Passages from the Masters: Leo Tolstoy’s “The Death of Ivan Ilyich” (part 4)

Sickness can be a very isolating experience, not just for the uniqueness and strangeness of the experience but also because of the ways it affects our relationships with others. This passage about a card game from Tolstoy’s short novel illustrates this:

What more could he have wished for? He ought to have felt cheered, invigorated–they would make a grand slam. But suddenly Ivan Ilyich became aware of the gnawing pain in his side, the taste in his mouth, and under the circumstances it seemed preposterous to him to rejoice in a grand slam.

He saw his partner, Mikhail Mikhailovich, rapping the table with a vigorous hand, courteously and indulgently refraining from snatching up the tricks, pushing them over to him, so that he could have the pleasure of picking them up without having to exert himself. “Does he think I’m so weak I can’t stretch my hand out?” Ivan Ilyich thought, and forgetting what he was doing, he overtrumped his partner, missing the grand slam by three tricks. And worst of all, he saw how upset Mikhail Mikhailovich was while he himself did not care. And it was dreadful to think why he did not care.

They could see that he was in pain and said: “We can stop if you’re tired. Rest for a while.” Rest? Why, he wasn’t the least bit tired, they’d finish the rubber. They were all gloomy and silent. Ivan Ilyich knew he was responsible for the gloom that had descended but could do nothing to dispel it. After supper his friends went home, leaving Ivan Ilyich alone with the knowledge that his life had been poisoned and was poisoning the lives of others, and that far from diminishing, the poison was penetrating deeper and deeper into his entire being.

For many people, I think this is one of the main reasons why we do not like to discuss our own pain and suffering: it brings a dark shadow into the lives of our loved ones and friends. It feels harder to hold it in, but it is actually easier to hide one’s suffering rather than let others share in it. When we, as physicians, wonder why it takes some people so long to seek medical help for their health problems, this may often be one of the contributing factors: not having frequent enough contact with someone outside one’s family or circle of friends who can assess and discuss one’s health without fear of bothering or hurting others.

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