The propriety and upwardly mobile course of Iván Ilych's life are disturbed in 1880, when Iván Ilych is passed over for promotion. The man favored is named Happe, and Iván Ilych quarrels with him and his superiors. As a result, feelings sour and Iván Ilych is passed over again and again in the future when other positions open up. Living beyond his means makes his salary insufficient, and to save money that summer he goes with his family to stay with his brother's wife in the country. Without work, Iván Ilych becomes depressed. He decides to go to Petersburg and raise hell with the bureaucrats until he obtains a post with a five thousand ruble annual salary. Long-term career plans and choosiness about the position are put aside, so long as the salary is high enough. His little quest is successful, due to some luck: personnel changes in the department of Justice have brought some of Iván Ilych's friends to prominence, and they help him get a good position with the desired salary. He returns to the country, happy, and he and his wife get along better.
He leaves for Petersburg before the rest of his family, and finds an excellent house. He throws himself into decorating. One day, when draping hangings, he slips and bumps his side. The pain goes away before long.
The family settles into their new life, making friends with the right sort of people, and Iván Ilych does his job adequately. He lives life as he believes life should be lived: "easily, pleasantly, and decorously" (133). The routine of life is only disturbed occasionally, as in the instance when Iván Ilych orders too many sweets for a party and he and wife argue about the bill. His chief pleasure in life is to play cards. If he can't play cards, he does work. Idling away time with his wife does not appeal to him. A young examining magistrate named Petríschev begins to court Lisa, Iván Ilych's daughter.
After some disappointment, Iván Ilych seeks out a new position with salary as the only consideration. Iván Ilych does not see work in the government as providing a vital service, or impacting the lives of others positively. He only wants to line his pockets, and for the rest of his life his career will be shaped by this consideration alone.
He throws himself into decorating, again placing importance on the unimportant. After the house if complete and the new routine settles in, Iván Ilych is extremely fussy about the house: "Every spot on the table-cloth or the upholstery, and every broken window-blind string, irritated him. He had devoted so much trouble to arranging it all that every disturbance of it distressed him" (133). The preoccupation with the unimportant isn't the only point here. The finished house also suggests stagnation: "When nothing was left to arrange it became rather dull and something seemed to be lacking . . ." (133).
Iván Ilych and family then throw themselves into their empty social lives. They are horrible middle class snobs, although Tolstoy always points this fact out indirectly. Regarding their "shabby friends," the Golovíns are unanimous in their policy of exclusion: "Soon these shabby friends ceased to obtrude themselves and only the best people remained in the Golovíns set" (135). The Golovíns buy into an extremely shallow value system for evaluating people's worth. They are all taste, and no brains.
Regarding career and his social life, Iván Ilych values the wrong things. These misplaced priorities are shared by the whole family, and show up in Iván Ilych's marriage. Tolstoy mentions a particularly violent quarrel between Iván Ilych and his wife, in which they argue over some surplus pastries he ordered. During the fight, Iván Ilych makes "angry allusions to divorce" (134). What a fine marriage it is, when divorce is brought up in an argument over pastries!
A pain in Iván Ilych's left side grows, and he now has a chronic unpleasant taste in his mouth. The pain grows, Iván Ilych becomes more irritable, and the easy, proper life the family leads gets disturbed. He picks fights with his wife, who begins to wish that he would die; but she knows that if he does, she'll lose his salary, and her dependence annoys her. After a bad fight, he excuses himself by speaking of his illness, and Praskóvya Fëdorovna tells him to get to a doctor.
The doctor behaves toward Iván Ilych with the same self-importance and detachment that Iván Ilych has honed in his own work. The doctor seems to lean toward a problem with the appendix being the culprit, and although his diagnosis is dressed in jargon, Iván Ilych takes the meaning as bad. As time passes, Iván Ilych realizes that he is getting worse. Iván Ilych goes to see numerous doctors, and in each case the diagnosis and prescription are different.
Others around him don't seem to be all too concerned with his illness. Iván Ilych's wife and daughter seem mostly annoyed by his irritability and depression, as if the illness is his fault. Praskóvya Fëdorovna always complains to others that her husband does not keep to his prescription. At work, others seem to be waiting for Iván Ilych's position to become vacant. Colleagues tease him as if his illness is a laughing matter.
One night, while playing cards, Iván Ilych becomes conscious of the taste in his mouth and the pain. Distracted by these things and the way others treat him, Iván Ilych misses an easy play. His partner, Mikháil Mikháylovich, is upset, but Iván Ilych is not, "and it was dreadful to realize why he did not care" (142). His friends see that he's suffering, but he insists on playing. Despite the effort, Iván Ilych's gloom is cast over all of his friends. After they leave, Iván Ilych has time to reflect: ". . . his life was poisoned and was poisoning the lives of others . . ." (142). Yet he must continue to live and work, isolated, "on the brink of an abyss, with no one who understood or pitied him" (142).
Chapter Four marks Iván Ilych's break with the pleasant and decorous life that he treasures. It is a break that the unfortunate man must make alone, as no one has sympathy to spend on him. Isolation is a key theme. New understanding separates Iván Ilych from his former world. He now is forced to contemplate that which no one wants to think about, and his very presence threatens to remind them of that thing.
The thing is death, and because this illness is Iván Ilych's, the others don't seem too concerned. Iván Ilych is amazed to see the doctor dealing with him in the same manner Iván Ilych uses in his work. Throughout the novel, people trivialize the lives of others, condescend to them, and see them as little more than a part of a routine. The doctor doesn't seem moved by the fact that he's dealing with Iván Ilych's very life, just as Iván Ilych doesn't seem aware of his case decisions' impacts on the lives of real people. Like Iván Ilych, the doctor seems wrapped up in the fun and self-importance of a workplace mask. His priorities and thought processes seem askew.
Iván Ilych realizes that he has become the enemy of the thing he previously treasured most: cheerful living, in accordance with the standards of propriety, without disturbances or too much thought. At the card game he realizes that he has ruined his friends' evening. He sees in Schwartz "what he himself had been ten years ago" (142), and correctly apprehends that he is now "poison," a thing that makes it impossible to live life glibly.