Season 6 of Peaky Blinders might be unfolding more slowly than many anticipated given that it's the drama's final TV outing, but there's still plenty happening, as episode 4 showcased.

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Following the death of his daughter Ruby, Tommy gunned down Bethany Boswell's sister Evadne and some of her family members "on behalf of the blue sapphire". A short time later, he also learned from Esme that he has another son, Duke, who is the product of a single encounter he had with a woman named Zelda before heading off to France in 1914.

In that same episode, Tommy opened his front door to Sir Oswald Mosley, Diana Mitford, Captain Swing aka Laura McKee and mobster Jack Nelson to discuss their grand plan to ensure that fascism prevails.

After performing a Nazi salute at Mosley's request to prove his loyalty to the cause, Jack granted Tommy permission to import his heroin into Boston. Mosley is also under the impression that Tommy will, when the time is right, resign from the Labour party and run as an independent, in turn bringing with him one of the largest Commons majorities in the country.

We also learned that Gina and Mosley have been spending some quality time together, so to speak, with Tommy now using her as a pawn in his ploy. He instructed her to travel to Germany with Mosley and report back on what's said during his interactions with German government officials.

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After swearing off the hard stuff for more than four years, Tommy also treated himself to a single sip during an intimate exchange with his brother Arthur as they reminisced about simpler times, before Polly's death, Mosley, Luca Changretta, Chester Campbell, and the war. A time when they were just boys, free of the weight that strangles them both during their waking moments and their nightmares, too.

But all of that paled in comparison to what we learned in the episode's final moments when Tommy discovered that his future is more uncertain than ever.

Cillian Murphy as Tommy Shelby in Peaky Blinders
BBC/Caryn Mandabach Productions Ltd/Robert Viglasky

Following Ruby's diagnosis, both Tommy and Lizzie were examined for signs of the disease, but unlike Lizzie, who was given the all-clear, Tommy's fate looks bleak.

The doctor informed the head of the Shelby clan that he has tuberculoma, a non-cancerous growth or tumour brought on by his daughter's illness. It isn't a brain tumour, but the symptoms – headaches, seizures, changes in brain function and behaviour – mimic the condition.

According to the doctor, the growth, which is located in the brain stem – the lower part of the brain that connects it to the spinal cord – is "inoperable" and "any attempt to remove it would result in trauma and brain hemorrhage", which can lead to death in 12–24 hours if the bleeding is "extensive and rapid".

"How bad will it get?" asked Tommy.

"As the tumour grows, the rate of physical and mental deterioration will increase," he replied. "Eventually, you will need people around you constantly."

It will be one year, perhaps 18 months before Tommy reaches that point.

But is this really the beginning of the end for Tommy F**king Shelby? Of all the enemies he has encountered, will this be the one that stops him in his tracks?

Cillian Murphy in a suit as Tommy Shelby in Peaky Blinders
(C) Caryn Mandabach Productions Ltd. - Photographer: Robert Viglasky

There is one specific case from 1933, highlighted in Wired (via the British Medical Association/ Wellcome Trust), in which surgeons carried out brain surgery to remove a tumour caused by tuberculoma. Miraculously, the patient not only survived but went on to make a full recovery, bar some "minor movement problems".

The doctor told Tommy that neither himself nor his colleagues would operate on him due to the futility of the endeavour, but is there someone out there who would be so bold and attempt to save his life? And would they succeed?

Given the gulf between modern medicine and what professionals were working with in the early 1930s, Tommy's chances of going on to life a full life are, realistically, non-existent. The less advanced methods available during that period, plus the absence of vital drugs, put him at a severe disadvantage – and even if the tumour was removed, Tommy would still be infected with tuberculosis.

This could, indeed, be it.

But there's a degree of hope, however slim, and with Tommy set to feature in the Peaky Blinders movie, we're choosing to believe that he will, once again, do the impossible.

Looking for something else to watch? Check out our TV Guide or visit our dedicated Drama hub for the latest news.

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