The Death of Ivan Ilyich: Chapter 4 Summary & Analysis

As life goes on, Ivan experiences an occasional pain in his side and an odd taste in his mouth. However, he doesn’t think that these ailments point to anything serious, though the feeling in his side soon intensifies into a bizarre “dragging sensation” that often puts him in a foul mood. As his temperament takes a turn for the worse, so does his everyday life. He starts arguing with Praskovya whenever he gets the chance, criticizing her for even the smallest matters. She, on the other hand, decides that he’s cruel and takes pride in restraining herself from saying anything about his unreasonable new attitude. Still, she comes to see him as the root of all her problems. During one particularly nasty argument that ends with Ivan blaming his bad mood on his poor health, she insists that he should see a doctor if he’s actually ill. 

Ivan agrees to visit a doctor, though he dislikes the idea. Just as he feared, the doctor is authoritative and pompous, striding in and speaking to him in the same way that Ivan himself addresses guilty defendants in court. As the doctor goes on about Ivan’s kidney and “blind gut,” Ivan has trouble understanding him, primarily wanting to know whether or not his life is in danger. At one point, he asks if his condition is life-threatening, but the doctor doesn’t answer, instead continuing his long assessment of Ivan’s internal organs, speculating that he might have a “floating kidney,” though he goes out of his way to add that they’ll know more after they receive his test results. Before leaving, Ivan asks again if his condition is life-threatening, but the doctor merely says that he’s already delivered his assessment. He then sends Ivan away.

The way the doctor looked at Ivan when he asked if he might die haunts Ivan on his way home. He feels as if this look communicated that he’s doomed, and this thought makes everything on the streets seem miserable and bleak. When he tells Praskovya what the doctor said, though, she replies, “Well, I’m very pleased.” She then leaves to get dressed to go out. After this exchange, Ivan supposes that his wife might be right, deciding that there’s nothing to worry about yet as long as he takes the medicine the doctor prescribed for him.

Ivan’s medicinal regimen changes after his test results come back, but nothing seems to make him feel better. Worse, the test results themselves are apparently not as conclusive as his doctor suggested, and this causes Ivan to think that the doctor was either mistaken, lying, or hiding the true nature of his illness. Still, though, he decides to keep taking the prescribed medication. During this period, he thinks constantly about illness and the human body, but this doesn’t help alleviate his pain, which is only getting worse. Throughout this process, he finds it more frustrating than normal to fight with Praskovya, and every little thing that anyone does to upset him seems to intensify his pain. Accordingly, he gets angry with anyone who causes him trouble, thinking that they’re throwing him into a rage and that this rage is what’s making him ill.

Ivan’s illness gets worse and worse, even as he tries to convince himself that he’s getting better. He also consults multiple doctors, and though some of them appear optimistic about his condition, nothing anyone does for him actually makes him feel better. Because of this, he seeks out homeopathy and even entertains the idea of ascribing to non-Christian spiritual beliefs, though this only makes him feel as if his illness is making him crazy. And all the while, his pain intensifies and the taste in his mouth becomes stronger. In keeping with this, he admits to himself that something terrible is happening inside of him, and though he recognizes this, nobody around him appears willing to agree. To his great frustration, everyone else acts like the world is going along like normal.

What bothers Ivan the most is that Praskovya and Liza hardly seem to care about his illness. They are, he sees, too invested in their social lives to pay attention to his condition. They try to hide this, he knows, but they fail to obscure that they’re annoyed by his new burdensome presence. Instead of sympathizing with his discomfort, Praskovya chastises him in front of their friends, saying that he’s uncomfortable because he’s not taking proper care of himself. His diet and lifestyle, she claims, don’t align with his physician’s advice, as evidenced by his tendency to stay out late playing whist with his friends. And though he argues that this only happened once, Praskovya remains steadfast in her belief that Ivan is to blame for his illness.

At work, Ivan senses his colleagues treating him differently because of his condition, and this frustrates him. In particular, he comes to dislike Schwartz’s good-natured attitude and respected reputation, both of which remind him of himself as a younger man. When playing whist, he begins to make mistakes, but instead of critiquing him, the other players simply ask if he’d like to stop playing because he’s too tired. Vehemently refusing to stop, Ivan finishes these games but realizes that his bad attitude has brought the entire mood down, and he feels bad for ruining the night. On his own after such experiences, he feels as if he’s alone with his pain and fear.