Zhivago arrives in Smolensky Square in Moscow and is greeted warmly by Tonya. She tells him that everyone is well and that they have given up some of the rooms to the agricultural college. Zhivago says that he is pleased they are living in a smaller space, since the rich always had too many rooms. She tells him that Uncle Kolya is back from Switzerland, and Yury is anxious to see him. Yury goes in to greet his son, whom he has not seen since he was an infant, but Sasha is afraid of him.
The family invites old friends for dinner. They eat the duck given to Zhivago by the deaf youth, realizing that such a feast is now a rarity in Moscow. Zhivago is frustrated by his friends' changed demeanors, feeling that the revolution has stripped the rich of their individuality.
Yury takes a job at the Hospital of the Holy Cross, where he worked before the war. He is in charge of statistics, as well as patient care. The family settles in three rooms on the top floor of their apartment. One day, Kolya races in, saying that there is fighting in the streets. Later, Sasha becomes ill with croup (laryngitis), and they cannot obtain milk or soda water to cure him because of the fighting. It is not safe to leave the house, and Yury must miss work. One evening in October, Yury walks out during a snowstorm and reads a newspaper declaring that the Soviet power has taken over Russia.
Winter comes, and it is a dark, cold, hungry season. There are new elections all the time, and many changes at the hospital, which is now called the Second Reformed. There are food shortages, and Tonya learns to bake bread to sell. Desperate for wood, Tonya exchanges the cabinet for a load of birch. Yury is called out for an appointment at a household offering stockings or cognac as payment. He diagnoses typhus and has the woman admitted to a hospital. The tenants of the building where she lives are engaged in a meeting, and Zhivago asks to see a member of the house committee to inform her of the typhus. He is surprised to see Fatima Galiullina and asks if she is indeed Galiullin's mother. She asks to speak to him outside and begs him not to reveal her identity, since Galiullin has taken the "wrong road," and she takes him to Lara's old friend Olya Demina to ask for a cab.
In the coming months, the Zhivagos are close to starvation. Yury is in constant fear of contracting typhus, and one day he collapses on the road. He is delirious for two weeks, and during that time, he dreams he is being fed white bread and sugar. When he recovers, he is told that they really did exist and were brought by his half-brother Yegraf, who worships everything Zhivago writes. In April, the family sets out for the old Varykino estate in the Urals.
It is 1917, and Zhivago is able to return home to Moscow. He finds that everything has changed substantially, but he is still close to his wife, Tonya. They have both forgotten their discussion of letters about Lara, and Zhivago is delighted with his son, Sasha, and the reemergence of his uncle.
While the Zhivagos are happy to abandon much of their pre-war lifestyle, firstly by giving up part of their house, they find that survival is genuinely difficult. Zhivago is exposed to sickness constantly and worries that he will bring it back to his family. After the October revolution, money ceases to be of value, and they must barter for firewood and bread. All the institutions of Russia are replaced by new organizations, and the people who were once wealthy become poor.
At the tenants' meeting it becomes clear that families are being torn apart by the changes. Galiullina pleads with Zhivago not to reveal who her son is, since she knows that no matter what she herself does she will be judged by the acts of those with whom she associates. The Zhivagos rely on their associations with others, such as Yury's half-brother Yegraf, for their survival.