1. Seagreen
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    Seagreen New Member

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    Any suggestions for a terminal illness for a character?

    Discussion in 'Research' started by Seagreen, Aug 29, 2016.

    Hello. My WIP needs an illness that was undetected until it escalated to point of no return. Patient needs to be lucid but tired. Was hospitalized for a few days (after a collapse, and following diagnosis) but then able to return home for last week before dying. (Monitors and palliative nurses can be supplied.)
    Was thinking brain tumour. Basically patient needs to be diagnosed and dead within 1-2 weeks but lucid. Can anyone advise on anything else that would fit the bill/plot?
    Apologies for gloominess. Any suggestions gratefully accepted.
     
  2. Jarvis XIX
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    Jarvis XIX Member

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    I would say a cancer is probably your best bet. Possibly not in the brain however, as I believe it could effect cognition and that may remove the lucidity you're after.

    Perhaps something cardiovascular would work, you could always riff on the "broken heart" allegory then.
     
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  3. Scot
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    Scot Active Member

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    Bile duct cancer (biliary system). Google it. Pretty much symptomless until too late.
    (Family experience)
     
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  4. Seagreen
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    Seagreen New Member

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    Thanks for your advice gents. Definitely good suggestions. And sympathies to you, Scot regarding your family member.

    My story needs something clean and fast. Two weeks after diagnosis would be ideal. But yes, do need coherence.

    Thanks again
     
  5. Sifunkle
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    Sifunkle Dis Member

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    Can you elaborate on 'lucid/coherent'? - still conscious of the outside world? Able to communicate? All the usual senses still intact? Etc?

    Also a bit unsure what you mean by 'clean' - no discharges, vomiting, diarrhoea, bleeding, etc? No surgery? Something else?

    A brain tumour could kill quickly after detection, but they're often only detected because a patient suddenly loses various brain functions, which may interfere with your lucidity, as @Jarvis XIX said.

    The target body systems that kill most quickly are brain, circulatory and respiratory (also probably those most likely to result in collapse, if by that you mean fainting/syncope). Of course, they could be affected secondary to failure in other organs, but that might complicate the cleanliness you're after. I'm inclined to agree that some type of cancer might be the simplest solution to work with in fiction - cancer (particulary lymphoma-type ones) is sometimes referred to as 'the great pretender' or similar as it can mimic so many other types of illness, depending on where it's spread throughout the body. You could pick a type of cancer with a high capacity for metastasis (spread to distant sites in the body) - perhaps it hasn't caused obvious problems in whatever the primary organ was, but it's been growing in the shadows for a while and eventually e.g. the lungs are so riddled with it that respiration is impaired, and it's so widespread that surgery/radiotherapy aren't really options and (pending discussions with medical personnel about prognosis) the patient opts out of chemo and such. A possible issue with that is that cachexia (extreme body wasting) is common with widespread cancers, and that's something that might be obvious prior to collapse, etc. Particularly with lymphoma. There are also specific complications of various cancer types that might messy things up a bit - e.g. hypercalcaemia of malignancy with lymphomas, multiple myelomas, etc.

    To what level of detail do you need to describe the illness? If you can gloss over lots of the nitty-gritty, I think cancer would be easy enough to work with. How old is the character? What sort of lifestyle do they lead? Smoker? Drinker? Diet? What are the circumstances in which they collapse? Are there any other symptoms/signs you could work with?

    Some type of conduction disturbance or cardiomyopathy (heart diseases) might work, although I suspect they'd either die more quickly than you have planned or they'd survive the initial crisis with medical intervention and then survive longer than you're after with medications, etc.

    Primary respiratory disease... hmm... most of the ones that spring to mind would probably have a slower course, be more noticeable or be less clean than you're after. The next most problematic organs would probably be liver and kidneys, but I think they might be a bit messy too. Infectious, immune-mediated and other inflammatory diseases are also probably too messy.

    A toxicity might be possible. Paraquat can cause death via respiratory failure over a few weeks, but the initial incident would be fairly 'emergencyish', and the character would probably know they'd been exposed (might they be involved in herbicide spraying?). Or perhaps asbestosis? That often emerges as a problem (respiratory distress) decades after exposure, and asbestos used to be a very common building material that many people might forget or never know they were around.

    Hopefully some part of that blather is of use... good luck!
     
