The Death of Ivan Ilych | Chapter 4 | Summary

Summary

As the months pass, Ivan Ilych believes he's in good health, even if sometimes he "had a queer taste in his mouth and felt some discomfort on his left side." The discomfort grows worse and interferes with Ivan's normal life. It makes Ivan irritable, and he often quarrels with Praskovya, who finds Ivan's bad temper trying. Ivan most often becomes angry during dinner, and his wife realizes his ire is related to the "taking of food." She comes to the conclusion that her husband has a terrible temper, and she wallows in self-pity at how miserable she's become because of it. Praskovya even begins "to wish he would die." She realizes that would not help her because then she'd have no income. She's upset that "not even his death could save her" from her unhappiness.

One evening Ivan Ilych admits that his bad temper results from how ill he feels. Praskovya suggests he see a highly reputable doctor, which he does. The doctor treats him with the same hauteur that Ivan Ilych had treated his petitioners in the law court. He is puffed up with self-importance and certain that if the patient does what he says, he'll be cured. After the examination, the doctor offers some possible diagnoses but states that it needs to be confirmed with further tests. Ivan Ilych only wants to know if his case is serious, but the doctor ignores him. The doctor is focused on a diagnosis, not on the severity of the illness. Just as Ivan Ilych did in court, the doctor sums up his findings but seems unconcerned with their gravity. Ivan Ilych feels bitter because the doctor is so callous and nonchalant when Ivan's condition might be quite serious. Finally, he asks the doctor outright, "Is this complaint dangerous, or not?" The doctor unhelpfully replies that he's already told Ivan Ilych "what [he] considers necessary and proper."

On the way home, Ivan Ilych mulls over what the doctor said, trying to tease meaning out of the obscure scientific language he'd used. Nothing the doctor had said addresses Ivan's main question: Is he seriously ill? "Or is there as yet nothing much wrong?" Ivan concludes that the essence of what the doctor said was that his condition "was very bad." This conclusion makes Ivan depressed, and he becomes more acutely aware of the persistent ache in his side.

At home, Ivan begins telling Praskovya what the doctor said, but she and Lisa quickly find the story tedious. Praskovya tells Gerasim to fill Ivan's prescription and reminds Ivan to take his medicine as prescribed. Then he will get better. This makes Ivan feel somewhat relieved. Ivan does take his medicine as told to. He hears from the doctor that there was a "contradiction between the indications from the examination of the urine and the symptoms that showed themselves." Ivan realizes that, obviously, the doctor had misdiagnosed the problem or doesn't know what he's talking about.

Still, Ivan dedicates himself to "the exact fulfillment of the doctor's instructions." Ivan Ilych becomes preoccupied with illness and asks awkward questions when any illness comes up in conversation.

Because he's following the doctor's orders, Ivan tries to convince himself that his pain is getting better. Yet as soon as something goes awry in his life—an argument with his wife or a colleague at work—the pain intensifies. The narrator says, "Now every mischance upset him and plunged him into despair." Ivan becomes furious with those who caused the mishap. His "fury was killing him" because it made him feel much worse. He does not try to remain calm, which might alleviate his pain. Instead, Ivan Ilych becomes more sensitive to even the tiniest impropriety or annoyance. So, his pain grows worse and worse.

Ivan Ilych turns to reading medical books and consulting more doctors, most of whom seemed to feel that Ivan's condition was indeed getting worse. Ivan goes to see a celebrated doctor who treats him with the same callousness as the first one. This only "increases Ivan's Ilych's doubts and fears" about his health. So Ivan consults yet another doctor whose diagnosis directly contradicts the diagnoses of the previous ones. This last doctor predicts that Ivan will recover, but he is beset by doubts. Some of Ivan's acquaintances suggest he see a homeopath or a faith healer, but Ivan Ilych decides he will not see any more doctors.

