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.

NCI describes how, in 1962, a US Department of Agriculture botanist collected bark from the Pacific yew tree. Researchers later isolated paclitaxel (Taxol) from that bark.

It is still used today. MedlinePlus lists breast, ovarian and non-small cell lung cancer, and Kaposi sarcoma related to AIDS. It is also used off-label for some other cancers.

MedlinePlus lists these common side effects:

• Numbness in the hands or feet.
• Muscle pain.
• Nausea and vomiting.
• Hair loss.

It can also lower white blood cell counts, which raises infection risk. Patients get medicine beforehand to help prevent allergic reactions. A fever of 100.4 F or higher during treatment needs a call to the care team right away.

So the film's central image is true. A tree did give us a cancer drug. What the film does with it, offering it as a last dramatic gamble, is a story choice.

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. The experimental drug is presented as a single gamble, with no talk of choices or odds. Real illness is rarely so tidy, and your own team can tell you what to expect.

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. 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.

For many cancers, USPSTF does not recommend routine screening in this age group, so symptoms matter.

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 (yellowing of the skin or eyes).
• A new mole or a changing one.
• Fatigue.
• Weight changes.

Its instruction is plain. NCI says these symptoms are most often caused by illness, injury, benign tumors or other problems. But symptoms that do 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. The film never says the word cancer, which is close to how it works in a house with a sick parent and a child nobody has told.

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
• NCI — The Pacific Yew and Taxol
• MedlinePlus — Paclitaxel
• 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.