Ivan Ilych had been a colleague of the gentlemen present and was liked by them all. He had been ill for some weeks with an illness said to be incurable. His post had been kept open for him, but there had been conjectures that in case of his death Alexeev might receive his appointment, and that either Vinnikov or Shtabel would succeed Alexeev. So on receiving the news of Ivan Ilych's death the first thought of each of the gentlemen in that private room was of the changes and promotions it might occasion among themselves or their acquaintances. (1.5)
Right from the start of the story we see a disgusting artificiality and fakeness in the characters and their way of relating to each other. We've just been told that Ivan was a well-liked friend of all three of the people we've just met. Yet when they first hear he's dead, their only thought is about their own promotions.
Fedor Vasilievich and Peter Ivanovich had been his nearest acquaintances. Peter Ivanovich had studied law with Ivan Ilych and had considered himself to be under obligations to him. (1.18)
Not only are Peter Ivanovich and Fedor Vasilievich – two of the three guys who greeted Ivan's death with eager thoughts of promotions – Ivan's friends and colleagues, they're his closest friends. Fedor Vasilievich doesn't even bother to go to Ivan's service, and Peter Ivanovich only goes from a sense of obligation.
His colleague Schwartz was just coming downstairs, but on seeing Peter Ivanovich enter he stopped and winked at him, as if to say: "Ivan Ilych has made a mess of things – not like you and me."
Schwartz's face with his Piccadilly whiskers, and his slim figure in evening dress, had as usual an air of elegant solemnity which contrasted with the playfulness of his character and had a special piquancy here, or so it seemed to Peter Ivanovich.] (1.21-22)
Schwartz is perhaps the most false character in the novella. Whereas Peter Ivanovich is somewhat affected by Ivan's death once he gets to the service, Schwartz is totally unaffected by it. He just as cheery as ever, and completely refuses to recognize that Ivan Ilych's death has anything to do with Peter Ivanovich and himself.
Schwartz, making an indefinite bow, stood still, evidently neither accepting nor declining this invitation. Praskovya Fedorovna recognizing Peter Ivanovich, sighed, went close up to him, took his hand, and said: "I know you were a true friend to Ivan Ilych..." and looked at him awaiting some suitable response. And Peter Ivanovich knew that, just as it had been the right thing to cross himself in that room, so what he had to do here was to press her hand, sigh, and say, "Believe me..." So he did all this and as he did it felt that the desired result had been achieved: that both he and she were touched. (1.29)
Ivan's widow is revealed to be just as false as everyone else. Both she and Peter Ivanovich just go through the motions of mourning. They do what it's appropriate to do in the situation because it's appropriate, rather than because they actually feel any sadness or sympathy for Ivan. That they've done what's appropriate makes them feel better about themselves.
What tormented Ivan Ilych most was the deception, the lie, which for some reason they all accepted, that he was not dying but was simply ill, and that he only need keep quiet and undergo a treatment and then something very good would result. He however knew that do what they would nothing would come of it, only still more agonizing suffering and death. This deception tortured him – their not wishing to admit what they all knew and what he knew, but wanting to lie to him concerning his terrible condition, and wishing and forcing him to participate in that lie. Those lies – lies enacted over him on the eve of his death and destined to degrade this awful, solemn act to the level of their visitings, their curtains, their sturgeon for dinner – were a terrible agony for Ivan Ilych. And strangely enough, many times when they were going through their antics over him he had been within a hairbreadth of calling out to them: "Stop lying! You know and I know that I am dying. Then at least stop lying about it!" But he had never had the spirit to do it. (7.33)
Ivan Ilych has become aware of the falsity of the world in which he lives. The willful blindness demonstrated by Ivan's friends and family in Chapter 1 prevents them from caring for Ivan; they refuse to see what he's experiencing. Ivan himself, though, is still such a part of that false world that he can't break through it and force the others to acknowledge that he's dying.
