Chronic Illness in Film: 50/50
by Briana Livelsberger
Note: This review contains spoilers of the film’s plot.
When I was looking up movies that focus on chronic illness, I came across 50/50. 50/50 follows the main character’s (Adam) journey with cancer. While there are a lot of movies about cancer, it sounded promising based on its description. Then, when I saw that Seth Rogen and Joseph Gordon-Levitt were in it, my expectations were fixed. Seth Rogen has been in a few serious films but, for the most part, he’s been in funny movies, sometimes bordering on stupid and cringey. Joseph Gordon-Levitt has been in films from a variety of genres but, when working with Seth Rogen, it’s often been funny films. I expected that 50/50 would be a silly film, with a few good laughs and some cringey jokes. I also figured that the cancer element of the film would take a back seat and would be “cured” by the end, that it would be an easier cancer to treat. I thought the film’s main focus would be on their characters’ friendship that would be strengthened, no doubt aided by medical marijuana meant for cancer. I also thought that the cancer elements would be unrealistic and either over- or under-exaggerated. What I was not expecting was a serious film going to great lengths to show realism in the character’s cancer journey.
Rather than a common and fairly easy cancer to treat, Adam has Neurofibrosarcoma Schwannoma, though now usually referred to as malignant peripheral nerve sheath tumors. For the purposes of this article, I will use the name that the movie uses. According to the Mayo Clinic, Neurofibrosarcoma Schwannoma is a rare form of cancer that develops in the myelin sheath (protective layer surrounding a nerve) of nerves extending from the spinal cord into the body. This happens because a mutation in the nerve cell’s DNA causes the cell to multiply rapidly. These tumors can form anywhere in the body but the most common places are in the arms, legs, and trunk. Neurofibrosarcomas usually result in pain and weakness in the area where they form and can form a lump. Treatment for neurofibrosarcomas is usually surgery but radiation and chemotherapy can also be used in situations where the tumor is too large to make surgery safe right away (Mayo Clinic). With Neurofibrosarcoma, there is a 50% chance of survival, as Adam finds out when doing research on WebMD (the percentages have changed since the film came out but they are still close to 50/50). However, that goes down to 10% after metastasis (when cancer spreads throughout the body). So, the film uses a more complicated and risky cancer than I thought it would.
In regards to my expectation that cancer would take a back seat in the plot, I found myself severely mistaken. Instead, cancer was woven into everything. In the beginning of the film, when we see Adam running, we can tell that he is tired. However, it’s not until we see him grabbing at his back in pain that it becomes clear that something is wrong. This continues when we see he’s hunched over in pain and grabbing his neck while waiting in line at a coffee shop. Here, he tells his friend, Kyle, that he’s seeing the doctor later that day. This opening is good at showing that something is wrong and that some bad news is going to come from the doctor’s appointment. However, it is very realistic in that, while we get this sense, Adam doesn’t suspect anything like cancer.
The appointment scene is fantastic in a number of ways. First, unlike some cancer movies where the main or side character has a caring doctor who is going to go all out to make sure that the character is supported and cared for, 50/50 shows an indifferent doctor. When the doctor enters the room, he sits down without acknowledging Adam. He then talks into a recorder, using a lot of medical terminology that the “average” person would not be familiar with. The doctor only acknowledges and talks to Adam when Adam raises his hand and asks if there was anything wrong with him. What is great about this is that the doctor answers using medical terms again and mumbles parts of what he’s saying, giving us an insight into how confusing this is for Adam. When the doctor finally says outright that Adam has a malignant tumor and bone erosion, Adam’s face changes. During this explanation, the room becomes blurry and the doctor’s voice is muffled, showing the distress Adam is feeling in response to this news. When the doctor’s voice is no longer muffled, he says that the size of the tumor needs to be shrunk through chemotherapy so that the surgery will be safer. Adam asks if he is going to be okay. However, the doctor avoids answering the question and instead refers him to a therapist. This scene captures the shock of being newly diagnosed with a life-changing disease but also of having a doctor that doesn’t really care.
While this movie does have a focus on relationships, its focus is on how relationships are affected by cancer. When we first meet Adam’s girlfriend, Rachael, we get the idea that she isn’t really committed to the relationship and that they won’t last much longer. So, when Adam tells her that he has cancer and he gives her the chance to leave him if she wants to, we’re prepared for her to run. However, Rachael claims she won’t leave him but the look she has on her face when she hugs him suggests that she does want to run away. As time goes on, what was clear to us becomes clear to Adam. Rachael leaves him to wait hours after chemo to be picked up, she doesn’t go with him to treatments, and she doesn’t help him in any way. The only good thing she did was give him a dog to care for. Adam decides he’s done and they break up.
