The Death of Ivan Ilych Technology and Modernization
By Leo Tolstoy
Technology and Modernization
"But what really was the matter with him?"
"The doctors couldn't say – at least they could, but each of them said something different. When last I saw him I though he was getting better." (1.9-10)
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.
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.
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.
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.
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.
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.
She described how he made Gerasim hold his legs up.
The doctor smiled with a contemptuous affability that said: "What's to be done? These sick people do have foolish fancies of that kind, but we must forgive them." (8.35-36)
Because the doctor's perspective is so blind to the real problem for Ivan – the problem of coping with death – he can just dismiss Gerasim's treatment of Ivan as nonsense. But Gerasim is the only person who is helping Ivan in any significant way. The doctors – and modern medicine by extension – have failed to help him.
The celebrated specialist took leave of him with a serious though not hopeless look, and in reply to the timid question Ivan Ilych, with eyes glistening with fear and hope, put to him as to whether there was a chance of recovery, said that he could not vouch for it but there was a possibility. The look of hope with which Ivan Ilych watched the doctor out was so pathetic that Praskovya Fedorovna, seeing it, even wept as she left the room to hand the doctor his fee.
The gleam of hope kindled by the doctor's encouragement did not last long. The same room, the same pictures, curtains, wall- paper, medicine bottles, were all there, and the same aching suffering body, and Ivan Ilych began to moan. They gave him a subcutaneous injection and he sank into oblivion. (8.40-42)
This is the last of the celebrity doctors that Ivan sees, and also the last time Ivan places any hope in the doctors' ability to save him. As soon as the specialist leaves and Ivan is confronted with the full reality of his situation again, the hope is gone.
The doctor came at his usual time. Ivan Ilych answered "Yes" and "No," never taking his angry eyes from him, and at last said: "You know you can do nothing for me, so leave me alone."
"We can ease your sufferings."
"You can't even do that. Let me be." (11.6-8)
Near death, Ivan at last tells the doctor what he really thinks. They can't do anything for him, not even to ease his suffering. It's unclear whether their treatments can affect his physical suffering, even though that's what they're designed to do. It is certain they can do nothing for his greatest sufferings, which are mental.