The Barbarian Invasions (Les Invasions barbares) (2003)

Rémy is a hedonistic, argumentative history professor in Montreal. He is dying of cancer in a public hospital so crowded that patients lie along the corridors.

His ex-wife calls their estranged son, Sébastien, a derivatives trader in London who despises almost everything his father stands for. Sébastien arrives and solves the problem the only way he knows. He pays hospital administrators and a union official to open and fit out a disused floor as a private ward. He pays for a scan across the border in the United States.

He also finds Nathalie, the heroin-dependent daughter of one of his father's old lovers. When morphine stops holding the pain, he pays her to buy heroin.

Then he gathers his father's circle at a lakeside cottage. Friends, colleagues, former lovers. They eat and argue and keep vigil. Rémy picks his moment, and Nathalie gives him a final, deliberately fatal injection while his son and friends sit with him.

Spoilers throughout. How Rémy dies is central to the film and is discussed openly here.

Dramatically this works. Medically it points people in the wrong direction.

The film's logic is that when prescribed morphine fails, the answer lies outside the system. Buy something stronger from a dealer. That is not what happens in good cancer care, and it is not what the drug itself represents.

The film's problem is not only the drug. It is that nobody offers Rémy a specialist.

Uncontrolled cancer pain is rarely the end of the options. It is usually the point at which a palliative care team gets involved, and they have a longer list than a ward has.

NCI's pain guidance describes a step-by-step approach: checking pain regularly and describing it carefully. Opioid doses can be converted when a person moves to a different opioid. Other medicines, such as gabapentin, pregabalin or duloxetine, can be added for nerve pain. And opioid side effects such as constipation and nausea are treated too.

NCI describes palliative care as care to improve quality of life in serious illness, given with or without treatment aimed at curing. Anyone can have it at any age and at any stage. It is not the same as hospice, which begins when cure is no longer the goal.

Asking for a referral is the move the film never lets its characters make.

Many people worry about strong painkillers. If you do, say so to your team. Ask what the medicine is for, what to expect and how side effects are handled. Do not leave pain untreated because of fear.

The film ends on a deliberate overdose. That is euthanasia, a separate question with its own law and its own arguments. It is not what pain management is.

Rémy's disease is never named or staged. So nothing in the film can tell you how it might have been caught earlier, and this page will not invent an answer.

What can be said is more general and more useful.

There is no general test that checks an average-risk adult for cancer overall. The CDC supports screening for four: breast, cervical, colorectal and lung.

The US Preventive Services Task Force sets the detail:

• Colorectal cancer: screen adults aged 50 to 75 (grade A) and adults aged 45 to 49 (grade B).
• Breast cancer: a mammogram every two years for women aged 40 to 74 (grade B).
• Cervical cancer: screening from age 21 to 65 (grade A), by cytology every three years, or from 30 by HPV testing every five years, or both together every five years.
• Lung cancer: a yearly low-dose CT scan for adults aged 50 to 80 with a 20 pack-year smoking history who still smoke or quit within the past 15 years (grade B).

For everything else, including cancers of the pancreas, liver, stomach and brain, detection depends on somebody reporting a symptom.

NCI lists signs that deserve a call to your care team. Weight gain or loss for no known reason. Severe fatigue that lasts. Swelling or lumps. Blood in the stool or urine. Changes in bowel habits. A cough or hoarseness that does not go away. Bleeding or bruising for no known reason. None of these means cancer, but all are worth getting checked.

The gap between what a health system can deliver and what a dying person needs is real, and so is the fact that money buys around it.

The social portrait is exact. Friends who cannot say the important thing. Former lovers with unfinished business. An adult child doing practical tasks because the emotional ones are unbearable. And the way the last phase becomes less about cure and more about who is in the room.

Where it may flatter reality is Rémy himself, who stays witty and mobile almost to the end. Real illness varies, and this page does not claim to say how his would go.

This page has no sponsor and no shop attached. If the section on pain control gave you something to ask for, you can help keep it available. Support our work.

The Barbarian Invasions is a fine film about dying badly in a good system. Its central medical suggestion, that the answer to unbearable pain lies with a dealer, is the part to leave behind.

The real answer is duller and better. Ask for palliative care, ask early, and ask again if the pain is not controlled.

• https://www.cancer.gov/about-cancer/advanced-cancer/care-choices/palliative-care-fact-sheet
• https://www.cdc.gov/cancer/prevention/screening.html
• https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/colorectal-cancer-screening
• https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/lung-cancer-screening
• https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-screening
• https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/cervical-cancer-screening
• https://www.cancer.gov/about-cancer/treatment/side-effects/pain/pain-hp-pdq
• https://www.cancer.gov/about-cancer/diagnosis-staging/symptoms

This page discusses The Barbarian Invasions 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.