While the tumor was fake, Tommy’s real-world symptoms like seizures and hallucinations were likely triggered by extreme stress, PTSD , or alcohol withdrawal after he stopped drinking earlier in the season.
By the end of the season, Tommy burns his wagon and personal effects, symbolizing the death of his old gangster identity. He rides away on a white horse , signifying a fresh start as a man no longer bound by his past. [S6E4] Why Is Tommy Still Alive?
However, the reason Tommy is "still alive" by the end of the series is one of the show's biggest twists. It turns out he was never actually terminally ill. The Great Deception While the tumor was fake, Tommy’s real-world symptoms
Mosley used Dr. Holford—a fellow fascist—to convince Tommy he was dying, hoping Tommy would take his own life to avoid a slow deterioration. However, the reason Tommy is "still alive" by
A recurring theme is that Tommy "died" in the tunnels of WWI in 1918, and everything since has been "borrowed time".
Tommy only discovers the truth in the series finale after seeing a newspaper clipping of Mosley’s wedding, which featured Dr. Holford as a guest. Why He Didn't Die
In Peaky Blinders Season 6, Episode 4, titled "Sapphire," Tommy Shelby receives a devastating medical diagnosis that seems to seal his fate: an in his brain stem. His doctor, Dr. Holford, gives him just 12 to 18 months to live, explaining that the growth was likely contracted from his daughter, Ruby.