The doctor is just coming out of the room. He still has the “squeamish” look, as though he’s afraid of dirtying himself on something. Captain Snegiryov runs after him, bowing low. The doctor suggests that he take Ilyusha to Syracuse, due to the more favorable climate there. Kolya remarks that that’s in Sicily, and the captain gestures around his home, as though to say that he can’t afford to move his family to Sicily. The doctor says that the matter of money isn’t his business—he’s only basing his advice on science. The doctor then looks anxiously at Perezvon. Kolya assures him that the dog won’t bite him, and calls the doctor a “leech.” The doctor says that Kolya should be whipped. Alexei warns Kolya that if he says anything more, he’ll “break with [him] forever.” Kolya obeys.
The Moscow doctor is a snob who doesn’t usually treat, and doesn’t care to treat, people of Ilyusha’s social station. He’s only there because Katerina Ivanovna sent for him as a favor to the family. The doctor is someone who represents modern Russia’s scientific advancement, though his attitude is in keeping with the country’s loyalty to an old class system. His aversion to the family and his indifference over their inability to afford his remedy also reiterates Ivan’s view that people often have difficulty loving each other up close.
Captain Snegiryov goes back to Ilyusha and begins to cry. Ilyusha comforts him, saying how sorry he feels for his father. He tells his father that, when he dies, he can get another little boy and call him “Ilyusha” and love him instead. Kolya tells Ilyusha to “shut up” and says that he’ll get well. Nina Nikolaevna weeps quietly in her chair. Kolya embraces Ilyusha, but then says that he has to leave to go home for dinner. He says he’ll return after dinner, however, and will bring Perezvon. Kolya then runs to the hall and begins to cry. Alexei finds him and reminds Kolya that he must keep his word, or Ilyusha will feel terrible. Kolya asks if Alexei is returning, and he says that he will, in the evening. Kolya then shouts fiercely to the dog for him to come and quickly strides back home.
The captain cries out of both sadness and frustration, as he’s upset over his inability to help his son. Kolya gets angry and snaps at Ilyusha because it frightens him to think that Ilyusha could die. Kolya likes to be able to control situations through his own ingenuity, but he has no control over his friend’s death. Ilyusha’s helpless suffering triggers grief in everyone else, and only Alexei is able to maintain some composure. His recent experience with the elder Zosima’s death has helped him to grow accustomed to the inevitability of losing someone he loves. Kolya hasn’t yet had this experience.