_The Death of Ivan Ilyich_ is a complicated novella with many different themes which could be reviewed. As is plainly evident from the title of the work, death is a major concept as well as how Ivan Ilyich handles his journey through the dying process. Ivan Ilyich’s family must also traverse his death although they do not react in the same ways. Ivan Ilyich’s illness and death are represented in the book through the five stages of grief that Kubler Ross models, which in some ways we can see by the way his family and doctors react both morally and ethically towards Ivan Ilyich.
Dr. Kubler-Ross developed a model to include the five stages of grief associated with loss or in the case of Ivan Ilyich, with dying. The stages are denial, anger, bargaining, depression and acceptance. They don’t necessarily occur in this particular order but can sometimes also overlap. There is no set amount of time for theses stages to occur, however, there are times when Ivan Ilyich experiences them all.
Shortly after Ivan Ilyich bumped himself on the window knob, he often told the story but insisted that he felt fine. He acknowledged a little bruise and a little pain but denied anything further. The pain continued and did not go away no matter how much he denied it. After what may have been a few months Ivan Ilyich “sometimes complained of a strange taste in his mouth and some discomfort on his left side” (p 63) but he continued to deny that anything could really be wrong.
In Ivan Ilyich’s case, denial and anger seemed to have overlapped.
As the pain in his side grew worse, he became more and more agitated and nasty until he finally “admitted being irritable but attributed this to illness”. (p64) He was not accepting death but he was finally accepting the illness. Once Ivan Ilyich accepted the illness and started seeing doctors, he began to feel that he had a serious condition. Since the Hippocratic Oath had already been written at the time of Ivan Ilyich’s demise, doctors around him did have a duty to nonmaleficence which meant that their first order of business for any patient was to do no harm. After the very first doctor Ivan Ilyich “concluded that things were bad but…it was of no consequence.”(p 65).
After the first doctor visit Ivan Ilyich also starts to enter into his first bout of depression. “He focused on it [the pain] now with a new sense of distress”. (p 66). Before the visit to the doctor he had not paid much attention to his pain although he was angrier. The doctor had been very aloof and had not given Ivan Ilyich very many conclusions on the reality of his situation which left Ivan Ilyich to assume the worst. After a few months and a few more specialists of that era, Ivan Ilyich had not improved Doctors of this era tried their best without much medical education to be helpful or beneficent to their patients but they were lacking in both education and in medication. His brother-in-law visited and was shocked to find that Ivan Ilyich had changed drastically in his appearance. Ivan Ilyich’s depression worsened but he decided to see one more doctor. In Ivan Ilyich’s mind, he believed that this doctor knew his field.
When Ivan Ilyich came home from his visit to the last doctor was in a cheerful mood he was beginning to bargain. He thought he “need only give nature a hand” (p 75) and he would improve. When thinking about the medicine the doctor had ordered, he told himself to “take it regularly” since he often did not. In talking to himself he had a more positive outlook. He kept telling himself that “he felt better already”. (p76) Moments after Ivan Ilyich began bargaining, he stopped just as quickly as the pain returned. He entered into a very angry acceptance “I’ll be gone.” he stated to himself (p. 76). He didn’t know what to expect and he was sure that his family didn’t know he was dying and didn’t care. He seemed to feel many emotions at the same time. He was accepting death but he was also angry and depressed.
Ivan Ilyich’s doctors did not leave the impression that they were highly educated. Their knowledge of the working of the human body was most likely limited by the technology of the era. However Ivan Ilyich went to quite of few doctors and they all seemed to point to either the problem with his kidney or his caecum. The doctors had an “exaggerated air of importance”
(p 64). They treated Ivan Ilyich as more of an object than a person. When they finished their examinations, they spouted their findings. One doctor, after Ivan Ilyich asked about the seriousness of his condition told him that he had “already told you what I considered necessary and suitable” (p 66). The doctors appeared to show little compassion for the feelings or emotions of their patients. They were from an era long before even the traditionalists of the 1920’s and 1930’s who felt that doctors know everything and weren’t to be questioned. Ivan Ilyich however wanted answers to questions that would have eased his mind. The doctors could have been less aloof and formal and more caring and kind.
Ivan Ilyich’s family and household staff treated him mostly like a petulant child who they believed continually complained of a problem that wasn’t real. On the occasion of the first doctors visit he began to tell his wife of his emotions but she “did not hear him out” (p 66). Instead she went to get dressed for the day. Life in Ivan Ilyich’s household went on around him as his illness progressed no matter how ill he became. His daughter and son did not visit often. Instead of avoiding Ivan Ilyich, his family could have visited with him, cheered his spirits, and taken care of him instead of leaving his care to the servants. They could have shown him love and compassion.
Ivan Ilyich had one staff member, a pantry boy, who had compassion for his dying master. No task was too time consuming, arduous, or disgusting for Gerasim. Gerasim acknowledged Ivan Ilyich’s plight by saying “we all have to die sometime, so why shouldn’t I help you?” (p 87). He treated Ivan Ilyich with compassion respect and dignity during the final weeks and days of his life.
In the beginning of Ivan Ilyich’s illness, he had autonomy with the doctor. He made the decision on his own to go to the doctor but due to the nature of the era, the doctor was incapable of truly giving all of the information necessary for Ivan Ilyich to make an informed decision about his condition. Informed consent as it is today did not exist in the time of Ivan Ilyich. Doctors did not have the knowledge they have today and they also felt that it was their job to make the decisions and not be questioned by their patients. Ivan Ilyich had to go on the word of the doctor without truly being able to make an autonomous decision.
Under Maszlow’s hierarchy of needs, only Ivan Ilyich’s basic needs for, clothing, and shelter were initially met. Pain medication was added by the doctors but no sense of security or understanding was provided. There was certainly no sense of belonging, love or understanding provided by his family. During his illness, Ivan Ilyich was mostly ostracized by his family and left to the servants for care.
By the time Ivan Ilyich had been sick for about three or more months his wife became paternalistic. His wife and doctors began making all his decisions for him. He was sleeping in his small study and he was very ill. Arrangements were made for him for everything. He had doctors’ visits arranged by his wife. He had special food to eat as ordered by the doctors. He was given medication to dull the constant pain he felt. Most of his life was being managed for him and for his care. Paternalism was probably necessary since he could do very little for himself.
The _Death of Ivan Ilyich_ shows the progression of a man as he passes through the stages of death. Ivan Ilyich originally denies that his death is even possible and finally after progressing through denial, anger and bargaining comes to the final stage of acceptance. During the final phase Ivan realizes that he has not lived the best of lives. He was materialistically driven most of his life by pleasure and wonders whether his way of living had any bearing on the kind of torturous death he had. He eventually finds in the final moments of his life that his family really is there in the room with him and that they love him and have compassion for him as he leaves his world.