Me and Earl and the Dying Girl (2015)

Greg Gaines is a Pittsburgh high-school senior whose survival strategy is to be faintly acquainted with everyone and close to nobody. His one real friend, Earl, he insists on calling a co-worker; together they have spent years making cheap parodies of art-house films in a teacher's office. Greg's mother forces him to spend time with Rachel Kushner, a classmate just diagnosed with leukemia. What begins as obligation becomes an actual friendship, conducted mostly in Rachel's bedroom and sustained by Greg's refusal to be sentimental about her. Earl, without asking, shows Rachel their films, and later suggests Greg make one for her. Rachel's chemotherapy makes her sicker without helping, and she decides to stop treatment; Greg attacks her for it and the friendship breaks. He neglects his college applications and everything else. Rachel deteriorates and is hospitalised. Greg finishes the film and plays it at her bedside while she drifts in and out of consciousness; she dies a few hours later. Greg, who told us at the start that she lives, admits he lied.

Spoilers throughout. Discussing the cancer storyline means discussing how this ends.

The film is sharp about how a teenager's illness reshapes everyone around her: classmates who perform grief, a friend recruited by a parent, the sheer awkwardness of visiting. Rachel's decision to stop chemotherapy is the most valuable thing in it. She is a competent young adult weighing quality of life against a treatment that is making her suffer for little gain, and the film lets that be her decision rather than a defeat, even though the people who love her experience it as one. Her physical decline is shown more honestly than in most films of this kind, including hair loss, weight loss, exhaustion and a world that shrinks to one bed. The ending is not redemptive, and the narration explicitly withdraws the consolation it had promised.

The medicine is thin. We never see an oncologist explain the disease, the treatment plan, or what stopping chemotherapy actually means; the decision arrives as a fait accompli discussed between teenagers. The subtype of leukemia is never made clear on screen, and the film omits the treatments that define modern leukemia care, including hospital induction chemotherapy, transfusion support, neutropenic infection risk and stem-cell transplant, which for AML in a young patient is a standard consideration. Rachel also remains conversational and coherent for longer than someone with failing bone marrow and untreated leukemia usually would.

Acute myeloid leukemia begins in the bone marrow, where immature blast cells crowd out normal blood production. Because it is a blood cancer, the early signs are consequences of that failure rather than a lump. NCI lists weakness or feeling tired, fever, infection, paleness or loss of normal skin colour, and bleeding, which in practice means nosebleeds, bleeding gums, easy bruising and unusually heavy periods. Bone or joint pain, breathlessness and pinpoint red skin spots are also common. Symptoms often resemble flu at first and typically build over a few weeks rather than months, so a flu-like illness that will not resolve, combined with bruising or bleeding, is a combination worth taking seriously. There is no screening test for leukemia in people at average risk, and no recommendation to check adults or children without symptoms. Diagnosis begins when a symptom prompts a full blood count that comes back abnormal, and is confirmed with a blood smear, bone marrow aspiration and biopsy, flow cytometry, and cytogenetic and molecular testing that identify the exact subtype and guide treatment. That absence of screening makes prompt reporting of symptoms the only route to early diagnosis.

A film is not a diagnosis, and a dramatised illness is not a guide to your own. What a story like this is genuinely good for is lowering the barrier to a conversation you might otherwise put off.

If something in your body has changed and stayed changed for a few weeks, that is worth raising with a doctor — not because it is likely to be cancer, but because most of the time it will not be, and finding that out is the point. Where screening exists for a cancer, it is the one thing you can do before anything is wrong at all. See screening and possible warning signs.

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Me and Earl and the Dying Girl is worth watching as a film. It is not a guide to the disease it portrays. The gap between the two is what this page is for — and the thing worth carrying away is that a change which persists is worth a conversation, whatever a story led you to expect.

This page describes a work of film or television 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].