In his author's note, Ness writes that Dowd "had the characters, a premise, and a beginning. After Dowd's death in 2007, her publisher arranged for Ness to write what would have been her fifth book. Ness based the novel on an idea by the late children's author Siobhan Dowd, who conceived of the story's premise while battling cancer herself. In its depiction of a boy privately struggling with the anger, isolation, and denial that result from his mother's diagnosis, A Monster Calls has been praised as a lesson in accepting the unfair truths of life and death. After the monster tells the boy three parables that illustrate the inherently complex truth of human existence, the boy accepts his contradictory feelings of wanting his mother to live while simultaneously wishing for an end to both her and his suffering. Haunted by a nightmare in which his dying mother slips from his grasp as she falls off a cliff, the boy is visited by a yew tree growing in a nearby churchyard that transforms into a monster. Patrick Ness's 2011 fantasy novel A Monster Callsis about a thirteen-year-old boy who learns to overcome his denial about his mother's terminal cancer.
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