Leo Tolstoy: The Death of Ivan Ilyich
Selected Excerpts
“Everything took place as he had expected and as it always does. There was the usual waiting and the important air assumed by the doctor, with which he was so familiar (resembling that which he himself assumed in court), and the sounding and listening, and the questions which called for answers that were foregone conclusions and were evidently unnecessary, and the look of importance which implied that “if only you put yourself in our hands we will arrange everything — we know indubitably how it has to be done, always in the same way for everybody alike.” It was all just as it was in the law courts. The doctor put on just the same air towards him as he himself put on towards an accused person.
The doctor said that so-and-so indicated that there was so-and-so inside the patient, but if the investigation of so-and-so did not confirm this, then he must assume that and that. If he assumed that and that, then . . . and so on. To Ivan Ilych only one question was important: was his case serious or not? But the doctor ignored that inappropriate question. From his point of view it was not the one under consideration, the real question was to decide between a floating kidney, chronic catarrh, or appendicitis” (Ch. 4)
“Left alone Ivan Ilych groaned not so much with pain, terrible thought that was, as from mental anguish” (Ch. 8)
“ ‘Can it be that I have not lived as one ought?’ suddenly came into his head. ‘But how not so, when I've done everything as it should be done?’ ” (Ch. 9)
Discussion Questions
“Ivan Ilyich’s life had been most simple and commonplace—and most horrifying.” What do you make of Ivan’s life before he becomes ill? Why does the narrator call it horrifying?
What stands out to you about Ivan’s interactions with his doctors, and his comparisons between medicine and law? Do these passages resonate with present-day medicine?
As Ivan becomes ill and approaches death, what are the different ways in which he suffers? What is the crux of his deepest suffering?
How do you interpret the ending of the story?
The Death of Ivan Ilyich is often assigned to medical students to read. Why do you think this is? What are your key takeaways from this story for clinicians?
Reflections from #MedHumChat
“He is lied to, his reality is denied, he is pitied, he is treated as weak, he has of course physical pain, he lacks agency, he is neither spoken to as an equal nor will anyone acknowledge the seriousness of his problem. Except of course Gerasim. It's bad enough to be not treated as an equal while people acknowledge your suffering; or to be treated as an equal while people pretend you're not suffering. But to be not treated as an equal while people pretend you're not suffering (and dying!!) is so cruel.”—@leoebrown
“There’s a disconnect between what he desires from his physicians (to know whether his illness is serious) and what the physicians tell him (which organ they think is the culprit). Reminds me of the idea we need to “see the patient not the disease””—@jennifermcaputo
“Important to note that Ivan Ilyich resorts to judicial metaphors when he's feeling deeply vulnerable. He tries to use the metaphor in a pathetic attempt to will himself back to health. It fails, of course. But we should note the psychology of his rhetoric, folks!”—@quickmuse
“Ivan Ilyich suffers from total pain. He has the physical pain of his illness, the emotional pain of his superficial interactions with the people in his life, psychological pain from the stresses of life/death, and existential pain from his "meaningless" life.””—@BeccaOm15
“I saw the ending being so abrupt & kind of... unsatisfying for the reader (did he realize meaning? What is the answer? Did he reconcile with his family) was thoroughly fitting. It’s how life goes. It’s about the journey and experience, not answers.”—@MGraceOliver
About this #MedHumChat
The Death of Ivan Ilyich was used as a standalone piece for a #MedHumChat discussion April 3, 2019 exploring this medical humanities classic.
We were honored to be joined by special guest Leo E. Brown (@leoebrown) for this #MedHumChat. Leo, who was trained in public health, social science, entrepreneurship, and the liberal arts, is now working as a Data Science Analyst building software used by health organizations. You can learn more about him here.
The piece and discussion questions for this chat were selected by Colleen Farrell.
About the Author
Leo Tolstoy (1828-1910) is considered one of the giants of Russian literature, his works including War and Peace and Anna Karenina. You can learn more about him here.