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Another two weeks pass, during which Fedor Petrovich proposes to Lisa one evening.
When Praskovya Fedorovna comes in to give Ivan the news the next day, she finds him in a very bad way, staring off into space and groaning.
When she tells him to take his medicine he gives her a killer glare and tells her to let him die in peace.
Lisa comes in, and asks how Ivan is doing, to which he responds with the same glare and an assurance that they'll all soon be free of him.
A doctor arrives, and after the examination is told brusquely by Ivan Ilych that he can do nothing to help him.
The doctor tells Praskovya Fedorovna afterwards that Ivan is doomed. All they can do at this point is try and relieve the pain, which must be very bad.
The pain is indeed very bad, but far more troubling is what's going through Ivan's head.
The night before, while looking at the sleeping Gerasim's kind face, it had once more occurred to Ivan that he might have lived his life wrongly.
But this time he can't dismiss the thought.
Ivan realized then that everything in his life which seemed good to him because it was good according to everybody else – his career, his marriage, his little pleasures – turned out not to be. It was false. His whole life was false.
Seeing his family and the doctor this morning has confirmed for Ivan that his suspicion is true.
Ivan is given a dose of opium and falls unconscious.
As soon as he comes to again later in the day, he finds his pain is just as strong as it was.
Praskovya Fedorovna asks Ivan to receive a priest and take communion, and Ivan grudgingly consents.
The priest arrives and Ivan confesses and receives communion. To his own surprise, he actually feels better afterwards, and even feels a new desire to live.
Then Praskovya Fedorovna promptly spoils everything by trying to get Ivan to admit that communion made him feel better.
She has the effect of reminding him of all the falsity in his life. Overwhelmed by his hatred of his wife and by his pain, Ivan loses it and screams at Praskovya Fedorovna.