Yury appears in Moscow with a young boy. Both are very shy, and Yury is dressed in rags. Yury made much of his journey on foot, then completed it by train. In a burnt-out village he met Vassya Brykin, the young boy. They arrive in 1922, at the start of the New Economic Policy period, which represented a rollback of socialist policy for the sake of economic stability. Yury helps Vassya to enroll in a printing and design course; he supports himself by writing booklets about philosophy. He tries to obtain either a visa to join his family in Paris or political rehabilitation for them to return to Russia, but his efforts fail. Vassya feels that Yury's efforts are half-hearted and loses respect for him; their relationship gradually deteriorates. Vassya moves out of the apartment they share and Zhivago ceases to associate with people and lives in great poverty.
Markel Shchapov, once the manager of Yury's building in Moscow, is now the manager of the Sventitskys' old home. Yury strikes up a friendship with Markel's daughter Marina, and they live together as husband and wife. They have two daughters. Misha Gordon and Nicky Dudorov live nearby. Although Yury is not yet 40, he has developed sclerosis of the heart. Gordon tells Yury that he must make peace with the past and reconcile his life with Marina with his still existing feelings for Tonya. Yury tells Misha that he has suddenly begun receiving letters from Paris and believes Tonya may have found someone else. The next day, Marina runs to Misha asking where Yury is, and Misha does not know. Misha, Nicky, and Marina all receive letters from Yury explaining that he is going to change his way of life and that he has sent money to pay for a nanny for the children while Marina goes back to work, so that she can support herself until he returns.
Yury sees his half-brother Yevgraf, who promises to find him a good job as a doctor. There is some delay, and Yury has time to write. Riding the tram on his way to his first day at his new job, he is suddenly faint and unable to breathe; he is seized by panic. He feels a pain that he senses is a sign of imminent death, and he runs outside for fresh air but collapses and does not get up again. On her way to obtain an exit visa to return to Switzerland, Mademoiselle Fleury passes the body without any awareness of who it belongs to.
Lara appears at the funeral. She traveled from Irkutsk to Moscow to enroll her daughter in a boarding school. She went to the Sventitskys' house to see if Pasha's acquaintances still lived there and instead found mourners surrounding Yury's body. Yevgraf asks her to stay to help sort through Yury's papers; she asks whether there is any way to trace the history of a child sent to an orphanage. Lara stays several days, but one day she goes out and never comes back. Her disappearance is mysterious, but it is likely she was captured and sent to a concentration camp.
Zhivago goes to Moscow because it is his home, and he finds that some of his friends are still there. He is not an old man, but his heart is weak, and he views himself as being near the end of his life. He marries again, though not formally. Vassya believes that Zhivago has not tried hard enough to be reunited with Tonya; Misha supports this sentiment when he tells Zhivago that he is acting badly toward both Marina and Tonya. It is Lara that Zhivago truly loves, and he has already banished her from his life.
After Zhivago's death Lara happens upon his funeral by chance, as so much of their relationship has been. In death they seem fated to meet, even as in life. She mourns him and their lost life together. She is angry that he abandoned her in the way that he did. And though Zhivago abandoned her in hopes that it would bring her safety, Lara's disappearance destroys that hope. Zhivago's abandonment of her was fruitless. The last sentence of chapter 15 is one of the most poignant sentences of the novel: Lara is "forgotten as a nameless number on a list which was later mislaid, in one of the innumerable mixed or women's concentration camps in the north." It is the cold indifference of the line that gives it such power. The most tragic result of the tragedies that took place during Lara's lifetime, the tragedies that were so influenced by the transformation of Russia into the Soviet Union, is the dehumanization of everyone, including Yury and Lara.