齊瓦哥醫生在1922蘇維埃時期終於回到了莫斯科，但物價更貴，生活更苦，大家都在搞投機，例如把家裡的舊貨拿到跳蚤市場轉賣好幾手抬價。
知識分子放棄當時常用的文化語言法文，改用勞工階級口氣說話（彷彿今日的美國）。齊瓦哥在那種時刻回故鄉，能對未來有什麼盼望呢？
總之，書裡有一段話，恰到好處地形容了藝術（或神）在亂世的目的：
"Everything had changed suddenly--the tone, the moral climate; you didn't know what to think, whom to listen to. As if all your life you had been led by the hand like a small child and suddenly you were on your own, you had to learn to walk by yourself. There was no one around, neither family nor people whose judgment you respected.
At such a time you felt the need of committing yourself to something absolute--life or truth or beauty--of being ruled by it in place of the man-made rules that had been discarded. You needed to surrender to some such ultimate purpose more fully, more unreservedly than you had ever done in the old familiar, peaceful days, in the old life that was now abolished and gone for good."
"說話語氣、道德氛圍都不一樣了；你不知道該想什麼，該聽誰的。彷彿曾一輩子像小孩被牽著手，突然間得靠自己，學會自己走路。這種時刻，你需將自己奉獻給某種絕對——生命、真理或美——並受其統治，取代人為規則。你得比過去更臣服於更巨大的終極目標。"
