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The inevitability of death is one of the central themes of The Death of Iván Ilych. There is no suspense about whether or not the protagonist will die. His death is the title, and in the first chapter of the novel his death has already happened. Tolstoy wants to bludgeon his reader with the presence of death: the novel begins with, ends with, and takes its name from death.
The events of Chapter 1 happen chronologically after the events of all of the subsequent chapters. Iván Ilych's struggle forms the true story of the novel, but by making a prelude out of his death's aftermath Tolstoy provides context for his central story. Certainly, Chapter 1 would be out of place if placed according to chronology, at the end of the novel. The social commentary of the first chapter, while brilliant, is not meaty enough to follow the spiritual crisis and struggle with mortality that finally ends in Chapter 12.
Tolstoy incorporates several patterns of reversal into the structure of the novel. The actual death of Ivan Ilych, the chronological end of the story, occurs in the first chapter. The remainder of the novel is devoted not to Ivan's death as the title seems to indicate, but to his life. Tolstoy reverses the very concepts of life and death. During his early life, when Ivan seems to be growing in strength, freedom, and status, he is actually being reduced to weakness, bondage, and isolation. After Chapter VII, when Ivan is confined to his study and suffers physical degeneration and alienation, he is actually being reborn spiritually. Tolstoy reinforces this point by means of several verbal formulations. Ivan describes his spiritual awakening as if he were moving downwards while all the time believing he was moving up. He compares his sudden insight into the true nature of his life to the sensation one gets in a railway car upon discovering that the true direction of travel is opposite the supposed direction.