As life goes on, Ivan experiences an occasional pain in his side and an odd taste in his mouth. However, he doesn’t think that these ailments point to anything serious, though the feeling in his side soon intensifies into a bizarre “dragging sensation” that often puts him in a foul mood. As his temperament takes a turn for the worse, so does his everyday life. He starts arguing with Praskovya whenever he gets the chance, criticizing her for even the smallest matters. She, on the other hand, decides that he’s cruel and takes pride in restraining herself from saying anything about his unreasonable new attitude. Still, she comes to see him as the root of all her problems. During one particularly nasty argument that ends with Ivan blaming his bad mood on his poor health, she insists that he should see a doctor if he’s actually ill.
What stands between Ivan and Praskovya is their shared tendency to blame each other. Instead of recognizing his physical discomfort as the reason for his bad mood, Ivan picks arguments with Praskovya, and instead of sensing that her husband is lashing out because he’s in pain, Praskovya decides that he’s responsible for everything in her life that makes her unhappy. With this dynamic at play, it’s no wonder that they’re unable to connect with each other, let alone help each other address the things that are bothering them.
Ivan agrees to visit a doctor, though he dislikes the idea. Just as he feared, the doctor is authoritative and pompous, striding in and speaking to him in the same way that Ivan himself addresses guilty defendants in court. As the doctor goes on about Ivan’s kidney and “blind gut,” Ivan has trouble understanding him, primarily wanting to know whether or not his life is in danger. At one point, he asks if his condition is life-threatening, but the doctor doesn’t answer, instead continuing his long assessment of Ivan’s internal organs, speculating that he might have a “floating kidney,” though he goes out of his way to add that they’ll know more after they receive his test results. Before leaving, Ivan asks again if his condition is life-threatening, but the doctor merely says that he’s already delivered his assessment. He then sends Ivan away.
The fact that Ivan is so threatened by his doctor’s authority demonstrates once again how much he cares about power. Having spent his entire adult life trying to become an influential and widely respected judge, he dislikes being put in a position of vulnerability, wherein he must defer to the doctor’s judgment. Worse, he can’t get the doctor to tell him whether or not his condition is life-threatening. For somebody who likes being in control, then, he finds the doctor’s unwillingness to reassure him extremely disconcerting.
The way the doctor looked at Ivan when he asked if he might die haunts Ivan on his way home. He feels as if this look communicated that he’s doomed, and this thought makes everything on the streets seem miserable and bleak. When he tells Praskovya what the doctor said, though, she replies, “Well, I’m very pleased.” She then leaves to get dressed to go out. After this exchange, Ivan supposes that his wife might be right, deciding that there’s nothing to worry about yet as long as he takes the medicine the doctor prescribed for him.
It’s possible that Ivan is reading too much into what his doctor thinks, but Praskovya’s flippant, unbothered response seems out of touch with what her husband is experiencing. After all, the doctor refused to answer whether or not Ivan’s condition might lead to his death, indicating that this is indeed a possibility. However, Praskovya is too focused on her social life to pay too much attention to what’s going on with Ivan’s health. Once more, then, readers see that an obsession with status and social image can interfere with a person’s ability to empathize with her loved ones. Furthermore, Ivan’s decision to ignore his worst fears suggests that he’s eager to recapture the sense of control that has—up until this point—governed his life.
Ivan’s medicinal regimen changes after his test results come back, but nothing seems to make him feel better. Worse, the test results themselves are apparently not as conclusive as his doctor suggested, and this causes Ivan to think that the doctor was either mistaken, lying, or hiding the true nature of his illness. Still, though, he decides to keep taking the prescribed medication. During this period, he thinks constantly about illness and the human body, but this doesn’t help alleviate his pain, which is only getting worse. Throughout this process, he finds it more frustrating than normal to fight with Praskovya, and every little thing that anyone does to upset him seems to intensify his pain. Accordingly, he gets angry with anyone who causes him trouble, thinking that they’re throwing him into a rage and that this rage is what’s making him ill.
During this period, Ivan’s life is marked by his anger. Indeed, he questions the doctor’s authority, blaming the specialist for what’s happening to his body. He also continues to fight with Praskovya, and he lashes out at anyone who makes him angry, finding ways to pin his ailments on them. Ironically, he acknowledges his anger and rage, but instead of addressing it, he faults whomever has made him mad. In this way, then, Tolstoy illustrates how unwilling Ivan is to take responsibility for his own feelings, doing anything he can to ignore his fear and uncertainty in this time of hardship.
Ivan’s illness gets worse and worse, even as he tries to convince himself that he’s getting better. He also consults multiple doctors, and though some of them appear optimistic about his condition, nothing anyone does for him actually makes him feel better. Because of this, he seeks out homeopathy and even entertains the idea of ascribing to non-Christian spiritual beliefs, though this only makes him feel as if his illness is making him crazy. And all the while, his pain intensifies and the taste in his mouth becomes stronger. In keeping with this, he admits to himself that something terrible is happening inside of him, and though he recognizes this, nobody around him appears willing to agree. To his great frustration, everyone else acts like the world is going along like normal.
As Ivan’s illness advances, he tries to tell himself that everything will be all right. This effort highlights his desire to be in control of his own life. However, it’s not always possible to control what happens, and this is something that Ivan slowly comes to realize as his condition becomes more serious. To make matters worse, the people around him are apparently incapable of empathizing with him because they don’t care enough to truly stop to consider his situation. After all, it’s easier to simply tell him to maintain hope. In other words, Ivan has surrounded himself with people who only care about the things he himself has always prioritized: money, status, and power. As a result, he has nobody to turn to when he needs emotional support.
What bothers Ivan the most is that Praskovya and Liza hardly seem to care about his illness. They are, he sees, too invested in their social lives to pay attention to his condition. They try to hide this, he knows, but they fail to obscure that they’re annoyed by his new burdensome presence. Instead of sympathizing with his discomfort, Praskovya chastises him in front of their friends, saying that he’s uncomfortable because he’s not taking proper care of himself. His diet and lifestyle, she claims, don’t align with his physician’s advice, as evidenced by his tendency to stay out late playing whist with his friends. And though he argues that this only happened once, Praskovya remains steadfast in her belief that Ivan is to blame for his illness.
Like Ivan, Praskovya blames others for the things in her life that threaten her happiness. In this case, Ivan himself is the person encroaching upon her ability to enjoy life, so she criticizes him and treats him like nothing more than a nuisance. In his illness, then, Ivan gains a new vantage point from which to observe the life he led with Praskovya, realizing that she—like him—has always prioritized social matters over all else.
At work, Ivan senses his colleagues treating him differently because of his condition, and this frustrates him. In particular, he comes to dislike Schwartz’s good-natured attitude and respected reputation, both of which remind him of himself as a younger man. When playing whist, he begins to make mistakes, but instead of critiquing him, the other players simply ask if he’d like to stop playing because he’s too tired. Vehemently refusing to stop, Ivan finishes these games but realizes that his bad attitude has brought the entire mood down, and he feels bad for ruining the night. On his own after such experiences, he feels as if he’s alone with his pain and fear.
Having led a life devoted to reputation and social status, Ivan is isolated from his peers now that he can no longer fully participate in the community. Because nobody is interested in empathizing with him, he has to either accept that he’s alone with his illness or try to go along like normal—two options that are nearly impossible for him to pursue, since he cares so much about his social life yet can’t find the strength to maintain his place in the public eye.