The Death of Ivan Illyich
by Leo Tolstoy
If I taught a death doula/midwife training course, “The Death of Ivan Ilyich” would be essential reading and the first assignment. It is an introduction to the complexities of the dying process. Ivan Ilyich shows us many things: the endless striving “hustle” encourages, the hollowness inauthenticity presents and the agony of dishonesty in the face of dying. But my favorite part of this novella is the archetype of death worker that we see in the character Gerasim.
Ivan Ilyich endures an agonizing disease process; it is filled with suffering in all the ways imaginable from murky diagnosis, plaguing symptoms, skepticism from his loved ones to abject terror at his own decline. He is tormented by the idea of death, feels abandoned and resentful as his family presses on living. As no one will address the obvious, isolation consumes Ivan and he is forced to weather his dying alone until we meet Gerasim.
Gerashim is the model death worker for all of us practicing death midwifery. Gerashim looks Ivan squarely in the eye with patience, compassion and humility. He acknowledges Death’s inevitability and Ivan’s suffering as he moves toward it. He does not try to offer the perfect salve, rather he shows up day after day to do the simple work of offering comfort with his hands, words and presence. He is not repulsed by the weakening of Ivan’s body, he does not try to gloss over suffering with hope-filled platitudes and does not “other” Ivan to protect his own fragile reckoning with mortality. He patiently holds Ivan’s feet on his shoulders hour after hour, night after night. He offers compassion and brevity. He connects his heart to Ivan’s, says “We’ll all die, so why not take a little trouble?”. Ilyich’s agony is only relieved by accepting the inevitable. As excruciating as his dying process is, Tolstoy suggests, it’s his refusal to accept Death that caused the suffering. Once he surrenders, suffering relents and he drifts into the presence of his soul without clinging to the remains of his life.
In his namesake, Ivan Ilyich, Tolstoy also teaches us about end of life suffering. For death care workers and caregivers, Ivan Ilyich illustrates the precise complexity of shedding one’s mortal coil, a valuable lesson for all humans. The book poses the consideration of what makes a life worth living, what leaves a mark of pride on the dying and how we can best prepare ourselves for our own inevitable deaths.
This easy-to-read novella delivers on many fronts. It’s a masterpiece of existential and philosophical gems— a must read from a mesmerizing Russian writer.