Medical advice, purely fictional

November 6, 2023 9:31 AM

Can you suggest potential illnesses that would fit, for a story I'm writing? The character fell seriously ill at age 19 (the seriousness is important); he was successfully treated and now, at age 25, he's fine. At the time of his illness his college girlfriend was an amazing support, and they ended up getting married. For various reasons, I would rather the illness NOT be cancer. Are there other possibilities that would fit this scenario? It's important that the duration be somewhat substantial, i.e., this wasn't just a bad week, but something of an ordeal.
posted by swheatie to Health & Fitness (38 answers total)

A congenital defect that required surgery/multiple surgeries to correct with a long recovery and rehab period.
posted by phunniemee at 9:33 AM on November 6, 2023

A serious circulatory defect (in the aorta or heart) that wasn't discovered until college, maybe some sort of an aneurysm?

(Hey, GMTA!)

You can make it worse by making the first surgery didn't quite work, but doing it again may just kill him, yet if they don't do anything he'll likely die anyway. Drama! :D
posted by kschang at 9:34 AM on November 6, 2023

An experience with serious mental illness that went untreated and took years to figure out which treatments/medication work to manage them.

I could also see a 19 year old having a serious accident that would have taken multiple surgeries to address and years of rehab.
posted by brookeb at 9:38 AM on November 6, 2023 [2 favorites]

At age 19, he could have picked up a parasite-born disease (maybe while traveling, and have had trouble getting it diagnosed in his own country) or even just from being at home and getting a parasite that confounds doctors. I knew college students back in the day suffering for a long time with things like toxoplasmosis and Schistosomiasis. Tick-born illnesses can also be hard to dx and treat.
posted by ojocaliente at 9:41 AM on November 6, 2023 [3 favorites]

Meningitis? It could require lots of rehab.
posted by sockerpup at 9:41 AM on November 6, 2023 [5 favorites]

I have a friend who, otherwise healthy, had a case of latent tuberculosis. I think it's unknown how long he had it before it was detected. He got it treated before it progressed to active disease, so he wasn't seriously ill, but the treatment involved months-long courses of antibiotics. Symptomatic tuberculosis can of course be quite serious, and as I understand it there are drug-resistant strains that can take even longer to treat.
posted by egregious theorem at 9:42 AM on November 6, 2023

Hyperthyroidism / thyrotoxicosis?
posted by eirias at 9:47 AM on November 6, 2023 [1 favorite]

The musician REN contracted Lymes Disease in his late teens which put him out of action for ~8 years, with huge expense he seems to have cleared it from his ssystem and is now fortunately a very high-functioning human. Ren was repeatedly misdiagnosed with depression, bipolar disorder, and Chronic fatigue syndrome and became near-suicidal.
posted by unearthed at 9:50 AM on November 6, 2023 [7 favorites]

Lyme disease is a good fit as some kind of outdoor activity would be a plausible cause and people go months with some pretty debilitating symptoms that can be treated but it is common to have pain, debilitating fatigue, and other symptoms for months after treatment.
posted by openhearted at 9:51 AM on November 6, 2023 [2 favorites]

Broken back from a fall while hiking, which damaged his spinal cord. She hiked to where she could call in the air ambulance, without which he would have died.

Stem cell treatment healed the spinal cord damage, and now...he can walk again! *music swells* He proposed on the same rock bluff where he fell from.
posted by wenestvedt at 10:00 AM on November 6, 2023 [5 favorites]

came to say Lyme
posted by fingersandtoes at 10:03 AM on November 6, 2023

I was also going to say meningitis, but another possibility would be any brief hospitalization (maybe mono or other common college viruses) followed by sepsis.
posted by muddgirl at 10:05 AM on November 6, 2023 [3 favorites]

Response by poster: Ack, I should have included this piece of info: my story is set in the early 90s, so the illness would have been in the 80s. Which knocks out stem cell therapy, as much as I like that potential scenario!
posted by swheatie at 10:06 AM on November 6, 2023

Does it have to be an illness? Or could it be an injury, like a car accident/skiing accident etc?
posted by dpx.mfx at 10:31 AM on November 6, 2023 [1 favorite]

Stem cell treatment for spinal cord injuries is still very much in the experimental stage now (set back by some really creepy fraud elsewhere, I think).