Next is his friend Kyle. Kyle is pretty typical for a Seth Rogen character in which he is mostly unconcerned, makes a lot of rude jokes, and can be a bit juvenile. However, we can see that he does care about Adam because he does tell Adam that Rachael is not good for him. When Adam tells Kyle about the cancer, Kyle reacts by going into complete panic and nearly throwing up. However, once he hears that the survival rate is 50/50, he seems to be calmer. He tells Adam that, “if you were a casino game, you’d have the best odds.” He also repeatedly says that Adam will be okay, this repetitive statement showing that Kyle is still panicking even if he sounds calmer. Despite this reaction, Kyle sticks by Adam, even though he uses Adam’s cancer as a way to pick up women and doesn’t fully understand the physical weakness/exhaustion involved with fighting cancer. He also takes advantage of the cancer diagnosis by smoking medical marijuana with Adam. As a result, there is a lot of the film where I thought that Kyle was pretty selfish but in a different way from Rachael. However, when I found out that he was reading books about how to help someone with cancer, I realized that he genuinely cared about Adam and that everything else was his way of coping.
Before his diagnosis, we didn't hear much about Adam’s mom. However, when Adam invites his mom over for dinner, we learn that she likes to be involved whenever something is going on in her son’s life. At first, she tries to stay calm while making it clear that she wants to help take care of him throughout his treatment. When Rachael says that she will be taking care of Adam, his mother both seems annoyed and doubtful, probably more aware of Rachael’s character than Adam is. However, his mother is only able to stay calm for so long before she bursts into tears away from the dinner table. Adam keeps her at a distance, not wanting to add to her worries (since Adam’s father has Alzheimer’s). When Adam finally let’s her get involved, Adam’s mom copes by scrutinizing everything involved with Adam’s care. She shows concern that he may not be seeing the best doctor or getting the best treatment. She also sticks up for Adam when he’s scared and makes sure that he’s given the chance needed to voice his fears. She stands her ground to do what needs to be done to help him get through his surgery.
Meanwhile, his father has no idea what’s going on because of his Alzheimer's. However, right before and during Adam’s surgery, it’s clear that he knows something serious is going on and shows great concern. All in all, 50/50 shows how multiple kinds of relationships can play out when cancer becomes a stressor.
While the film doesn’t go too much into what chemo is like, it still paints a realistic picture of what feelings are involved or how the body responds to it. Chemotherapy describes treatment in which drugs are used to destroy cells, cancer cells specifically when used to treat cancer (Cancer). Adam goes to his first chemo treatment nervous and scared, as is highlighted by the camera’s focus on an older, coughing woman leaving the infusion center. However, he meets two men who are also battling cancer, Mitch and Alan. What most may not pick up on is the attention to detail of where their IV lines are going. Mitch’s IV line goes in his shirt from the front, suggesting that he has a port (more common) or tunneled central line (both placed in a bigger vein with the line/port entering through the chest). Alan’s IV is shown going up his right sleeve, most likely suggesting a PICC line (often placed on the inside of the upper arm) though it’s also possible that he could have a pot or central line. This is important because, often when needing to be treated with chemo, bigger veins are needed because smaller veins can’t handle such medication. This often results in the need for ports/central lines placed in arteries leading directly into the heart as these arteries are big enough to handle chemo. After the first dose, Adam ends up throwing up in the middle of the night, going along with the knowledge that chemo makes one very nauseous. As his treatment goes on, he looks paler and thinner, which shows how having a hard time keeping food down and chemo’s constant attacks on his body can wear one out. However, he also becomes friends with Mitch and Alan. This aspect reflects heavily on how those going through similar experiences often seek comfort in knowing they aren’t alone.
Another thing I liked was how his therapist recognized that Adam taking the bus after chemo was not a good idea. The problem with chemo is that it suppresses the immune system, making it easier to catch viruses. It also makes it that viruses that often cause people only mild discomfort can become a long, uphill battle that can even be deadly. Typically, you’re supposed to spend so many days away from others after chemo until your immune system is able to bounce back. For me, when I was on chemotherapy for Rheumatoid Arthritis, I needed to be away from others for 48 hours as well as during cold and flu season. Before his therapist pointed this out, I was thinking about how risky his taking the bus was and wondering if the film was just going to make it seem okay. I know that there are cases in which no one has any other mode of transportation and so it isn’t necessarily an uncommon occurrence, but it is taking a big risk. However, I was glad to find that the film did address that fact.