Only Gerasim recognized it and pitied him. And so Ivan Ilych felt at ease only with him. He felt comforted when Gerasim supported his legs (sometimes all night long) and refused to go to bed, saying: "Don't you worry, Ivan Ilych. I'll get sleep enough later on," or when he suddenly became familiar and exclaimed: "If you weren't sick it would be another matter, but as it is, why should I grudge a little trouble?" Gerasim alone did not lie; everything showed that he alone understood the facts of the case and did not consider it necessary to disguise them, but simply felt sorry for his emaciated and enfeebled master. Once when Ivan Ilych was sending him away he even said straight out: "We shall all of us die, so why should I grudge a little trouble?" – expressing the fact that he did not think his work burdensome, because he was doing it for a dying man and hoped someone would do the same for him when his time came. (7.33)
Gerasim is the only honest, authentic person in Ivan Ilych's world. He's the only one who can see that Ivan Ilych is dying. For the same reason, he's the only one who can comfort Ivan: he can understand how much Ivan is suffering from his fear of death, and thus can show him pity. Gerasim can be honest because he is open to his own eventual death in a way no other character is. He fully understands that he will die, as Ivan is dying now.
Ivan Ilych wanted to weep, wanted to be petted and cried over, and then his colleague Shebek would come, and instead of weeping and being petted, Ivan Ilych would assume a serious, severe, and profound air, and by force of habit would express his opinion on a decision of the Court of Cassation and would stubbornly insist on that view. This falsity around him and within him did more than anything else to poison his last days. (7.34)
This is a revealing passage. When his colleague Shebek (who's certainly false just like the rest of them) comes to visit, it is Ivan, not Shebek, who initiates the artificial interaction. Ivan is still very much a part of the false world he now he condemns, and is responsible to some extent for keeping it going around him. The falsity is just as much inside him as outside him. But it's not clear that he recognizes this yet.
Ivan Ilych feels that the doctor would like to say: "Well, how are our affairs?" but that even he feels that this would not do, and says instead: "What sort of a night have you had?"
Ivan Ilych looks at him as much as to say: "Are you really never ashamed of lying?" But the doctor does not wish to understand this question, and Ivan Ilych says: "Just as terrible as ever. The pain never leaves me and never subsides. If only something ... " (8.25-26)
Even once Ivan's condition is hopeless, the doctor still can't be honest with him. Not only will the doctor not tell Ivan straight out that he's dying; he won't even ask questions that might lead to such a discussion. Ivan now fully recognizes this.
Ivan Ilych knows quite well and definitely that all this is nonsense and pure deception, but when the doctor, getting down on his knee, leans over him, putting his ear first higher then lower, and performs various gymnastic movements over him with a significant expression on his face, Ivan Ilych submits to it all as he used to submit to the speeches of the lawyers, though he knew very well that they were all lying and why they were lying. (8.29)
Ivan associates the lying doctor with his own social class. This might be seen as an implied admission that his own life – at least his work life – was false. What makes the doctor similar to a lawyer? Both doctors and lawyers deal with clients, and sometimes try to mask over concerns of real people with specialized language.
It occurred to him that what had appeared perfectly impossible before, namely that he had not spent his life as he should have done, might after all be true. It occurred to him that his scarcely perceptible attempts to struggle against what was considered good by the most highly placed people, those scarcely noticeable impulses which he had immediately suppressed, might have been the real thing, and all the rest false. And his professional duties and the whole arrangement of his life and of his family, and all his social and official interests, might all have been false. He tried to defend all those things to himself and suddenly felt the weakness of what he was defending. There was nothing to defend. (11.12)
Ivan now reaches the conclusion that perhaps all of his life was false. Not just his work life, but also, his family life, his friendships, and everything he pursued was false. What's more, he places the blame for this on others. Ivan's been misled by his own social surroundings into living a false life. Everyone else around him (except Gerasim) is part of the same false social world.