Commotio cordis (what happened to Damar Hamlin) is a possibility. Or, if you prefer something more inherent and less injury-related, hypertrophic cardiomyopathy has nearly killed some athletes about that age. After recovery from the cardiac arrest, treatment allows return to a basically normal life for many, I believe.

If you like the lifesaving aspect, for either of these heart conditions the girlfriend finding and using an AED until help could arrive would work. They've existed since the 1950s, though I don't think they were a "standard" part of large office building safety supplies until much more recently.
posted by praemunire at 10:38 AM on November 6, 2023 [1 favorite]

Guillain-Barre syndrome.? The immune system attacks the peripheral nerves. The catastrophic cases will leave the patient unable to breathe independently and if it’s that severe, recovery can be pretty incremental
posted by jacy at 10:39 AM on November 6, 2023 [6 favorites]

Nonclassic congenital adrenal hyperplasia
[A Brief History of Congenital Adrenal Hyperplasia]
Addison's Disease [JFK was diagnosed at age 30]
posted by Iris Gambol at 10:45 AM on November 6, 2023

Do you need him to be hospitalized? Or just shuttling around from doctor to doctor? I know a couple people who've just had unusual presentations of autoimmune stuff and ended up needing to see easily half a dozen specialists over five years, waiting ages for each appointment, getting inconclusive tests, feeling worse and worse, until finally they wound up in front of the right doctor.
posted by potrzebie at 11:20 AM on November 6, 2023 [1 favorite]

Coma, and her voice brings him out of it after months of daily visits? Or would Kumail Nanjani get pissed that I stole his story?
posted by wenestvedt at 11:34 AM on November 6, 2023

The congenital defect angle Phunimee mentioned is what I would suggest as well. There can be fairly serious congenital heart defects that aren't diagnosed until later in life and they can be quite intense with a resolution that includes open heart surgery but if they're corrected, your prognosis is excellent.

The timing works pretty well too -- I was born in 1980 with a massive heart defect that wasn't diagnosed until I was in my 40s. I had a heart murmur when I was born, but it resolved by the time I turned one. At that time, the doctor assumed I had a small issue that had just gone away as I grew but I learned 40 years later that what actually happened was that the defect (a hole) had grown so big it was no longer making noise. In present-day America, the baby would have an echocardiogram before they left the hospital, in the 1980s, they listened to my heart with a stethoscope and called it good.

Please feel free to reach out if you have questions.
posted by kate blank at 11:37 AM on November 6, 2023 [5 favorites]

He could have a serious respiratory illness that caused him to be put on ECMO and have an extended hospital stay. Some other possibilities: necrotizing fasciitis, encephalitis, an acute kidney injury that causes him to be on dialysis for a time period but where he ultimately regained kidney function, rhabdomyolysis (which could cause the kidney injury), or some kind of injury requiring rehab.
Source: I work at a children’s hospital and I’m trying to think of treatable things that have put otherwise healthy teenagers in the hospital for extended periods of time!
posted by MadamM at 11:50 AM on November 6, 2023

Jacy has what could be the best suggestion: Guillain-Barre syndrome.

It's an auto-immune disease and nerve damage is intensely, devastatingly painful. For me the actual attack on my nerves only lasted four weeks, but it took me over a year to recover function (I couldn't lift my hands above my shoulders, and my hands were partly paralysed) My symptoms were comparatively mild but ended with an opiate addiction: without heavy opiates the pain was unbearable during the attack. I'm 95% OK now, three years later.
posted by anadem at 11:56 AM on November 6, 2023 [6 favorites]

Traumatic brain injury? Coma for a few weeks, in hospital for months, inpatient rehab for half a year, a few years of outpatient rehab, pretty much a full recovery in a few years with a few lasting effects.
posted by third word on a random page at 12:06 PM on November 6, 2023 [1 favorite]

The congenital defect angle Phunimee mentioned is what I would suggest as well. There can be fairly serious congenital heart defects that aren't diagnosed until later in life and they can be quite intense with a resolution that includes open heart surgery but if they're corrected, your prognosis is excellent.

