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always cheerful and sunny.” He carries out the most intimate of tasks, such as cleaning up after Ivan Ilyich’s bowel movements.Ivan Ilyich is fraught with self-judgement, however, and is “embarrassed by seeing this man…having to do this repulsive job.” One assumes that Gerasim shares such embarrassment—but far from it.
He is denied a meaningful death, instead surrounded by dishonesty and judgement.
There is one source of comfort for Ivan Ilyich, however.
He is married, but unhappily so; he is successful, but never satisfied.
At some point, a seemingly-innocuous fall leads to perplexing medical agony, and his eventual death.
This novella has much wisdom for hospice and palliative care professionals today—from nurses, to physicians, to home health aides and more.
By looking through its lens, we find palpable truths for our complex professions.But as in so much of life, the messiness of literature provided tremendous insight.In both arenas, I have found valuable reflection in the Peter Carson translation of Leo Tolstoy’s classic, (Tolstoy, 2014).Three traits point us toward an answer: honesty, authenticity, and humility.By embodying these traits, Gerasim validates and comforts Ivan Ilyich.That comfort is in Gerasim, a young servant attending to Ivan Ilyich’s personal needs.Gerasim moves Ivan Ilyich, positions him, and cleans him. The young man, Tolstoy writes, is “a clean, fresh young peasant…When Ivan Ilyich apologizes for his messy, smelly suffering, Gerasim “replies not with forgiveness, but with the observation that Ivan Ilyich does not need forgiveness for a disease” (Charlton & Verghese, 2010). If modern patients are anything like Ivan Ilyich, they will benefit from our humble honesty.In acknowledging their vulnerability—but not blaming them for it—we give patients much-needed space to grieve. If patients need honest support in their illnesses, caregivers must be authentic in that support. Authenticity means the visible joy of life; it means working with “sleeves rolled up over his strong, young, bare arms;” and it means that peculiar blend of gentleness and fortitude, which enables him to handle Ivan Ilyich “effortlessly and with next to no pressure.” When entering the room of a hospice patient, I am often tempted to leave myself—my joys, my energy, my youth—at the door.The latter group is absorbed in activities and appearances; the former refuses to admit defeat.In both cases, Ivan Ilyich is isolated from his caregivers when he needs their intimacy most. for someone to have pity on him like a sick child.” Not all patients want such pity, of course.