This movie also captures what it’s like to be “helped” by a bad therapist. The thing is, Adam doesn’t see an actual therapist but a student (Katie) working on her PhD and who needs experience. While many non-therapists can still do a good job helping people in various situations, it is clear that she is not good at helping anyone with a serious and terminal illness. This is refreshing because many movies like to show therapists that help people. However, it is important to show how and why a therapist who is unskilled could be problematic in a situation like this. Adam often calls her out whenever something she says makes no real sense or is just a general and unthoughtful response.
Despite this, the film also shows how one can approach therapy as well as the grieving process that comes with diagnosis. In his first session, Adam claims he is calm and that he is fine. He is both not open about sharing his feelings and is in denial about them. In the second therapy session, Adam only describes physical feelings about the first chemo session (headaches) and behaves angrily but denies being angry. He still refuses to open up but is also going through the angry phase of grief. The first time he opens up more in therapy is when he talks about how he feels he can’t talk to his mom cause she drives him crazy. Again, he isn’t open about his feelings and instead shifts the focus to feelings that he is okay with sharing. However, when Mitch dies, Adam suffers from existential dread, knowing that he is going to die someday, most likely from the cancer. He resigns himself to that fate, claiming that he is okay with it. Adam feels like there isn’t much to be done to help himself. This scene is powerful because it is clear that Adam is not okay with the idea that his cancer could kill him. It’s clear that he doesn’t want to die yet. However, there isn’t much he can do but keep up with treatments.
When it was time for Adam’s surgery, a lot of things happened that show the struggle one can feel at any point when coming to terms with the situation one is in. The surgery itself is dangerous because Adam’s tumor actually grew bigger. There was a real possibility that he wouldn’t make it through the surgery. However, he is told that he has no more options if this surgery doesn’t cause the cancer to improve. We can see that he is terrified but he tries to keep things together. This doesn’t last long. He breaks down the night before the surgery, screaming, crying, and talking about all the things he never got a chance to do.
Before the surgery, he does his best to remain calm until he’s given the liability and organ donation forms. He begins to freak out and, when the anesthesiologist comes in to give him anesthesia, he asks some questions. First he asks if the anesthesiologist is giving him the anesthesia, since the anesthesiologist is behind him out of sight. Then he asks how long it will last, if they know if he will wake up during the surgery, or if he will wake up again afterward. At this final question he bursts into tears and his mother hugs him, telling him he’s going to be okay. They try to take him away quickly after but, seeing that Adam is still freaking out, his mother demands a little more time. Though it isn’t much, she continues to hold him and give him words of comfort before no more time can be spared and he is rushed off. I don’t get why they give him anesthesia in the waiting area rather than in the operating room. There are hospitals that do this but it’s dangerous to give anesthesia without having oxygen on. Plus, while it can be anxiety inducing to see the equipment and lights in the operating room, I think it would be scarier to be knocked out in the waiting area.
But this scene demonstrates something that most surgery scenes don’t. Most of the time, if the main character is scared, there seems to be enough time for the character to calm down and be comforted. Whenever the character is able to face surgery without as much anxiety, that is when they are taken away. In this, however, it shows that one doesn’t always become free of anxiety or has time to calm down. Surgeries happen on the hospital’s schedule, not yours. They will get the surgery started when they want to, whether you’re ready for it or not. I also love how realistic it is with Adam asking questions before the surgery. Personally, asking questions is one of my coping mechanisms before going into surgery, partially to gain some feeling of control.
When I started watching 50/50, I was expecting a silly story in which cancer was an afterthought. But what I got was a movie that goes through all the different stages one feels emotionally and physically when diagnosed with something and all the different scenarios that one can end up in because of it. Even though I don’t have cancer, I too found many of the filming choices and feelings relatable and honest throughout the film, making me feel more for a character than some other movies have accomplished. The film was written by Will Reiser who had the same cancer, making me think that is why this movie turned out so well (Roger Ebert). This film shows how chronic illness affects not only the way you look at yourself after being diagnosed, but also how others look/think about you and the impact that has on your mental state, emotions, and self-image. As a result, 50/50 is one of my favorite films that I’ve watched related to chronic illness so far.