I know a few people who have had heart surgery at young ages -the recovery period isn't that long and the pre-"Oh no I need a heart valve replaced" isn't that severe, unless the character is like a professional athlete or something. I actually know someone who needs a full heart replacement at a young age, and 3 years in, he's more or less back to 'normal', still working (more or less) daily.
posted by The_Vegetables at 12:19 PM on November 6, 2023

Went to high school in the late 80s early 90s and here are two examples from my peer cohort: a friend who disappeared for 2 years and it was mono, and a friend who re-appeared at our favorite summer music festival in a wheelchair and it was Lyme. She eventually walked again.

My partner had an undiagnosed aortic valve malformation that required surgical correction when he hit 30. It made him feel very bad in the several months between symptomatic emergence and open heart surgery, and then the recovery period from surgery was its own thing. I don't know if that's a long enough period for your purposes.
posted by Lawn Beaver at 12:26 PM on November 6, 2023 [2 favorites]

The CDC says that about one in seven strokes occur in adolescents and young adults ages 15 to 49. My husband had one in his early 40s with no known cause, but car accidents and other traumatic injuries can cause a stroke, and rehab may take years depending on what sort of issues were caused by the stroke.
posted by jabes at 12:33 PM on November 6, 2023 [2 favorites]

Nth-ing sepsis, perhaps alongside a cranial or epidural abscess and/or bacteremia. Speaking from recent unfun experience: this (usually) Staph aureus m-fer can strike anybody, any age, any state of health, and it may never be clear how someone contracted it.

If not caught quickly enough, sepsis is deadly... and excess death is super-common for years post-acute-sepsis, though part of that is probably owing to many sepsis cases occurring in older adults. Abscesses are rare enough that (as in my case) they can go un- or misdiagnosed for days to weeks (for me it was just a couple of days, fortunately), which of course gives them opportunity to do Additional Bad Things (like rupture and spread more S aureus through the body).

An MRI may be needed to correctly diagnose an abscess, which I suspect in the 80s would have been a Whole Dang Thing. (CT scans may pick them up, but then again may not.)

Recovery... well, it takes a while. I'm still on serious antibiotics, and my diagnosis was over a month ago. Severe anemia is a super-common sequel, as is general fatigue/lethargy. The bacteria causing the sepsis can attack other organs (kidneys, liver, heart, lungs), so they may have suffered damage and need to heal even after the bacteria are conquered. The hardcore antibiotics needed for sepsis cause their own litany of later issues.

In conclusion: sepsis fits your needs here, and you would be doing a mitzvah by explaining it to people. I hadn't a clue before I went down with it.
posted by humbug at 12:35 PM on November 6, 2023 [3 favorites]

An undiagnosed illness will do that to a person. If you'd like to get inside the mind of such a person, look into the music artist Ren. He discusses what it was like to have an illness that wasn't correctly diagnosed for years, with improper treatments and medications that made things worse or had no effect. Also, he is open about the heartbreak of getting up hopes for successful treatment that failed again, then finally getting proper diagnosis (lyme disease) and still is suffering the aftereffects of the damage done to his body.

