Abstract
Tolstoi's novel The Death of Ivan Ilych provides an instructive, though fictional case history of individual and family suffering. A contrasting actual case history is presented here in which a visiting nurse was asked to help an elderly woman care for her terminally ill husband at home. Husband and wife were both of Russian heritage. The experiences of the Ilych's and the Tchinsky's are compared with respect to the dimensions of consciousness, pain, communication network, relationship, life value, at-home services, and the nature of the dying person's physical being as a transactional symbol. These observations are then examined with respect to current theoretical approaches to understanding the process of dying. The usefulness and limitations of these theories are briefly examined. The dying person's physical being and its symbolic construction and communication are relatively neglected by current theories. A suggestion is made for the development of a contextual theory of dying that would be more inclusive, integrated, and helpful to caregivers.
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