I just finished this book and I wanted to offer my thoughts.
What really stuck to me was Ivan’s ability to compartmentalize the various aspects of his life, like when his marriage stopped functioning like he imagined he started to dedicate less and less energy and time to it without ever trying to find the cause.
Chronic pain was the perfect narrative device because Ivan (or any other human for that matter) couldn’t ignore it and corrupted every area of his life.
This perfect storm caused him to confront with the fact that he averted his eyes from reality whenever that wasn’t matching with his wishes; the problem is that reality doesn’t account for unhealthy coping mechanisms.
That’s why Ivan heavily relapses after he accepts to confess himself towards the end, because he tried to avert his gaze from the fact that he was dying (actually that’s also what he disapproves of his family, that they don’t acknowledge his state).
I think in the end Ivan releases his grasp over the illusion of control over incontrollable things and in doing so he becomes able to confront reality, his death in particular, in a honest manner.
I found this story to be quite pragmatical and realist, obviously this is only my interpretation of it.
by thedreath