For most of the story, Ivan Ilyich faces a bleak mortality.
But in truth, his primary suffering is “the lie, for some reason recognized by everyone, that he was only ill but not dying.” Instead of validation and support, Ivan Ilyich’s companions provide this lie, “which could only bring down this terrible solemn act of his death to the level of all their visits and curtains and sturgeon for dinner.” As a result, he is left alone to grapple with pain and mortality.
That comfort is in Gerasim, a young servant attending to Ivan Ilyich’s personal needs.
Gerasim moves Ivan Ilyich, positions him, and cleans him. The young man, Tolstoy writes, is “a clean, fresh young peasant…
By following his example, hospice and palliative care professionals—regardless of rank or role—can do the same for their patients.
Honesty is the first and most potent of Gerasim’s characteristics.having to do this repulsive job.” One assumes that Gerasim shares such embarrassment—but far from it.He enters the room, “obviously masking the joy in living shining out from his face so as not to hurt the sick man.” The servant does not struggle to find joy in his work, but only to temper that joy.But this lack of transparency hinders Ivan Ilyich from what all patients do need: a meaningful life until death. For him, death is not shameful, nor a sign of weakness. Illness, then, does not separate us, but rather unites us: “We’ll all die,” Gerasim notes, while explaining his dedication to the man, “so why not take a little trouble?” As commentators have noted, this honesty absolves the patient of shame.He does not cheapen death, but only refuses to flout life.The result is unprecedented for the dying man: “In all other people Ivan Ilyich was offended by health,” but somehow, “Gerasim’s strength and high spirits didn’t depress but calmed Ivan Ilyich.” How does Gerasim do this? How does his strength connect him with someone so weak?When Ivan Ilyich apologizes for his messy, smelly suffering, Gerasim “replies not with forgiveness, but with the observation that Ivan Ilyich does not need forgiveness for a disease” (Charlton & Verghese, 2010). If modern patients are anything like Ivan Ilyich, they will benefit from our humble honesty.In acknowledging their vulnerability—but not blaming them for it—we give patients much-needed space to grieve. If patients need honest support in their illnesses, caregivers must be authentic in that support. Authenticity means the visible joy of life; it means working with “sleeves rolled up over his strong, young, bare arms;” and it means that peculiar blend of gentleness and fortitude, which enables him to handle Ivan Ilyich “effortlessly and with next to no pressure.” When entering the room of a hospice patient, I am often tempted to leave myself—my joys, my energy, my youth—at the door.Through the brief glimpse of an unidentifiable and anonymous patient, we are brought into a fresh -- if classic -- view of one Russian man's suffering in Leo Tolstoy's classic, .I hope this piece can elicit thought and conversation on suffering, caregiving, and the humble humanism which ought to pervade our deepest selves.