He starts having to struggle with fear, discomfort, and isolation. As he grows sicker, Ivan's mood and attitude toward life begin to change dramatically. That's when he injures a critical organ (appendix, kidney?) and starts to show signs of illness. Ivan's fall while putting up the curtains is what causes the whole mess that follows. Also we get an idea of what Ivan himself was like before he got sick, since Peter Ivanovich and his friends are a lot like Ivan used to be. It gives us a more vivid (and unflattering) picture of what the people in Ivan's social world are like. The opening chapter – even though it technically occurs after Ivan has already died – also serves as setup. We get to know Ivan, his habits and desires, his family and friends, and his circumstances. He tells us Ivan's whole life story up to the point when he becomes sick. The central drama of the story is Ivan's struggle with illness and death, and Tolstoy gives us quite the setup. Initial Situation Ivan Ilych's funeral…and now for the story of his life.
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