Ivan Illych has devoted his life to propriety, rising up the social ladder and having better material possessions and wealth. He is superficial and shallow, he is surrounded by the same type of people, even his family is formal and distant for the most part.
When he gets hurt, falling as he tries to hang curtains, a silly, pointless exercise, his life is changed. He becomes a prisoner of pain and his thoughts about death. He is comforted by the simple kindness of a peasant named Gerasim, who acts as his nurse. Observing this man, Ivan Illych cannot imagine why he is so content with his life.
Illych begins to see that his life is very artificial. As he lays dying, he begins to embrace the true meaning of life. He then understands his simple peasant nurse's contentment. He understands his misplaced priorities and begins to worry that he has not lived a good life.
Embracing an expanded consciousness is the only way that Ivan Illych can make peace with himself. He must examine his soul and find a way to face death. All the physical, superficial aspects of life that he has worshiped all his life, fade in the background of his accounting of the value of his life.
Spending his last days with his son and his servant, Ivan Illych is at last able to embrace death. It becomes an escape from his physical existence that no longer has value.
It is only the spirit that matters now.
Growth through consciousness is extremely important in this book. A prime example is Ilyich himself. He has much time to reflect on his life when he falls terminally ill and he realizes in the last days of his life that he has not lived the way he should have. He has filled his days with too much hate and loathing. He finally is able to take pity on his wife and others he despised and dies with this sense of peace, although he suffers greatly physically before he dies.
In the last section, Tolstoy turns to giving Ivan's reactions to his illness, to describing his feelings and his questioning of the meaning of life and death. In this way, he emphasizes the epiphany that Ivan experiences at the moment of death.