Ivan Ilyich sleeps less and less, finds foods distasteful, and must rely on others to assist him with daily hygiene. He finds comfort with Gerasim, his butler’s assistant and now de facto sick nurse, whose cleanliness and sense of purpose contrast with Ivan Ilyich’s own. Everyone else around Ivan Ilyich is most concerned with “whether he would soon vacate his place, and at last release the living from the discomfort caused by his presence” (283).

While others avoid Ivan Ilyich’s suffering and inevitable death, Gerasim puts aside his to-do list to spend time making Ivan Ilyich more comfortable. He is the only person who fully acknowledges Ivan Ilyich’s coming death; others insist on treating Ivan Ilyich as though “he was not dying but was simply ill” (285). Ivan Ilyich wants to tell everyone, “You know and I know that I am dying. Then at least stop lying about it!” (285), but cannot bring himself to say it. Though Ivan Ilyich longs “to be petted and comforted” but continues assuming “a serious, severe, and profound air” that he thinks is proper for “an important functionary” like himself (286). This repressed longing for human compassion leaves him feeling poisoned by “this falsity around him and within him” (286).