The novella opens after its hero is already dead. In a room at the Law Courts his colleagues read the notice of Ivan Ilych's death, and their first thoughts are of the promotions it may free up and the tiresome duty of attending the funeral. At the service Peter Ivanovich feels a flicker of dread that this could happen to him too, then reassures himself that it has happened to Ivan Ilych and not to him, and goes off to play cards. This cool, self-protecting world is the world the dead man lived in.
Tolstoy then turns back to the life itself. Ivan Ilych rises smoothly through the legal service, marries because it is suitable and pleasant rather than out of deep love, and withdraws from his quarrelsome marriage into the orderly satisfactions of his work. When the family moves to a better post he throws himself into decorating a new apartment, and while hanging a curtain he slips from a stepladder and knocks his side. The bruise seems trivial, but from it his fatal illness begins.
A vague pain in his side grows worse, and the doctors, examining him exactly as he himself used to examine defendants, talk learnedly of a floating kidney or an appendix while never answering the only question that matters: is this serious. Ivan Ilych slowly grasps that he is dying. The old screens that once hid death from him, his work, his card games, his domestic routines, stop working, and the fact he names only as It stands before him and will not look away.
His sharpest suffering is not the body but the falsehood surrounding it. Everyone around him insists he is merely ill and will get better, and forces him to keep up the same lie. The one exception is Gerasim, the healthy young peasant who nurses him, holds his legs up through the night, and speaks plainly because we shall all die one day. Gerasim's simple pity gives Ivan Ilych the only comfort he can feel, and shows by contrast how loveless the rest of his life has been.
In his last days a question forces its way up: what if his whole life had been wrong. He resists it, recalling how correct and approved everything had been, but the defence collapses because there is nothing real to defend. Two hours before the end he falls, as if through a black sack, toward a light. His hand touches his weeping son, he feels sorry for the boy and for his wife, and he wants to release them and himself. With that turn from self to pity the terror dissolves: he looks for his fear of death and cannot find it, and in place of death there is light.