The Worst Person in the World (2021)

Julie, in her late twenties in Oslo, drifts between medicine, psychology, photography and writing while trying to work out who she is. She spends years with Aksel, a successful underground comics artist fifteen years older who wants children, then leaves him for Eivind, a barista she meets after wandering into a stranger's party. The story is told in twelve chapters with a prologue and epilogue. In the later chapters Aksel's brother finds Julie at work and tells her Aksel has pancreatic cancer that cannot be cured. Julie goes back to him. She visits the hospital, photographs him, and they revisit the flat and streets they shared. Thinner and frightened, Aksel talks about a life measured in the objects and records that will outlive him, and about having wanted a life with her. His brother leaves a voicemail saying Aksel is unlikely to survive the night. Julie walks through Oslo until sunrise. She also miscarries a pregnancy. The epilogue finds her working as a stills photographer, alone and steadier.

Spoilers throughout. Discussing the cancer storyline means discussing how this ends.

The film gets the shape of a late pancreatic diagnosis right: nothing found early, then news that arrives already incurable, with the conversation moving straight to how long rather than whether. Aksel's decline is shown honestly — weight loss, a hollowing face, the shift from outpatient visits to a hospital bed, appetite and energy draining away. Trier is unusually good on the social mechanics of terminal illness: the news reaching an ex-partner second-hand through family, the awkward question of who is entitled to grieve, and visitors running out of things to say. Aksel's monologue about mourning a life of small ordinary things, rather than fearing death in the abstract, matches what many patients actually describe.

Aksel stays lucid, verbally dazzling and largely comfortable almost to the end. Real advanced pancreatic cancer usually brings severe pain, jaundice, digestive failure, profound weakness and often heavy sedation in the final weeks. The clinical journey is compressed to almost nothing — no staging discussion, no chemotherapy side effects, and little sign of the palliative care team who would in practice be central. That is a defensible artistic choice, since the film is about Julie rather than Aksel's illness, but viewers should not read the tidiness of his dying as typical.

Pancreatic cancer's defining problem is lateness. NCI states that early on pancreatic cancer may cause no signs or symptoms, which is why most cases are found once already advanced. When symptoms do appear they are easily mistaken for something else: jaundice (yellowing of the skin and whites of the eyes), pain in the upper or middle abdomen that can go through to the back, unexplained weight loss, loss of appetite, fatigue, light-coloured stools and dark urine. New diabetes appearing in an older adult can also be a clue. None of these are specific; painless jaundice is the sign that most reliably sends people to a doctor. There is no screening for average-risk adults. The US Preventive Services Task Force recommends against screening for pancreatic cancer in asymptomatic adults (Grade D, 2019), because available tests do more harm than good at population level. Surveillance with MRI or endoscopic ultrasound is offered only through specialist programmes to people with strong inherited risk, such as certain genetic syndromes or marked family history. Persistent unexplained jaundice, abdominal or back pain, or weight loss should be assessed promptly.

A film is not a diagnosis, and a dramatised illness is not a guide to your own. What a story like this is genuinely good for is lowering the barrier to a conversation you might otherwise put off.

If something in your body has changed and stayed changed for a few weeks, that is worth raising with a doctor — not because it is likely to be cancer, but because most of the time it will not be, and finding that out is the point. Where screening exists for a cancer, it is the one thing you can do before anything is wrong at all. See screening and possible warning signs.

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The Worst Person in the World is worth watching as a film. It is not a guide to the disease it portrays. The gap between the two is what this page is for — and the thing worth carrying away is that a change which persists is worth a conversation, whatever a story led you to expect.

This page describes a work of film or television 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].