The Best Man Holiday (2013): Dying Over Christmas

Fifteen years on, novelist Harper Stewart is broke and blocked. He secretly agrees to ghostwrite a biography of his estranged college friend, the retiring NFL star Lance Sullivan. Lance's wife Mia gathers the old group at their home for Christmas, and buried grievances resurface.

During the visit Harper finds Mia downstairs, vomiting blood. She tells him her cancer is terminal and asks him to help prepare Lance for it. She later collapses in front of the women, and the secret goes public.

Spoilers below. This page discusses Mia Sullivan's diagnosis, the football game she sends her husband to, and how The Best Man Holiday ends.

The film uses this as a reveal. Mia is found bleeding, she swears Harper to secrecy, and the story carries on downstairs.

MedlinePlus, the patient service of the US National Library of Medicine, is blunt about it. Get medical attention right away. Contact your health care provider or go to the emergency room if vomiting of blood occurs, because you need to be examined right away.

It also describes what you might actually be looking at, which is more varied than the movie version. Vomited blood may be bright red, dark red, or look like coffee grounds. It may be mixed with food or be blood alone. And it can be hard to tell apart from coughing up blood from the lung, or from a nosebleed.

The causes MedlinePlus lists run from the minor to the serious. Hard, repeated vomiting can tear small vessels in the throat. It can also tear the lower food pipe. An ulcer may bleed, in the stomach, the small bowel or the food pipe. Swollen veins called varices may bleed, which MedlinePlus links to severe liver damage. Other causes include a sore stomach lining, clotting problems, blood swallowed after a nosebleed, and tumours of the mouth, throat, stomach or food pipe.

Someone in Mia's situation has a further reason to move fast. NCI notes that some cancer treatments lower the platelet count, and lists bleeding when you vomit among the more serious problems to call a doctor or nurse about.

Knowing what is on the other side of the door makes it easier to walk through.

MedlinePlus lists the questions first. When did it start. Has it happened before. How much blood was there, and what colour. Have there been recent nosebleeds, dental work, surgery or bad coughing. Then come tests. They may include blood counts and clotting tests. They may also include an EGD, a lit tube with a camera passed through the mouth to look at the food pipe and stomach.

If a lot of blood has been lost, MedlinePlus says the treatment may include oxygen, fluids into a vein and a transfusion. It may also include drugs to cut stomach acid, and work through the EGD to stop the bleeding. Surgery is used if the bleeding will not stop.

None of that requires a diagnosis first. That is the point. Recognising cancer emergencies covers the small set of symptoms that override whatever else is happening.

Mia hosts, mediates and manages everyone else's feelings, with no visible clinical support of any kind.

In practice, someone in her position would have palliative care involved. NCI describes it as care meant to improve quality of life in a serious illness, which can be given with or without treatment aimed at cure, and which anyone can receive regardless of age or stage. It is given by specialists who usually work in a team. NCI says that team may include nurses, dietitians, pharmacists, therapists, chaplains, psychologists and social workers.

The list of what it covers reads like Mia's week. Physical symptoms: pain, fatigue, poor appetite, sickness, breathlessness, no sleep. Emotional support, for the patient and the family. Carer needs, which NCI names directly. It notes how often carers are overwhelmed. And practical needs: money and legal worries, insurance, work, and the talks about what the care is for. Palliative care sets it out.

The film's sharpest instinct is that the blockage is not medical. Mia has already done her grieving. Lance is still bargaining, and until he stops, nothing can be planned or said.

She breaks it by taking off her wig so he has to look at her. That is a recognisable dynamic in households where one person insists on a miracle. NCI's palliative care description includes exactly this work: helping guide communication among family members, carers and the care team.

What the film gets wrong is time. Mia is well enough to host a large gathering, referee several arguments and make phone calls during a football game, then dies within a day or two of collapsing. Her symptoms appear when the plot needs them. And there is one correction worth stating plainly, because it has circulated: this film has nothing to do with prostate cancer. Mia is the only character with a cancer storyline at all.

Cancer Explained is free to read and free of advertising. If one reader treats vomiting blood as an emergency because of this page, it has paid for itself. Support our work.

The Best Man Holiday is honest about how a terminal diagnosis becomes public inside a friendship group, and dishonest about the pace of dying. If one detail sticks, make it the right one. Vomiting blood means being examined right away, not after the party.

• MedlinePlus — Vomiting blood
• NCI — Bleeding and Bruising (Thrombocytopenia) and Cancer Treatment
• NCI — Palliative Care in Cancer

This page discusses The Best Man Holiday for education. It is not medical advice, and nothing here is a judgement of anyone's real medical care. Spotted an error? Please email corrections@cancerexplained.org.