In Tolstoy’s “the Death of Ivan Illyich” we see doctors through the eyes of the judge, Ivan, who has a mysterious illness.
Visits are described : “He (a doctor) comes in fresh, hearty, plump, and cheerful, with that look on his face that seems to say: ‘There now, you’re in a panic about something, but we’ll arrange it all for you directly.’”
Ivan leaving a doctor’s room, “… rose, placed the doctor’s fee on the table, and remarked with a sigh: ‘We sick people probably often put inappropriate questions. But tell me, in general, is this complaint dangerous, or not?’ The doctor looked at him sternly over his spectacles with one eye, as if to say: ‘Prisoner, if you will not keep to the questions put to you, I shall be obliged to have you removed from the court.’ ‘I have already told you what I consider necessary and proper. The analysis may show something more.’ And the doctor bowed.”
Ivan observes them come and go asking questions that they knew the answers already. Amid these consultations, Ivan accidently overhears his brother-in-law say to Ivan’s wife that Ivan is for certain dying.
What tormented Ivan Ilyich most was the deception, the lie, which for some reason they all accepted, that he was not dying but was simply ill, and the only need keep quiet and undergo a treatment and then something very good would result. He however knew that, do what they would, nothing would come of it, only still more agonizing suffering and death. This deception tortured him — their not wishing to admit what they all knew and what he knew, but wanting to lie to him concerning his terrible condition, and wishing and forcing him to participate in that lie.
His family also did not understand: “Those about him did not understand or would not understand it, but thought everything in the world was going on as usual. That tormented Ivan more than anything. He saw that his household, especially his wife and daughter who were in a perfect whirl of visiting, did not understand anything of it and were annoyed that he was so depressed and so exacting, as if he were to blame for it.
His servant, Gerasim, recognized his agony and pitied him. And so Ivan Ilyich felt at ease only with him. He felt comforted when Gerasim supported his legs (sometimes all night long) and refused to go to bed, saying: “Don’t you worry, Ivan Ilyich. I’ll get sleep enough later on,” Gerasim alone did not lie; everything showed that he alone understood the facts of the case and did not consider it necessary to disguise them, but simply felt sorry for his emaciated and enfeebled master. Once when Ivan Ilyich was sending him away he even said straight out: “We shall all of us die, so why should I grudge a little trouble?” — expressing the fact that he did not think his work burdensome, because he was doing it for a dying man and hoped someone would do the same for him when his time came….. Later a celebrated consultant arrived…the question arose of the floating kidney and appendix which were not behaving as they ought to.
In conclusion, though the doctors asked many questions, ultimately, it is the doctors who are questioned, whether they saw no need or did not have the capacity for intimacy (burnout?) and whether when treating the disease they neglected the person?
Striving for aequanimitas,
John Mary Meagher
- Your Theory of Error Matters
- Meditate on death to live more fully.
- Tolstoy’s Ivan Illyich asks, “how have I lived?” A Cautionary Tale.
- Ivan Illyich’s Doctors treat his disease but neglect him.
- The Elephant in the Dark House
- “Needless” Mr. Lemond’s reflection on end of life gasping for breath.
- We see what we expect to see.
- The ageless conquest of oneself
- The Inner Game of Golf- of Medicine
- What advice would you give to a medical student?
- “That was a curious incident – the corneal abrasion did not pain.
- Poems to jolt when humanity has flat-lined in the hosptial
- Heard at a Journal Club On “the Difficult Encounter”
- Brochure for upcoming CME event: Staying Tuned La Malbaie, May 8th, 2016
- Staying Tuned CME May 8th at La Malbaie QC
- Percocet (oxycodone): This White Collar Heroin is a dog collar. Who will escape?
- Is Cynicism pernicious to your health?
- Should the privileged get privileged care?
- Antoine Saint de Exupery (or The Carpenter and his Block of Wood)
- Heartsink is a better term than Difficult Patient?
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