| Quote #1
"But what really was the matter with him?"
Only one page into the story and we're given an indication that doctors will be useless for Ivan Ilych. Not only could they not save him; they couldn't even agree on what he had. Medical science seems to have failed completely. It's a quick clue-in to how badly the doctors will come across throughout the story.
| Quote #2
He went. 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. (4.4)
Ivan's first visit to the doctor instantly reveals the narrator's uncharitable attitude towards the profession. The doctor comes across as arrogant, filled with his own importance. He also dehumanizes Ivan, making just another case out of him, just like all the others. The comparison to the law courts ties a damning link between the two groups of professionals – they're both part of the larger false middle-class world that Tolstoy is satirizing. It also suggests the degree to which Ivan's experience as a suffering patient will turn him against the world he lived in before.
| Quote #3
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. It was not a question of Ivan Ilych's life or death, but one between a floating kidney and appendicitis. And that question the doctor solved brilliantly, as it seemed to Ivan Ilych, in favour of the appendix, with the reservation that should an examination of the urine give fresh indications the matter would be reconsidered. All this was just what Ivan Ilych had himself brilliantly accomplished a thousand times in dealing with men on trial. (4.5)
What matters to the doctor is not what matters to Ivan. To the doctor, Ivan is a fascinating medical puzzle to be solved; he wants to figure out which of Ivan's organs is malfunctioning. To Ivan, all that matters is whether or not he'll live. The doctor seems to care about Ivan as a medical case and not as a person. Again Tolstoy draws a comparison between doctors and lawyers.