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The Death of Ivan Ilyich by Leo Tolstoy,1 first published in 1886, is well known for its remarkable insight into the suffering of a dying man and can be considered a ‘medical classic’.2 But can a reading of this short story over a hundred years later give any insight into contemporary medical practice or is it an historical curiosity? One interpretation is to consider the story a depiction of a man experiencing ‘total pain’, a concept central to the practice of modern palliative care in which ‘the sense of hopelessness and fear of impending death may add to and exaggerate the pain, which contributes to the overall suffering of the patient’.3 But is such an interpretation warranted? Or is it wresting a concept from the second half of the twentieth century and applying it to imaginative literature without justification, falling into the trap of imposing a diagnosis retrospectively on a character in an act of ‘medicalisation’ that detracts from other interpretations of the story? Ilyich’s pain is central to Tolstoy’s tale, a pain that involves a search for possible meanings. It is left-sided abdominal pain that leads him to seek a medical opinion. But Ilyich and his doctor are in different camps concerning the meaning of the pain:

The Death of Ivan Ilyich and the concept of ‘total pain’