassessment of Medtner as a composer—from once being dismissed as a mere structuralist, to attaining greater recognition for the symbolic and narrative elements incorporated within his formal designs.