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  6. Shadowfax
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    Shadowfax Contributing Member Contributor

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    Massive stroke could do it. A succeeding stroke could carry them off at any point (do you want them to be on "They've only got a couple of weeks to live", or just "I can't tell you; they could go tomorrow or in a year's time."? The problem is that ANY medical prognosis is an estimate based upon statistics...e.g., my father was given a 50% chance of surviving for a year with his AAA. So, no responsible doctor will give you a "10 a.m. on Thursday the 5th" prediction!). You'll lose physical coherence - slurred speech, physically weak on the affected side - and will lose some facility with, e.g., language. But they could still be bright as a button inside...i.e., the brain can still process data and come to a logical conclusion - Left-brain seems the way for you to go.

    http://my.clevelandclinic.org/health/diseases_conditions/stroke/hic_Stroke_and_the_Brain

    A right-brain stroke survivor may have a hard time with processing information (visual and verbal) and decreased cognitive (thinking) skills such as poor judgment, short attention span, and short-term memory loss.

    Left-brain stroke survivors may experience communication problems and paralysis (loss of use) on the right side.
     
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  7. Seagreen
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    Seagreen New Member

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    Thank you very much. Sifunkle I appreciate the time you've taken and obvious expertise , and thanks for those links Shadowfax. So helpful. All of it. I'm quite tempted to go with a skin cancer that has been removed (incompletely) and metastasizes into an inoperable tumour. Possibly brain. It seems that depending on location, the patient can be quite lucid and it's a very fast/aggressive cancer. Thanks again for all your advice.
     
  8. Sifunkle
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    Sifunkle Dis Member

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    In light of that, I reckon go with malignant melanoma. It's one of the more common skin cancers (varies geographically, particularly with UV levels; also varies with skin colour I believe) one that kills lots of people, and often metastasises to the brain. I think they usually metastasise later in the course of disease, but it's still possible to have early metastasis. Even if your character notices a mole has changed and has it promptly removed, maybe your character is one of the unlucky ones and it's already metastasised.

    I'm not sure what sort of 'met checks' might be done (not my field of expertise), but it's much easier to check lungs and liver (x-rays/ultrasound) than the brain (need more advanced imaging, ideally MRI), so I'd find it plausible that the character might have a brain metastasis overlooked at the time, which could slowly grow to cause trouble later (even if they do MRI, it could be smaller than the image's resolution and be undetectable at the time). A lot of brain tumours are clinically invisible until they grow past a certain size that the brain can no longer tolerate, at which point many of the problems arise either from 'mass effects' either of having a big lump directly pressing on something important, or from the mass obstructing the natural movement of cerebrospinal fluid through the brain, which increases intracranial pressure --> trouble. The exact symptoms you'll see can vary a lot - it just depends on what parts of the brain are impinged upon - so it is possible that your character could remain fairly lucid (although I'd probably expect that to fade at some point before death). What parts of the brain are affected also governs the amenability of surgery too, although further comment on that is out of my league. Depending on the type of tumour, you might also get problems related to the specific cancer itself rather than just mass effects. Melanoma is associated with several 'paraneoplastic syndromes', which might be something to read up on (Wikipedia has a decent overview of melanoma :)).

    My grandfather died from a brain tumour (not sure what type). As is typical, it came out of left-field when he woke up one morning with symptoms fairly similar to those Shadowfax described for stroke - uncoordinated movement and some trouble using language (not complete aphasia though). He lasted another few weeks, but that included some surgery - he did get out of hospital, but into care rather than being able to return home. He was still able to hug and hold hands and have slow, simple conversations for a while, but in the last few days he wasn't really responsive; it was more of a fevered delirium until the end. (This was a long while ago now; I've had enough time not to feel awkward discussing it, don't worry!)

    A small note on MRIs: I know a few pathologists who recommend not getting them done 'for fun' (i.e. without an actual diagnostic reason), because a lot of us actually have small tumours and other lumps and abnormalities in our brain and/or spinal cord, most of which are no problem at all. But there's ~no way to tell benign from malignant with diagnostic imaging alone, and it's pretty hard/invasive to sample the brain... so there's a solid argument for 'ignorance is bliss'.
     
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  9. Sapphire at Dawn
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    Sapphire at Dawn Member

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    How about a chest infection/pneumonia being the thing that actually carries him off? His primary illness (the tumour or cancer or whatnot) could have weakened him to such a state that he's unable to fight the infection off. Or perhaps sepsis?
     
  10. Iain Aschendale
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    Iain Aschendale Contributed Member Contributor

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    Stomach cancer. My buddy's dad thought he had an ulcer, put off going to the doctors, and only ended up with 38 days from diagnosis to death.
     
  11. Seagreen
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    Seagreen New Member

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    Amazing detail, thanks again Sifunkle. Extremely grateful for your expertise. That sounds exactly right (although sorry to hear about your family's experience of this). Thanks again
     

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