Living (2022): A Terminal Diagnosis, Unnamed

London, 1953. Mr Williams is a senior clerk in the County Council's Public Works department, a man reduced to a bowler hat and a habit of moving awkward files to the bottom of a pile. A hospital appointment tells him he has cancer and only months to live.

Spoilers throughout. Mr Williams keeps his diagnosis to himself. This page does not.

He cannot say it to his son and daughter-in-law. He withdraws his savings, goes to the seaside, and asks a stranger — a bohemian writer — to show him how to enjoy himself. The night out leaves him hollow. Back in London he keeps seeking out Margaret, a young former colleague whose appetite for life he envies, until she guesses the truth.

Then he goes back to the office. Local women have petitioned for a children's playground on a bombsite, and he drives through the obstruction that has stalled it. He dies not long after it opens, last seen on a swing in falling snow. At his funeral his colleagues vow to work as he did, then quietly slide back.

Oliver Hermanus directs from a screenplay by Kazuo Ishiguro. It is an English-language remake of Kurosawa's Ikiru, transplanted to postwar England.

The film is precise about a specific kind of appointment: the one where treatment stops being the subject.

It is just as precise about what many people do next, which is nothing. Williams cannot say the word to his son. He rehearses the sentence silently and abandons it. He becomes suddenly intimate with near-strangers, because they carry no history and expect nothing. Anyone who works in palliative care recognises all of this.

The physical decline is understated but correct in kind. Tiredness. A shrinking appetite. A growing stillness rather than a dramatic collapse.

The film also captures something clinicians see constantly and scripts rarely use. People given a short prognosis often want, above everything, to finish one concrete thing that will outlast them. That can matter far more to them than any medical decision, and it is worth asking a dying relative what theirs is.

The film shows no oncology, no palliative care team, no district nurse, and no symptom control of any kind. Williams stays upright, tidy and able to walk to work and lobby committees almost to the end. His death happens offscreen and appears serene.

The 1953 setting explains part of this. Diagnoses were often withheld, treatment options were thin, and the modern hospice movement did not yet exist. It is not a fair complaint that a period film shows period medicine.

The risk is that a modern viewer reads it as a forecast. The last months of an untreatable abdominal cancer usually bring significant pain, nausea, marked weight loss and increasing dependence on other people. All of those are treatable. A district nurse visiting the house, medicines kept ready for a bad night, and a palliative team who answer the phone are the difference between Williams's decline and a manageable one.

The film never names the cancer. Its source, Ikiru, gives the equivalent character stomach cancer, so that is the closest real subject.

Gastric cancer is notorious for early symptoms that read as ordinary indigestion. NCI's list for early disease is deliberately unremarkable:

• Indigestion and stomach discomfort.
• A bloated feeling after eating.
• Mild nausea.
• Loss of appetite.
• Heartburn.

Later signs are harder to explain away: stomach pain, vomiting, blood in the stool, unintended weight loss, trouble swallowing, jaundice, and fluid collecting in the abdomen. Slow bleeding from a tumor can also cause anaemia, so the first sign is sometimes just being unaccountably tired and pale.

NCI is direct about the consequence: early on, stomach cancer usually causes no symptoms, and symptoms tend to begin only after it has spread.

There is no routine stomach cancer screening in the United States for people at average risk, and NCI says so plainly. Britain does not screen for it either. The NHS cancer screening programmes cover cervical, breast and bowel cancer, with lung health checks now offered in parts of England to people aged 55 to 74 who have ever smoked. Stomach cancer is not on the list, because it is not common enough here for population testing to do more good than harm.

Endoscopy — a thin camera passed down to look at the stomach lining — is offered instead to people at higher risk, on specialist advice. That includes people with certain inherited syndromes and people with known precancerous changes in the stomach lining.

For everyone else the safeguard is time. Indigestion that has gone on for several weeks and is not settling should be assessed rather than managed indefinitely from a pharmacy shelf, and much sooner if it comes with weight loss, vomiting or food catching when you swallow.

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Living is a film about what a person does with a deadline, and it is very good at that. It is not a description of how the last months of an untreatable cancer feel, and it should not be used as one. The thing to carry out of the cinema is smaller: symptoms that stop being temporary deserve an appointment, and a diagnosis you cannot say out loud is much heavier carried alone. Living cannot tell you what to watch for, but screening and possible warning signs can.

This page discusses Living for education. It is not medical advice, and nothing here is a judgement of anyone's real medical care. Spotted an error? Please email corrections@cancerexplained.org.