Several months later, Ivan’s brother-in-law comes for a visit. Upon setting eyes on Ivan, he can’t disguise his horror, gaping at him in a way that confirms Ivan’s worst fears about his physical decline. After this interaction, Ivan seeks out a mirror and stares at his gaunt face, comparing what he sees to a photograph of himself and noting the extreme difference. He then pulls up his sleeves and looks at his wrists before covering them once more and saying, “No, no. I mustn’t.”
At a certain point, there’s only so much Ivan can do to convince himself that he’ll be all right. When his brother-in-law reacts so intensely to the way he looks, it becomes impossible for him to deny the toll his illness has taken on him. This leaves him feeling distraught, which is why he gazes at his wrists, apparently considering suicide before deciding that he “mustn’t” do such a thing. Although nothing Ivan has done until now has indicated that he’s religious, this sense that it would be wrong to kill himself hints that he may harbor certain religious ideas. After all, he stops himself from committing suicide not because he doesn’t want to, but because he thinks he shouldn’t. Given that suicide is a sin, this suggests that Ivan stops himself for vaguely religious reasons.
Listening in on a conversation between Praskovya and his brother-in-law, Ivan hears his brother-in-law call him a “dead man,” though Praskovya insists that her brother is exaggerating. Withdrawing from the door, Ivan goes to lie down and thinks about the various diagnoses he’s received, picturing his kidney floating in his body and trying to imagine fixing it in place. He then springs up and goes to visit his doctor. During this visit, the doctor insists that everything can be fixed inside of Ivan’s body simply by following a certain regimen. Filled with newfound optimism, Ivan goes back home and enjoys a pleasant evening with Praskovya and several guests, but he never manages to forget about his condition. Before long, he retires to the single bedroom that he’s been sleeping in ever since his illness began.
Only by seeing his brother-in-law’s shock is Ivan finally able to realize the true severity of his illness. Because everyone around him is too focused on their own lives and doesn’t want to empathize with Ivan, they don’t tell him the truth about how he looks. Now, though, Ivan is able to register just how much he has changed. And though he derives a certain amount of comfort from his visit to the doctor, it’s not enough to fully push his worries out of his mind. Similarly, even a night of socializing doesn’t make him feel better, even though such activities used to bring him comfort.
Lying on his bed, Ivan takes his medicine and thinks about the doctor’s advice to simply follow his regimen. As he swallows the prescription, he feels as if he’s getting better already, thinking that his pain has actually receded. The next moment, though, the pain comes crashing back and the foul taste returns. Cursing the “blind gut” and the kidney, Ivan thinks that his condition has nothing to do with his internal organs. Rather, he sees it as a plain matter of life and death, believing that his life is “steadily going away” and cannot be helped. He wonders why everyone else won’t admit that he’s dying, when it’s so obvious to him that he only has a little bit of time left on Earth. Thinking this way, he wonders with a jolt what, exactly, will happen when he dies.
Ivan’s optimism—fleeting as it is—demonstrates how desperate he is to ignore the serious implications of his illness, wanting badly to go back to living the carefree life that his peers and family are enjoying. However, there’s no stopping his pain, which comes back to haunt him as soon as he tricks himself into thinking he’s better. When this happens, he bitterly resents everyone around him, cursing them as if it’s their fault that he’s ill. Once again, then, he lashes out at others in a moment of hardship, proving his vengeful, scornful nature.
Ivan jumps up to light a candle but drops it on the floor and collapses once again on his bed, finding everything pointless. Death, he knows, is coming for him. He is dying and nobody cares. Even though everyone will die, they refuse to admit their own mortality. With this in mind, Ivan sits up and tries to calm himself, reviewing everything that has happened to him. The pain began when he bumped his side, he remembers. Then the pain intensified, he became depressed, and he sought out multiple doctors. And all this time, death has been getting closer and closer while he has foolishly been worrying about his gut and kidney.
As Ivan thinks about the nature of mortality and tries to relate it to his illness, he realizes that he has been ignoring an important fact, which is that he will someday die no matter what he does to prevent it. One of the reasons he feels so alone with his illness is that everyone around him is—like he used to be—unwilling to recognize the inevitably of death. Now, though, Ivan understands that he’s destined for death and that this will likely happen sooner rather than later. For this reason, focusing on his internal organs seems futile, as does the social life that Praskovya and Liza continue to lead.
Having heard him drop the candle, Praskovya enters Ivan’s room and asks him what’s wrong. He tells her that he simply dropped something and that everything is fine, deciding that there’s no point talking to her about his condition because she won’t understand. Praskovya, for her part, is all too eager to pick up the candle, light it, and rush out of the room. After their guests have departed later that night, she returns and asks if he’s feeling even worse, and he admits that he is. Hearing this, she expresses her desire to have a celebrated doctor visit him at home, but he only smiles and says no. As she bends to kiss him on the forehead, he feels nothing but hatred for her—hatred that consumes his entire being.
Praskovya is apparently incapable of empathizing with Ivan. This is most likely because they don’t have a legitimate connection, since their marriage is built on little more than a shared interest in money and reputation. As a result, Praskovya finds herself unable to emotionally support her husband through his illness, which causes Ivan to resent her. In turn, Ivan’s resentment further estranges him from her, as he conveys nothing but scorn when she tries to reach out to him.