Dying Young (1991): Leukemia and the Hired Carer

Hilary O'Neil is out of work and out of a bad relationship. She answers an advertisement and becomes live-in carer to Victor Geddes, a wealthy man in his late twenties who has had leukemia since childhood. She has no nursing background. She reads up on the illness and learns the job as she goes, nursing him through a punishing course of chemotherapy.

When the course ends, the two of them move to a rented house on the coast, and the working relationship becomes a love affair. Then Hilary finds used syringes in the rubbish.

Spoilers below. This page says what Victor Geddes has been hiding in Dying Young, and why the film's ending leaves it open.

Victor admits he has been dosing himself with morphine, and that he never finished his treatment. He decided he would rather live well than be treated, and he told nobody.

Both halves of that deserve to be pulled apart, because the film runs them together as a single betrayal.

Deciding that treatment costs more than it buys is a legitimate decision. People make it thoughtfully, and a care team can work with it. What causes harm is the secrecy. A team that does not know you have stopped cannot support the decision, cannot manage what happens next, and cannot stop you improvising with drugs.

The film half-understands this. Victor hides the decision because telling the people who love him would mean an argument about it. That is a real reason, and it is the reason most people give.

Victor's second secret is that he has been treating his own pain. The film treats this as tragic. In practice it is the part with the most obvious alternative.

NCI opens its pain guidance with something worth quoting almost directly: having cancer does not mean you will have pain, but if you do, it can usually be controlled with pain medicine and other approaches. It also warns that trying to "deal with" pain can make it harder to control later. Pain, it says, is not something you have to put up with.

There is a whole apparatus behind that. NCI notes that some hospitals have pain specialists who work as a team, which may be led by your own doctor or by a palliative care specialist, and can include a nurse, a pharmacist, an acupuncturist, a surgeon, a psychiatrist or a psychologist.

Morphine is on the list, but it is one option among several. NCI groups pain medicines into over-the-counter drugs, prescription medicines such as antidepressants, antiseizure drugs, muscle relaxants or steroids, and opioids for moderate to severe cancer pain. Which one, how much and when are questions with answers. Cancer pain and symptom relief covers the ground.

The mechanics of pain control depend entirely on honest reporting, and this is where Victor's secrecy actually bites.

NCI describes the plan as something built and then adjusted. The team asks whether the medicine is lowering the pain, how much you take, when and how often, and whether the side effects are bothering you. They ask whether you would like to try acupuncture, mindfulness, hypnosis or guided imagery alongside it. Then they change the type or the dose based on your answers.

None of that works on a fictional dataset. NCI also says to take the prescribed amount at the scheduled time, and not to wait until pain is bad, because waiting means it takes longer to settle or needs more medicine.

So if you have quietly stopped taking something, or quietly started taking something else, that is worth saying out loud at the next appointment. Nobody is going to be surprised, and the plan cannot be corrected without it.

The film's other honest note is Hilary. She has no training, no support and no time off, and she slides from employee into family without anyone noticing it happening.

That is much closer to most people's experience than the coastal house suggests. Wealth is doing a lot of work in this film: it removes cost, logistics, employment and waiting, which lets the story treat illness as pure emotion. Strip that away and the carer is the person absorbing the shortfall. See caregiver burnout.

To the film's credit, it does not flinch from chemotherapy itself. Here it is an ordeal rather than a montage, which was not the norm for its era.

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Dying Young is a romance with a hospital in it, and it never names the disease at its centre. What it does capture is worth keeping. A person can decide they would rather live well than be treated. The damage comes from making that decision alone.

• NCI — Pain and Cancer
• NCI — Leukemia, Patient Version

This page discusses Dying Young for education. It is not medical advice, and nothing here is a judgement of anyone's real medical care. Spotted an error? Please email [email protected].