You can find plenty of interviews and posts online where he discusses this. A good start is here.
posted by mightshould at 12:38 PM on November 6, 2023 [1 favorite]

the pre-"Oh no I need a heart valve replaced" isn't that severe, unless the character is like a professional athlete or something

I think the response can vary from person to person, but for me the months between realizing there was a problem (with an EKG) to assessing how serious the problem was and getting surgery on the books were fucking endless and terrifying. And the whole thing is that the BEST CASE SCENARIO for you is that they use a bone saw to split your sternum and then stop your heart while repair it*. Certainly, a teenager would recover from surgery more quickly than a middle-aged adult, but it’s tough. I’ve seen a lot of different numbers, but between 10-50% of open heart surgery patients have persistent pain from the wires that were twisted around their sternum to close it after surgery. It’s particularly painful for very thin patients, and sometimes they do a second surgery to remove the wires. You’re also really prone to infection after heart surgery and an infection could lead to sepsis, the symptoms and issues of which humbug covered quite well.

*I had my open heart surgery in 2023, so they did a thoractomy and tunneled through my chest wall and in between my ribs to access my heart, stop it, and do the surgery. This was hugely preferable to a traditional sternotomy for me, but it’s a relatively rare approach now and was decades away from being invented in the 90s.
posted by kate blank at 12:58 PM on November 6, 2023

Polio, then Post-Polio Syndrome if a recurrence of the influence of the affliction is part of the story.
posted by rhizome at 1:06 PM on November 6, 2023

I have ulcerative colitis, which is an autoimmune disorder related to Crohn's disease -- the difference being that, in the worst case scenario, UC can be cured with surgery while Crohn's cannot be. I was miserable from 2008 until early 2020 when I finally found a gastroenterologist who prescribed the drug that has kept me in remission for almost 4 years now. Surgery is almost certainly not in my future, but it's there as a final measure if need be. I'm just super thrilled with my current drug and live a fully normal life now, no dietary restrictions or anything.
posted by janey47 at 1:11 PM on November 6, 2023 [2 favorites]

Oop, just to add on a bit -- there are two times in life when UC onset is most common and late teens is one of those times.
posted by janey47 at 1:13 PM on November 6, 2023

Ack, I should have included this piece of info: my story is set in the early 90s,

As I recall, late 80s into early 90s was when AIDS/HIV shifted from something that would kill you to something that could be managed, and managed quite well in many situations.

The History of HIV Treatment: Antiretroviral Therapy and More
posted by philip-random at 1:31 PM on November 6, 2023

I know someone who got hepatitis from a trip abroad and was VERY ill for a long time.

Giardia or amoebas might also fit the bill- serious gut infections - can get them camping from unsafe water - and they cause explosive gastro symptoms, weight loss, weakness, and general misery type symptoms that take forever to resolve.
posted by nouvelle-personne at 2:00 PM on November 6, 2023

Postural orthostatic tachycardia syndrome (POTS) can be disabling and very mysterious (especially in the 80s). When it starts in the teen years, it often goes away in early adulthood.
posted by theotherdurassister at 6:38 PM on November 6, 2023 [1 favorite]

Some kind of organ failure requiring transplant might work (depending how strictly you mean "fine" afterwards).
posted by randomnity at 5:57 AM on November 7, 2023

Undiagnosed Marfan Syndrome.

Because of his long, lanky frame, he was always the first picked for basketball. Then in college he joined the team, but collapsed on the court. He was rushed to the hospital with an aortic dissection and miraculously survived.

It's uncommon in someone so young, which led to further testing. He has Marfan Syndrome.

His girlfriend stood by him through everything. At 25 he has to manage his condition, but you'd never know from looking at him that he'd been through so much.

Another option would be a ruptured cerebral aneurysm.

Roughly one percent of us have a weakness in a blood vessel, and most will never rupture. They're just there, to remind us we're mortal. Your hero was one of the unlucky ones.

One day he has the worst headache he could imagine. His girlfriend rushes him to the hospital, insists it's no ordinary headache, he's not hungover, it's an emergency. He finally gets seen, and gets surgery. There's a long recovery, but now he's ok.
posted by champers at 7:55 AM on November 7, 2023 [1 favorite]

Response by poster: Thanks, everyone, for these wonderfully wide-ranging suggestions. Definitely something here (many somethings) will work and will have lots of thematic potential.
posted by swheatie at 11:37 AM on November 7, 2023 [2 favorites]