| Quote #4
His condition was rendered worse by the fact that he read medical books and consulted doctors. The progress of his disease was so gradual that he could deceive himself when comparing one day with another – the difference was so slight. But when he consulted the doctors it seemed to him that he was getting worse, and even very rapidly. Yet despite this he was continually consulting them. (4.16)
Not only do the doctors fail to give Ivan medication that works, they actually worsen his condition. The doctors, and the medical books Ivan reads, (i.e., the medical approach to his condition) make him more uncertain, afraid, and helpless. Yet Ivan keeps going anyway, because that's just what one does and he doesn't know what else to do.
| Quote #5
That month he went to see another celebrity, who told him almost the same as the first had done but put his questions rather differently, and the interview with this celebrity only increased Ivan Ilych's doubts and fears. A friend of a friend of his, a very good doctor, diagnosed his illness again quite differently from the others, and though he predicted recovery, his questions and suppositions bewildered Ivan Ilych still more and increased his doubts. A homeopathist diagnosed the disease in yet another way, and prescribed medicine which Ivan Ilych took secretly for a week.
Ivan goes "doctor shopping." We get a glimpse at the cult of celebrity doctors that was so popular among the city-dwelling middle class of Tolstoy's day. We also see how much of the relationship between doctor and patient in this case depends on the patient having no idea what's going on. Ivan doesn't know how to evaluate what the different doctors tell him, and so he just keeps going from one to the next.
| Quote #6
There were the absorption and evacuation and the re-establishment of normal activity. "Yes, that's it!" he said to himself. "One need only assist nature, that's all." He remembered his medicine, rose, took it, and lay down on his back watching for the beneficent action of the medicine and for it to lessen the pain. "I need only take it regularly and avoid all injurious influences. I am already feeling better, much better." He began touching his side: it was not painful to the touch. "There, I really don't feel it. It's much better already." He put out the light and turned on his side ... "The appendix is getting better, absorption is occurring." Suddenly he felt the old, familiar, dull, gnawing pain, stubborn and serious. There was the same familiar loathsome taste in his mouth. His heart sank and he felt dazed. "My God! My God!" he muttered. "Again, again! And it will never cease." And suddenly the matter presented itself in a quite different aspect. "Vermiform appendix! Kidney!" he said to himself. "It's not a question of appendix or kidney, but of life and...death. (5.15)
This is the decisive moment when Ivan rejects the medical explanation of what's happening to him. Death raises a whole bunch of existential (in this context, meaning of-life) questions that have nothing to do with medical treatment. It's just like Ivan's attempt here to imagine that his pain is going away: artificial and based upon a denial of the real problem.