The DO Book Club, October 2023: Facing Death: Leo Tolstoy and ‘The Death of Ivan Ilyich’

Leo Tolstoy’s best-known writings, “War and Peace” and “Anna Karenina,” do not pack quite the punch found in his short novella, “The Death of Ivan Ilyich.” A powerful read, his novella remains a classic for narrative medicine, offering philosophical, religious, ethical and moral dilemmas and attempting to distinguish between right and wrong and good and evil. The narrative is an account of an ordinary man, Ivan Ilych, his struggle with a life wrongly lived and his ultimate realization of the meaning of life at death.

Ivan is an educated, relatively prosperous, yet ordinary member of the privileged class. Tolstoy eloquently directs the narrative toward Ivan’s display of falseness, insincerity, insensitivity and spiritual inadequacy. Behind the narrative is a deeply philosophical read about the meanings of life. The story represents spiritual, societal, family and individual processes of dying.

Ivan’s struggle with whether his life had meaning represents the tension between desire, order, meaning and happiness versus lack of purpose, natural indifference and selfishness. In the end, privilege and choices mean nothing without service to others for the greater good. Judging whether life is or is not worth living is a fundamental philosophical question: “What is the meaning of life?”

‘Purpose’ is among the hidden themes

We meet Ivan during the final months of his life. After an apparent trivial injury in which he hurts his side after falling from a ladder while hanging curtains in his new apartment, his pain quickly develops into something worse. Tolstoy is a master with hidden themes—Ivan has literally fallen from a ladder, a theological fall from grace, while hanging a curtain.

His symbolic ladder is like John Climacus’ “Ladder of Divine Ascent (Scala Paradisi),” where each monastic virtue is a rung which must be ascended. Ivan’s fall from the ladder reminds readers that in living life, we sometimes miss the mark, fall and need to start again. Losing one’s purpose and falling is not as bad as lacking purpose. 

The scriptural and religious overtones of the novella are explicit, especially in the last chapter. Russian Orthodox scripture of Holy Friday would have been well-known to Tolstoy, who espoused the faith but was later denounced at the beginning of the 20^th century. Throughout the book, one could argue that Ivan is the wise thief, recounted in Luke’s Gospel, whose life was transformed at the end, in a single moment (Luke 23:39-43) —“… all this happened in a single moment.”

Readers can find many connections between Ivan and Tolstoy. Tolstoy was a visionary reformer, moralist and philosopher, all themes displayed in this short novella. Even through his own death in 1910 in a remote Russian village, Tolstoy left his family in the middle of the night, walking out on his wife Sonia and children. According to a written letter to his wife, Tolstoy voiced the need to leave “this worldly life to spend the last days of my life in solitude and quiet,” not unlike Chris McCandless, the vagabond and lover of Russian literature, who ventured into northern Alaska, as described in Jon Krakauer’s “Into the Wild.”

Tolstoy was critical of social privilege; he denounced and was frustrated with the materialism of bourgeois society. Later in his life, Tolstoy even embraced the role of the Russian peasant (the mujik) and that of an itinerant traveler or pilgrim, almost a holy fool, also known as a yurodivyy. He was a critic of the Tzarist regime and the Russian Orthodox Church. He launched welfare programs, including soup kitchens. He funded schools. In solidarity with the underprivileged, he renounced his aristocratic titles, wearing the characteristic dress of peasants and commoners.

Connections to Tolstoy’s own life

Tolstoy’s personal experiences with death and dying are expressed in his writings. He was an active-duty soldier in the Crimean war, vividly recalling both the agonizing death of his brother from tuberculosis and the agonizing sounds of a Parisian being guillotined. Among his 13 children with Sonia, no fewer than five died before adolescence. However, his writings went beyond the horror of death. They reflect on the ability to meditate on death and gain a deeper understanding around the meaning of life. Thus, if one must die, what is the point of living? Some of his most memorable reflections on this theme are found in the novella.

There is a psychological aspect to the novella—one might search for the diagnosis of his disease; however, objective reality is less important. Tolstoy masterfully makes this clear by never divulging the diagnosis. Ivan’s physiological disease is not the problem; his spiritual well-being is the main issue. Ivan’s common life and journey is contrasted with a retrospective analysis of his life. This life inventory and self-reflection allows Ivan to escape “that which was oppressing him.” (p. 113)

Ivan’s oppression can only be liberated through a painful awareness of his moral and psychological shortcomings. It is this refining process of finding redemption that allows one to live a truthful, meaningful and purposeful life.

The takeaways lead to reflection

Tolstoy invites readers to see that a purposeful life is not based on social status, money or position. Ivan’s peasant caregiver’s virtues are contrasted with the process of dying. The peasant caregiver is kind and compassionate to his master, showing no discomfort in providing the dying man positional relief from pain and discomfort.

Tolstoy’s writing makes readers appreciate that those who live a purposeful life without pursuing the unnecessary trappings of existence gain meaning.

This novella is a phenomenal read. Regardless of one’s own religiosity, the inevitability of death, its meaning and how physicians and patients face mortality can be informed by the novella. This should be an essential read in narrative medicine.

Tolstoy allows readers wonderment—if perception of life changes as one approaches death. Thus, the novella becomes a generalized reflection on the human condition, even for the atheist and agnostic. There is a struggle, not only within the book, but for the author. Tolstoy, the son of a wealthy commercial family, expresses his need to help others despite his nobility. His complex and refreshing novella is consistently relevant for physicians.

Related reading:

The DO Book Club, August 2023: “Only the Paranoid Survive” and “The Ottava Method: Take Your Life Up an Octave”

The DO Book Club, July 2023: ‘Darkness Visible: A Memoir of Madness’