Of what would be his final symphony, Tchaikovsky wrote in a letter to his brother Anatol in February 1893: “I am now fully entrenched in the new work and I find it difficult to pull myself away from it. I believe it will be one of my best works. I must complete it as soon as possible.” His brother Modest suggested that the symphony should be titled Pathétique, which Tchaikovsky approved. The first movement shifts between bottomless darkness and exalted beauty. The second movement is an elegant waltz, while the third is quick and explosive. The final movement is slow and contemplative, filled with pain. 

There is no reason to doubt that the music gives shape to his own sense of exclusion and dread. Just nine days after the unsuccessful premiere performance in St. Petersburg on 28 October 1893, Tchaikovsky passed away in the throes of cholera after drinking a glass of contaminated water. It has been speculated that a court of honour of conspirators was behind his death, and that he was sentenced to empty the glass because of his homosexuality.