The opera begins at the end; Pyotr Ivanovich arrives at the wake of Ivan Ilych to pay his respects to Praskovya Fedorovna, his widow. Social pleasantries give way to the cause of Ivan Ilych’s death. The doctor admits sadly he could not diagnose the ailment, nor prescribe a cure. They agree it’s a shame that Ivan Ilych died so young.
The scene shifts and flashes back to the Ilych family at dinner. Ivan Ilych complains of having no appetite and everything tastes off. Praskovya asks her husband to see a doctor and Ivan Ilych reluctantly agrees. Praskovya continues to fuss over her husband, who appears ungrateful for her help. Once gone, Ivan Ilych wonders aloud why he ever became a judge, a position that has brought him no joy.
Ivan Ilych is alone with his thoughts. He considers the larger world and the ineffability of life. He hangs his head and recalls his childhood. He believes his life is like a falling stone, “flying further and further towards its terrible end.” Ivan Ilych, knowing he has not been a loving husband starts a process of atonement.
Praskovya is alone with the doctor. He tells her Ivan Ilych's death is a certainty and both must accept this irrefutable fact. Surrounded by family, Ivan Ilych calls for death and finds light in the end. He dies with joy.