The Midnight Club (2022): A Hospice for Teenagers

Mike Flanagan and Leah Fong's Netflix series is drawn mainly from Christopher Pike's 1994 novel. It is set at Brightcliffe, a rambling hospice for terminally ill teenagers.

Ilonka arrives having deferred a university place after a thyroid cancer diagnosis, convinced there is a cure hidden in the building's history. She joins the Midnight Club: eight residents who meet in the library at midnight to tell each other horror stories. They make a pact that whoever dies first will try to send word back.

Those stories play out as self-contained episodes while Ilonka investigates a cult that once occupied the house. Anya, whose bone cancer has already cost her a leg, becomes her closest tie. Anya dies after a ritual meant to cure her fails. Netflix cancelled the show after one season, so the mysteries stay open.

Spoilers throughout. Anya's death and the season's unresolved ending are both discussed here.

This is the show's real achievement, and it is rarer than it should be.

Brightcliffe is explicitly a place for symptom control and company, not for cure. The residents are not saintly. They are bored, funny, angry, sexual and sick of being handled gently. Anya's amputation, her prosthetic and her fury about her body are shown without any inspirational framing.

Dr Stanton insists on being honest with the residents rather than protectively vague, which is what good practice actually looks like. The show also lets deaths be sudden and unceremonious, and lets the survivors' grief stay messy.

Ilonka's diagnosis is the one the plot hangs on, and it is the least plausible thing in the series.

Thyroid cancer is uncommon in teenagers, and most thyroid cancers are treatable. The well-differentiated types, papillary and follicular, can usually be cured. A rapidly fatal teenage thyroid cancer is possible in the way that most things are possible, but it is not what this disease normally does.

That matters because a viewer takes the emotional shape of a story with them. The shape here is wrong for this cancer.

Thyroid cancer is also the clearest example in all of cancer screening of a test doing harm, so it is worth explaining properly.

The US Preventive Services Task Force recommends against screening for thyroid cancer in adults without symptoms. That is a grade D, which means it concluded the harms outweigh the benefits.

The reasoning is unusually concrete. South Korea has run an organised cancer screening programme since 1999. Thyroid screening was not officially part of it, but clinicians often offered a thyroid ultrasound for a small extra fee. The Task Force records the result: by 2011 the rate of thyroid cancer diagnosis was 15 times the rate in 1993, while the thyroid cancer death rate stayed flat.

Fifteen times as many diagnoses. The same number of deaths. Those extra cancers were real under a microscope, but they were never going to hurt the people who had them.

Meanwhile treatment carries real risks. The Task Force reviewed studies of permanent damage to the nerve that controls the vocal cords, and of permanent damage to the parathyroid glands, which sit beside the thyroid and control calcium.

The grade D applies only to people with no symptoms. It is not a reason to ignore something you can feel.

NCI says thyroid cancer may cause no early symptoms and is sometimes found during a routine examination. When signs do appear, it lists:

• A lump or nodule in the neck.
• Trouble breathing.
• Trouble swallowing.
• Pain when swallowing.
• Hoarseness.

NCI also notes that thyroid nodules are common and usually are not cancer. When one is found, an ultrasound and a fine-needle biopsy are often done to check.

A history of radiation to the head or neck in childhood, or thyroid cancer in a close relative, raises risk and is worth telling a clinician about.

Bone cancer, which is Anya's diagnosis, has no screening programme either. The CDC supports screening for four cancers only: breast, cervical, colorectal and lung.

The series treats this as understandable rather than stupid, which is the right call. Rituals, supplements, a promised miracle in the woods. That is much closer to how frightened people and families behave than the smug version usually shown.

The useful response is not contempt. It is a question you can ask your own team: someone has offered us this, can you tell me what is actually known about it?

The diagnoses here work as labels more than as conditions. The characters are dying, yet mostly walking, articulate and out of bed at midnight.

There is little pain, almost no medication burden, and few of the practical realities: nausea, breathlessness, sudden confusion, and the steadily shrinking radius of what a body can still do. Glioblastoma, an aggressive brain cancer, is given to a teenage character with almost no neurological effects at all.

Brightcliffe is a gothic set, not a clinical environment. That is fine as horror and misleading as information.

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The Midnight Club is unusually good on what a hospice is for, and unusually careless about the diseases it hands its characters.

The one piece of real medicine underneath it is counter-intuitive. Screening healthy people for thyroid cancer is recommended against, because it finds cancers that would never have caused harm. A lump you can feel is a different question, and that one gets examined.

• https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/thyroid-cancer-screening
• https://www.cancer.gov/types/thyroid/patient/thyroid-treatment-pdq
• https://www.cdc.gov/cancer/prevention/screening.html

This page discusses The Midnight Club for education. It is not medical advice, and nothing here is a judgement of anyone's real medical care. Spotted an error? Please email [email protected].