The Death of Ivan Ilyich: Novel Summary: Chapter 4

Here, Tolstoy begins to allude to the growing physical pain that Ilyich feels in his side which he struck during his accident.  This, in turn, hurts his mood, and he begins to argue more frequently with his wife.  Though he consults a doctor, nothing seems to be able to be done for him.  He takes the prescribed medicine, but slowly realizes that his condition is not improving, but indeed getting worse.
Not helping matters, Praskovya Federovna doesn't support her husband during his illness, but, as Tolstoy explains, "[her] attitude to Ivan Ilyich's illness, as she expressed it both to others and to him, was that it was his own fault and was another of the annoyances he caused her." He continues, "he had to live thus all alone on the brink of an abyss, with no one who understood or pitied him."