Ivan Ilych follows the treatment of the first of several "celebrated doctor(s)", but it does not help. His incessant pain increases, and he feels that "something terrible, new ... was taking place within him." Only Ivan Ilych was aware of what was happening to him. Others thought life was going on as usual. They were annoyed, not concerned, with his depression "as if he were to blame for it." His wife blames Ivan for not "keeping to the treatment prescribed for him," which is why she blames him for not improving.

People at work also treat Ivan Ilych in a new way, "as a man whose place might soon be vacant." Sometimes his colleagues try to joke with him to improve his humor. Schwartz, particularly, uses "jocularity, vivacity" to amuse Ivan Ilych. Ivan reacts with intense irritation at these efforts because they "reminded him of what he himself had been ten years ago." Occasionally Ivan Ilych and his acquaintances sit down to a game of bridge. In one memorable game, he and his partner nearly "make a grand slam." But the big win is spoiled when Ivan notes his "gnawing pain [and] that taste in his mouth." Under these conditions, a grand slam seems ridiculous to Ivan Ilych. Ivan deliberately plays the wrong cards, and the victory slips out of reach. His bridge partner is furious, but Ivan Ilych doesn't care. The other players are aware that Ivan Ilych is ill and offer to stop playing so he can rest. But Ivan wants to keep playing, even though "he had diffused [a] gloom over them and could not dispel it."

Later, Ivan realizes that through his illness and depression "he was poisoning the lives of others." Lying in bed at night, Ivan is wracked with physical pain and fear. Yet each morning he has to get up and go to work. Part of his suffering is that he is totally alone with it. He feels that no one understands what he's going through.

Analysis

Ivan Ilych's suffering is both physical and psychological, and it's made worse by the isolation that walls him off from others. His physical pain gets worse over time, despite the doctor's treatment. His psychological, even spiritual, suffering and isolation are made clear at the end of the chapter. He realizes that "he had to live thus all alone on the brink of an abyss, with no one who understood or pitied him." His wife, Praskovya, blames him for his illness and depression. She insists, contrary to evidence, that Ivan does not "keep to the treatment prescribed for him." Her dismissive attitude and faultfinding further isolate Ivan Ilych from those in whom he might find or expect comfort.

His growing pain and illness make Ivan Ilych more depressed, which casts a pall of gloom over his life and the people he is with. He recognizes that the psychological depression caused by his pain and illness "poisoned his life and the lives of others." As his illness progresses, his suffering and depression cause this poison to "penetrate more deeply into his whole being."

Ivan's colleagues react to his illness mainly with selfishness. When they realize he's ill, their first thoughts are about how the vacancy at work (Ivan's death) might result in their promotion. This attitude mirrors that of Ivan's colleagues in Chapter 1 when they first learn of his death. Some of his acquaintances, such as Schwartz, try to use humor to bring Ivan Ilych out of his funk. But now Ivan recognizes how trivial and meaningless such efforts are. He sees how they're primarily intended to distract others from the (unpleasant) seriousness—and reality—of Ivan's grave situation. Ivan's growing impatience with social trivialities is evident during the bridge game. Ivan purposely makes a wrong move to prevent him and his bridge partner from getting a grand slam. When his partner gets terribly upset, Ivan thinks "it was dreadful to realize why [I] did not care."

Ivan's wife, Praskovya, also views Ivan's illness through the lens of her own selfishness. When Ivan is irritable at dinner, Praskovya does not try to understand what he's going through. Instead, she "began to feel sorry for herself, and the more she pitied herself the more she hated her husband." When she contemplates Ivan's death, she's irritated because "she [was] dreadfully unhappy ... because not even his death could save her." Later, Ivan recounts to her (and their daughter, Lisa) what transpired at the doctor's office. The women quickly find "this tedious story" impossible to concentrate on. So Praskovya and Lisa get ready to go out. Later, "his household and especially his wife and daughter ... saw [him] as an obstacle in their path" to pleasure. In seeking pleasure they have no use for Ivan's complaints. Here again, it's clear that Ivan Ilych and his wife and children have no true human connection. Their self-absorption and disinterest in each other guarantee Ivan's isolation at this time when he has the greatest need for comfort and understanding.

