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. He has one real friend, Earl, whom he insists on calling a co-worker. Together they have spent years making cheap parodies of art-house films in a teacher's office.

Spoilers throughout. The narrator lies about the ending. This page tells you what actually happens.

Greg's mother makes him spend time with Rachel Kushner, a classmate just diagnosed with leukemia. Obligation turns into an actual friendship, conducted mostly in Rachel's bedroom and held together by Greg's refusal to be sentimental about her. Earl shows Rachel their films without asking, and later suggests Greg make one for her.

Rachel's chemotherapy makes her sicker without helping. She decides to stop. 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 told us at the start that she lives. He admits he lied.

This is the most valuable thing in the film, and it is easy to miss under the jokes.

Rachel is a competent young adult weighing quality of life against treatment that is making her suffer for little return. The film lets that be her decision rather than a defeat — even though the people who love her experience it as one, and one of them says so at volume.

Stopping treatment is a real option, and it is not the same as giving up. It usually means changing the goal from controlling the disease to controlling how the person feels. Palliative care continues. Symptom treatment continues. What stops is the part that is costing more than it is buying.

Her physical decline is also shown more honestly than in most films of this kind. Hair loss, weight loss, exhaustion, and a world that shrinks to one bed. The ending is not redemptive, and the narration takes back the consolation it promised.

The medicine is thin. No oncologist ever explains the disease, the plan, or what stopping treatment will mean. The decision arrives as a settled fact, discussed between teenagers.

The subtype is never made clear on screen either, and in leukemia the subtype is the plan. Which cells are involved, and which genetic changes they carry, decides the drugs, the intensity and the odds.

The film also leaves out most of what modern leukemia treatment actually consists of. There is no hospital admission for intensive chemotherapy. No transfusions of red cells or platelets. No mention of the infection risk that comes when treatment strips out the white cells that fight it — the reason patients end up in isolation and are told to come to hospital for a fever, not to wait it out. No discussion of a stem cell transplant, which is one of the options weighed for younger patients.

Rachel also stays conversational and coherent for longer than failing bone marrow usually allows.

Leukemia is a cancer of the blood and bone marrow. Immature cells build up in the marrow and crowd out normal blood production. So the early signs are consequences of that failure, not a lump you can find.

NCI's list for acute myeloid leukemia, the most common acute leukemia in adults, is:

• Weakness or feeling tired.
• Fever.
• Infection.
• Paleness, or loss of normal skin colour.
• Bleeding.

Bleeding here means the ordinary kinds that suddenly happen too easily: nosebleeds, gums that bleed when you brush, bruises with no cause, periods that are heavier than usual.

Two details from NCI make this useful rather than alarming. First, the early symptoms may resemble flu or other common illnesses — which is exactly why they get ignored. Second, symptoms of acute leukemia often develop between four and six weeks before diagnosis. This is a fast illness, not a slow one.

That gives a workable rule. A flu-like illness that has not resolved after a few weeks, especially alongside easy bruising or bleeding, is worth a blood test rather than more rest.

There is no screening test for leukemia in people at average risk, and no recommendation to check adults or children who have no symptoms.

Diagnosis starts when a symptom prompts a full blood count and the result comes back wrong. From there it is confirmed with a blood film, a bone marrow sample, and laboratory tests that identify exactly which cells are involved and what genetic changes they carry.

Because nothing screens for it, the whole early-detection pathway rests on someone deciding a symptom is worth mentioning. That is not a satisfying answer, but it is the true one, and it is why a blood count is such a cheap thing to ask for when something has been off for weeks.

Cancer Explained is free and ad-free. Nothing is sold on this page. No sponsor sits behind it.

If this page helped you understand something about Me and Earl and the Dying Girl, or moved you to ask a question you had been avoiding, reader support is what keeps it free for the next reader. Support our work.

The narration promises that Rachel lives, and then admits it was a lie. That is the film arguing with the genre it belongs to — the one where illness exists to improve a healthy person.

It mostly wins the argument. What it does not give you is any sense of what her treatment involved or why it stopped working, and no viewer should read Rachel's course as a forecast of anyone else's. If something has been wrong for a few weeks, ask for a blood test. Me and Earl and the Dying Girl cannot tell you what to watch for, but screening and possible warning signs can.

This page discusses Me and Earl and the Dying Girl for education. It is not medical advice, and nothing here is a judgement of anyone's real medical care. Spotted an error? Please email corrections@cancerexplained.org.