Ivan awakes, conscious that morning has come because Gerasim is no longer sitting with him. By now, Ivan's life has become an undifferentiated cycle of suffering, with Death as the only reality. Peter, the footman, enters and begins tidying the room. Ivan is afraid to be alone, and asks Peter to give him his medicine in order to delay Peter's departure. Ivan knows that the medicine is "all tomfoolery," but he takes it anyway.
With Ivan's consent, Peter leaves to bring the morning tea. When he returns, Ivan stares at him for several moments, not realizing who he is. Presently Ivan comes to himself, recognizes Peter, and begins to wash and dress with Peter's help. A doctor comes to visit Ivan, and begins his examination. Ivan knows that it is all nonsense and deception, but he submits to it "as he used to submit to the speeches of the lawyers, though he knew very well they were all lying and why they were lying."
Praskovya enters the room, and her cleanness, glossy hair, and vivacious eyes cause Ivan to feel a thrill of hatred for her. Praskovya's adopted attitude toward Ivan, much like the doctor's relation with his patient, has not changed. When the examination is over, Praskovya announces that she has sent for a celebrated specialist. Saying that she is doing it for her own sake, she lets it be felt that she is doing it solely for Ivan and is only dissembling so as to give him no reason to refuse. Ivan, upon hearing Praskovya, "felt that he was so surrounded and involved in a mesh of falsity that it was hard to unravel anything." He realizes that everything Praskovya does for him is for her own sake, and he finds it incredible that by telling him it is for her own sake Praskovya expects Ivan to think the opposite. The celebrated specialist comes and goes. Ivan is given an injection, and falls asleep until dinner.
After dinner, Praskovya comes into Ivan's room. She is in full evening dress, and Ivan remembers that she and the children are going to the theatre to see Sarah Bernhardt. Ivan's daughter, Lisa, along with her fiancé, Fedor, come into the room; and Vasya, Ivan's son, creeps in behind them. Seeing his son's look of fear and pity, it seems to Ivan that Vasya is the only one besides Gerasim who understands him. A conversation between Praskovya, Lisa, and Fedor springs up about the realism of Sarah Bernhardt's acting, but it is stopped short when they notice Ivan's glittering eyes and indignant expression. As a profound silence fills the room, everyone becomes afraid that the "conventional deception" will be revealed, and that the truth will come out. Lisa is the first to break the silence, and on her suggestion, everybody leaves for the play. When they depart, "the falsity" leaves with them and Ivan feels better.
Tolstoy presents a day in the life of the dying protagonist, and along with monotony, artificiality emerges as a dominant motif. Ivan submits to the doctor's examination, knowing the uselessness of the charade, but conforming his actions to the expectations of the situation. The doctor, disregarding the true concerns of his patient, carries on the routine prescribed by his position and his patient's condition. Praskovya, moreover, adopting a line of loving concern, fulfills a wife's obligations to her dying husband despite her true feelings. What is important to realize is that for Ivan and his society, superficiality chokes out honest and direct human interaction. Actual attitudes are covered over by artificial attitudes. Praskovya's loving concern for Ivan is actually hostile impatience for his death. The doctor's routinized medical charade is merely a cover for helplessness. And Ivan's tacit acceptance of the examination ritual is really sardonic disgust. In Ivan's life, individuals are actors. And by associating with the actors, Ivan is drawn into the play, i.e., into the "mesh of falsity."
It is especially fitting that the visit paid to Ivan by his wife, his daughter, and her fiancé occurs before they depart for the theater. The posturing and pretense of the visit is as much a performance as the one they are about to see. The visitors insist on treating Ivan as if he were merely sick instead of dying. Conversation centers on trivial topics, and it is clear that they are paying the visit because propriety calls for their presence. Just as the topic of conversation turns to the "realism" of Sarah Bernhardt's acting, Ivan refuses to act any further. And as the family leaves to attend the play, we realize that Ivan's whole life is a play and that the falseness and artificiality of conventional life has caused his death.