No matter whom Ivan Ilych interacts with, he seems to find only indifference to his suffering and his need. His doctors are indifferent to his need to know how gravely ill he really is. The reader should note that doctors treat Ivan with an indifference that resembles Ivan's haughty and indifferent attitude toward those he dealt with at work. The narrator says, "The doctor put on just the same air towards him as he himself put on towards an accused person." While Ivan Ilych wants to know how serious his illness is, his doctors talk only of "floating kidney[s] ... or appendicitis." The author describes the self-important callousness of the doctors and their focus on details, while ignoring the living patient before them. The author is pillorying the primacy of Western science and medical knowledge and technology (such as it was at that time). The author ridicules the doctors by stating that each comes up with a different diagnosis. If at that time medical science and doctors' skills were so useful, surely they'd agree on what was wrong with him. But they don't. Each doctor who examines and treats Ivan Ilych is celebrated and highly reputable, but they're all equally useless when it comes to helping him. None of the doctors deign to answer Ivan his most pressing question about his condition.

One celebrated doctor puts Ivan in his place by telling him, "I have already told you what I consider necessary and proper." And that was that. Leo Tolstoy's description of medical professionals and their self-importance and superiority is likely a critique of the West's rational egoistic elevation of science above everything else. In these chapters the doctors behave as if they're knowledgeable and competent, yet they cannot or will not answer Ivan Ilych's most basic human question about his condition: "Was his case serious or not?" The doctors refuse to address this existential but nonscientific plea.

Everyone around Ivan Ilych reacts to his awful situation with indifference. His doctors are indifferent to him and do not treat him like a suffering human being. His wife and family are indifferent to his suffering. His wife thinks Ivan's illness is his own fault, and this makes it easy for her to dismiss his illness with crass indifference. Ivan's colleagues are indifferent to his illness insofar as he's experiencing it. They see it only in terms of making their lives better or more pleasant. They seek to raise his spirits so he doesn't make them feel unpleasantly gloomy when they're around him. However, they don't really care about what he, as a person, is going through. Ivan Ilych realizes that "things were bad, but that for the doctors, and perhaps for everybody else, it was a matter of indifference."

Propriety and pleasantness directly affect how Ivan feels and the degree of his suffering. It is his total absorption in propriety and pleasantness that makes his illness worse. Every time something happens that irritates Ivan, "he was furious with the mishap, or with the people who were causing the unpleasantness." Mishaps are breaches of propriety, and Ivan Ilych cannot abide improprieties because propriety rules his life. Instead of "ignoring unpleasant occurrences" and not getting irritated and furious about them, he becomes increasingly sensitive to them. His reaction to unpleasant events and impropriety cannot be changed because correctness defines him. Ivan "said he needed peace, and [yet] he watched for everything that might disturb it and became irritable at the slightest infringement of it." The reader might consider the extent to which Ivan Ilych's total identification with propriety and pleasantness might actually cause his illness to get worse. There is even the possibility that it might cause it to become fatal.

For a time Ivan Ilych retains his unswerving belief in propriety and order. He determines to take the medicine the doctor prescribes for him. He is certain that if he rigidly follows the advice of a celebrated medical man he will be cured. Believing in an acceptably ordered life has been the cornerstone of Ivan Ilych's existence. Yet as he assiduously follows doctor's orders, he begins to question the value and propriety of an orderly, and thus, predictably good life. Ivan's identity is compromised as he begins to succumb to doubt about propriety and the pronouncements of respected, upper-class experts.

As his pain and illness worsen, Ivan Ilych's toleration of the social conventions he once lived by diminishes. He no longer can bear the trivialities that once made up his pursuit of pleasure. Illness has made Ivan Ilych see these silly pastimes as trivial and meaningless. He does not care about bridge or fatuous jokes because he's coming to realize how very ill he is. It's not stated here, but he may be approaching a realization that his illness may be fatal. The terror he feels when he lies awake in bed foreshadows the coming recognition of this mortality.