Ivan Ilych is essentially dead. He awaits only formal removal from the scene. Opium and hypodermic injections of morphine do not relieve his pain. The special foods prepared for him are distasteful and disgusting. He can no longer control his own bodily functions. Yet in the midst of the unpleasantness, Ivan receives his first comfort. Gerasim, the servant from Chapter I, is assigned the task of helping Ivan with his excretions. Gerasim is a "clean, fresh peasant lad, grown stout on town food and always cheerful and bright." He is young, strong, and energetic. Unlike the health and vitality of others, Gerasim's health and vitality do not offend Ivan. One day, as Gerasim is helping Ivan to the sofa, Ivan finds that his pain is much relieved while Gerasim is holding his feet. After that, Ivan frequently asks Gerasim to hold his legs on his shoulders, finding that that position is best of all. Gerasim serves Ivan "easily, willingly, simply, and with a good nature."
More than the physical pain, what begins to torment Ivan most of all is the awful deception of those around him. They use the pretense that he is not dying but is simply ill. As Ivan sees the act of his dying reduced to an unpleasant and indecorous incident, he is bothered by the fact that no one seems to understand his position. Ivan longs to be pitied as a sick child is pitied, to be petted and comforted. But not his wife, nor his daughter, nor his friends can offer Ivan that consolation. Only Gerasim's attitude toward Ivan seems to provide Ivan with what he needs. At times Gerasim supports Ivan's legs all night. Gerasim alone does not lie about the nature of Ivan's situation. With the words, "We shall all of us die, so why should I grudge a little trouble," Gerasim makes clear to Ivan that he does not consider his work a burden, but a service to a dying man. Moreover, as the falsity around him continues to "poison" his final days, Ivan is only truly comfortable in Gerasim's presence.
Tolstoy's moral elevation of Gerasim, a "peasant lad," is both a defiant attack on convention and traditional authority as well as a clear statement about the proper way to live. Not the elite, nor the wealthy, nor the nobles experience the peace and assurance that Gerasim does. Only the peasant servant has no fear of death and no discomfort in dealing with someone who is dying. Gerasim accepts unpleasantness and pain as a part of life. He understands that the world is unpredictable, and he knows the value of sympathy.
Gerasim's qualities temporarily rescue Ivan from his life of isolation and unhappiness. Ivan is cut of from his family, friends, and colleagues not only by their indifference to his predicament but also by his own chosen attitude toward life. Through Gerasim, Ivan renews contact with another human being. He reverses the lifelong process of self-enclosure that has characterized his behavior. It is interesting that Gerasim's contact with Ivan is intimately physical. He not only helps Ivan with his bodily eliminations, he also comforts Ivan by "supporting" Ivan's feet on his own shoulders. This position is strikingly similar to the position of women during childbirth, and Tolstoy may be hinting at a process of spiritual rebirth helped along by Gerasim as a kind of midwife.
In addition to his function as spiritual midwife, Gerasim also represents truthfulness. Gerasim's willingness to admit and accept the fact that Ivan is dying is in contrast to the hypocritical attitude of Ivan's family and friends. By acknowledging that it is death and not illness, Gerasim explodes "the lie" and is able to connect with Ivan on a sympathetic and human level. By the end of the chapter, it is the moral pain caused by "the lie" that torments Ivan most of all. And it is clear that "the lie" carried on by his friends and family is symptomatic of a larger problem plaguing Ivan's society as a whole: the inability to acknowledge the unpleasant aspects of life.