A Monster Calls (2016): A Cancer Never Named

Conor O'Malley is about thirteen. He lives in a small English town with his mother, who is having treatment for cancer. He makes her breakfast. He washes up. At school a boy called Harry beats him, and everyone else looks through him.

At 12.07 each night, the yew tree in the graveyard walks over as a monster. It tells Conor three stories. Each one refuses the clean moral he expects. The good prince is a murderer. The bad-tempered apothecary is right.

In exchange, the monster wants a fourth story. Conor's own.

His mother's treatments fail one after another. The last is a drug drawn from that same yew. His grandmother takes charge of him. His father visits from America and cannot stay. Conor finally says what happens in the nightmare. He lets go of her hand, because part of him wants the waiting over. She dies at 12.07.

Spoilers throughout. This page says how A Monster Calls ends.

Most films that reach for a plant remedy are making it up. This one is not.

Paclitaxel was originally named taxol. StatPearls describes it as a naturally occurring diterpenoid compound extracted from the Pacific yew tree, Taxus brevifolia.

It is still a workhorse drug. It is given for breast, ovarian, lung, bladder and several other cancers. StatPearls lists its main adverse effects as hair loss, nausea and vomiting, mucositis, low blood counts, hypersensitivity reactions, joint and muscle pain, and peripheral neuropathy.

So the film's central image is literally true. A tree in a churchyard did produce a cancer drug. What the film does with it, offering it as a last dramatic gamble, is not how it works. Paclitaxel is not a final throw of the dice. It is a standard agent with a boxed warning, given with steroid and antihistamine premedication.

No diagnosis, stage or type appears anywhere in the film or the novel.

That choice serves the story. It also means the illness cannot teach anything. There is no test to describe, no decision to explain, no reason given for why one treatment followed another.

The decline is compressed into shorthand: pallor, a headscarf, a hospital bed. In the last scene she is gentle and lucid. Advanced cancer in a young woman often involves breathlessness, sedation, and long stretches when she would not be reachable at all.

The experimental drug is presented as a single gamble. In practice that route involves eligibility criteria, a consent conversation, and an honest account of the odds.

Here the film is unusually precise, and it is worth saying so.

It catches the role reversal. A boy doing the cooking and the dishes. It catches the invisibility at school, where nobody knows what to say so nobody says anything. It catches adults speaking in euphemisms, then being surprised the child is furious.

Its central insight is the real one. People caring for someone who is dying often wish for it to be over, and then feel monstrous for having wished it. Naming that as ordinary rather than shameful is the most useful thing the film does.

Because the cancer is unnamed, the honest thing to describe is what would actually be on offer.

For an average-risk woman in her thirties in the United States, USPSTF recommends cervical screening and nothing else. From 21 to 29, cytology every 3 years. From 30 to 65, one of three options: cytology every 3 years, high-risk HPV testing alone every 5 years, or HPV testing with cytology every 5 years. All are Grade A.

Mammography starts later. USPSTF recommends biennial screening mammography for women aged 40 to 74, a Grade B recommendation.

Colorectal screening starts at 45. That is a Grade B recommendation for ages 45 to 49, and Grade A from 50 to 75.

There is no general blood test that rules cancer in or out for someone with no symptoms. For most cancers in young adults there is no screening test at all.

That gap is why symptoms carry the weight.

NCI's list of changes cancer may cause includes a lump anywhere, unexplained bleeding or bruising, a cough or hoarseness that does not go away, a sore that does not heal, jaundice, a new mole or a changing one, severe lasting fatigue, and weight loss or gain for no known reason.

Its instruction is plain. Symptoms are most often caused by illness, injury, benign tumors or other problems. But anything that does not get better after a few weeks should be seen by a doctor. NCI adds that cancer often causes no pain, so pain is not a threshold to wait for.

That is what a story like this is genuinely good for. Not diagnosis, but the push to make an appointment that has been drifting. Cancer Explained is free and ad-free, and you can support this work if it helped.

For the screening picture in full, see cancer screening. For what a symptom does and does not mean, see symptoms of cancer.

• USPSTF — Cervical Cancer: Screening
• USPSTF — Breast Cancer: Screening
• USPSTF — Colorectal Cancer: Screening
• StatPearls — Paclitaxel (NCBI Bookshelf, NBK536917)
• NCI — Symptoms of Cancer

This page discusses A Monster Calls for education. It is not medical advice, and nothing here is a judgement of anyone's real medical care.