View Full Version : Need a medical emergency scenario for a patient with advanced cancer.

07-06-2014, 05:25 AM
Still in the very early planning stages of this book, so a lot of details are still pretty flexible. I'm trying to figure out my options with regard to my character's condition before I dive too deep into the outline.

My character's cancer has relapsed and spread. Not 100% decided on exactly what type of cancer, or to what extent it's spread, so... flexible.

What I need is a scenario where he suddenly needs medical attention, preferably involving emergency surgery. It doesn't have to turn out to be an actual brush with death (i.e., something that looks a lot worse than it actually is), but it'll seem like it to the person who is there when the incident starts. There's a possibility he'll be using an experimental drug/procedure within the story, so some sort of reaction/side effect would work.


07-06-2014, 09:28 AM
Build-up of fluids can be a big problem in late-stage Cancer patients. Depending on where the fluids are accumulating it could be an emergency. Or maybe complications arising from earlier surgery, like scar tissue forming and pulling on something in a painful way, or bleeding.

Karen Junker
07-06-2014, 10:19 AM
When my 3 year old son was getting chemo for a brain tumor, he went into a coma -- naturally, I panicked when I couldn't wake him. We were given a choice of waiting to see if he came out of it, or putting him on life support at a research hospital. Fortunately, he just woke up within a couple of days.

We were told he was cancer-free after months of chemo and radiation -- but one day, he walked up to me and had a swelling on the site of his surgery that was about the size of an apple. I rushed him to the hospital and they took him into emergency surgery -- the tumor had returned, bigger than ever.

If you have time, you should read Jay Lake's blog-- he recently passed away, but he blogged about his cancer, treatment and problems, for the past 5 years or so. He went into a lot of medical detail.

07-06-2014, 10:38 AM
You have some good options above, if you need something less severe; they can have complications with their central line, or any type of catheter. An infection would be especially problematic.

Michael Davis
07-06-2014, 11:28 AM
Advanced cancer usually refers to stage four or stage three before it goes into four. What's the difference? In four the cancer cells have begun to become mobile and move via the blood stream or lymph system to other locations in the body. All type of cancers are not equal in terms of treatments, survivabilty, likeihood of relapse, duration of treatment, and the nightmare you go through for treatment, as well as the enduring side affects. For example, I had throat cancer five year ago, latter stage three. Prob of survival was 80% but the treatments were hell on earth (took 11 months to recover before the sickness and side affects from chemo and radiation began to subside.) Loss 50 pounds. Side effects have been high and still remain after five years. Other types in their latter stage are not so painful to treat, have minimal side effects, but the change of survival is much lower. For example, my tumor was in the voice box where the cells tend to remain local and not migrate until the end. One inch lower in the throat, at the same stage, and the survival rate is 5%. Both forms of throat tumors typically require long treatment periods (mine was five months yet I didn't recovery for 11), yet a friend with stage two ovary cancer only required two months, plus surgery. Another patient I got to know in the center had very virtually no side affects and zero pain (blood cancer) yet he was in his second year of treatments (once every two weeks.) He only received mild chemo with no radiation and no tossing cookies where as after six weeks I tossed mine constantly. While he was in and out of the center after an hour, mine took five hours to complete each chemo treatment. Another lady with stomach cancer in latter stage was only offer a few months and elected no treatments. My sister experienced kidney cancer, was operated on (removed half a kidney) within a week with no chemo or rad, with 95% survival rate. She's has zero side affects. I was retested every month first two years, then every 3 months for next two, she was tested ever three months for only first year. My point is that there are so many forms and variation the beast appears in, you'll need to be very specific in your story. What ever you pick suggest you target a form that aligns with surgery treatment (some lung cases, kidney, spleen, etc.) Hope that helps.

07-06-2014, 12:11 PM
I second the infection suggested above. If they are undergoing chemotherapy then they will be heavily immune-suppressed so unable to fight off any level of infection. A possible scenario would be some kind of rapid infection (less than 6 hours from onset to being in deep trouble) requiring immediate hospitalisation and heavy duty iv antibiotics

07-06-2014, 06:22 PM
If you want something not expressly cancer-related, a bad panic attack mistaken for a heart attack, or a severe allergic reaction to a new medication can get you fast-tracked to the treatment area of the ER. Appendicitis or peritonitis, will do the trick, too, as would a blunt force hit to something like the spleen that can be removed fairly easily if in danger of rupturing, but has to be seen to quickly. Depending on the type of cancer, there are issues with obstructed or impacted bowels that could require surgery.

07-06-2014, 06:55 PM
Awesome. Thanks, everyone! This gives me some options to play with. (And keep them coming if you have more ideas!)

(And please don't take that as "yay! cancer!"...more like "yay! story is finally coming together after I beat my head against it for months!")

07-06-2014, 07:53 PM
Echoing Waylander's suggestion. When my mother had pancreatic cancer, she developed an acute abdominal infection that required emergency surgery. The surgery was successful & the infection was cured, but the cancer was quite advanced at that point and she died a couple of weeks later.

07-07-2014, 07:54 AM
Man, Cancer really sucks.

07-07-2014, 08:23 AM
It really does. :(

07-08-2014, 06:15 PM
On the plus side, we're making tremendous advances in cancer treatment - survival rates keep rising, and new treatments appearing that give fewer nasty side effects. I lost my granddad to oesophageal cancer a few weeks ago and it's a horrible disease. it takes away so much of the person, physically and emotionally. But we're winning the battle, slowly but surely.

There will come a time when almost all of us will be able to beat cancer. It may even be in our lifetimes. There's your positive thought for the day.

07-08-2014, 08:21 PM
Mr. Maryn beat cancer, but one crisis he had was with the surgically implanted catheter in his chest through which blood draws were taken and transfusions and chemo given. While there's a rigorous protocol for keeping it clean and he followed it religiously, he got an infection that damn near killed him anyway, as the chemo had completely wiped out his immune system. He didn't need emergency surgery but he needed high-dose IV antibiotics in the hospital, and he was quite ill for several days. The medical staff was adept at avoiding the words death and cure but one seemed close and the other dangled far away.

Maryn, knowing we've been lucky

07-08-2014, 10:49 PM
One of the things chemo does is totally knock out not only your immune system (white blood cells), but also other cells in the blood (red blood cells -RBC's - that carry oxygen and platelets). You're already anemic (low RBC count) and don't have enough platelets to effectively clot the blood, so any cut can be life threatening. So can anything that would cause a bruise for someone with normal counts - for a person with low counts they could bleed internally.

07-11-2014, 05:47 PM
On the same note as pkbax--any injury that caused internal bleeding would lead to an emergency surgery.

Another scenario with internal bleeding is if the tumor were to rupture.

07-11-2014, 06:13 PM
Thanks, everyone!

07-11-2014, 06:13 PM
A common acute emergency in cancer patients (especially lung or breast) is a malignant pleural effusion, where fluid shifts into the pleural spaces, restricting the lungs. That's one that's easily treatable in the ED with a chest drain, so it might be a little too simple for what you need. But it's amazing how quickly people improve. I've seen a woman go from obtunded and nearly unconscious to sitting upright and having a conversation, in the space of minutes.