Connective Issues — The Death of Ivan Ilyich

My intended blog was going to be about connective tissue cells called telocytes. This subject got to be too big and I’ve not had time to complete it. Instead, I want to review one of my all-time favourite short stories by Leo Tolstoy.

One of my personal strategies for getting through the past two pandemic years has been to read historical novels and non-fiction describing times where people had to put up with a lot worse than we have had to. Subjects have included the plague in times of Shakespeare, solving the origin of a London cholera epidemic (the first example of epidemiology), the Holocaust, French resistance, and Shostakovich in the siege of Leningrad. All we’ve had to do is sit tight.

Every couple of years I re-read ‘The Death of Ivan Ilyich’, written by Leo Tolstoy in 1886. He wrote this novella having just endured nine-years of writers block after the publication of my wife Wendy’s all-time favourite novel, Anna Karenina (she still doesn’t believe it wasn’t written by a woman). I read it because just about every sentence is perfect, and because the progression of the storytelling is so seductive.

Ivan Ilyich is one of Tolstoy’s great characters, written soon after he underwent a religious conversion. Ivan is a hard-working 45 year-old member of the Court of Law. He has a respectable, pretty wife of twenty years, a son and a daughter, and a house with servants, filled with lovely things. After marrying, his wife begins to disrupt the pleasantness by finding fault with everything. Ilyich buries himself in work.

One day, having had new curtains hung not to his liking, he climbs a ladder, misses his footing and bumps his ribcage on a knob on the window frame. Just a bit of a bruise. Life continues well, but he does notice a strange taste in his mouth and some discomfort in his stomach.

He seeks out a doctor who says things like ‘a floating kidney’, ‘chronic catarrh’, or ‘appendicitis’. As a lawyer, Ilyich compares the doctors summation to how he himself might wind up a case. Things look bad.

He takes his prescribed medicines but the pain increases. He becomes irascible and angry. The pain he suffers affects his family, friends and work colleagues. He seeks out new doctors, but they are of the same conclusion. He can’t sleep or eat. He notices his work colleagues talking behind his back. Months go by. His visiting brother-in-law gasps when he sees Ivan. Ivan notices this. He sees that he is dying and takes to his sofa, facing the wall, barely able to move.

There are just twelve chapters in my fifty-two page translation by Pevear and Volokhonsky. The beauty of Tolstoy’s telling is that each chapter gets shorter as the suffering increases. The last chapter is just two pages long and finishes with the line “He drew in air, stopped at mid-breath, stretched out, and died”. Oops, spoiler alert, but I am assuming that the title rather gave it away.

To me the story resonates when I think of some of my more severe pain patients as they describe the hopelessness of their condition. People get told things that they then own; ‘bone-on-bone’, ‘failed back-surgery syndrome’, ‘bulging discs’. Part of our job is to ‘talk people off the cliff’, as one doctor asks me to do. No, I don’t get them to read this story, but I, like you, always try to seek out various ways for them to find their redemption. Find out if Ivan found his own redemption.

BTW I have signed up for the FRS conference in Montreal in September. Hope to see many of you there.

Cheerio for now,