In movies, cancer tends to be more device than disease, a way of preserving a romance for the ages (e.g. Love Story, A Walk To Remember) or delivering people to a better place through the withering of a beatific martyr. There's a shred of the latter in Miss You Already, an affecting but ragged portrait of female friendship, but few movies have been so intent on showing cancer as the excruciating ordeal it is in real life. This isn't Mandy Moore fading gently into twilight, but a stage-by-stage slog to the death, through grim diagnoses, painful treatments, and an unending series of domestic crises. When a patient is told there's a 20 percent chance she'll experience severe nausea during chemotherapy, Miss You Already makes damn sure she falls into that unfortunate minority.

Adapting her British play Goodbye for the screen, writer/actress Morwenna Banks threads one woman's fight against breast cancer into a story of intimate friendship and the circle of life. Jess (Drew Barrymore) and Milly (Toni Collette) have been best friends since childhood, when Jess moved to England from America as a little girl and Milly merrily sidled up to her on the first day of class. As adults, Jess and Milly are as close as ever, even though their lives have gone in different directions. Milly balances a frantic schedule as a PR executive and mother of two small children, but she has a mostly harmonious relationship with her husband (Dominic Cooper), who's gone from pot-smoking roadie to superdad in the space of a montage. Jess has also married well, living quaintly on a houseboat with a sensitive oil rigger (Paddy Considine), but the two have struggled to conceive.

Not long after an oncologist gravely informs Milly that she has a malignancy, Jess' fertility treatments finally yield dividends, and their fortunes fall drastically out of alignment. Though Banks' script graphs their opposing trajectories far too neatly, there's something touching about life and death passing through this friendship and life after death taking a different form. Milly's cancer ultimately overwhelms the drama, though, to the point where Jess feels uncomfortable even mentioning that she's pregnant, not knowing how her friend is going to react. But that's another area where Miss You Already is keenly insightful: Milly's husband, her mother (an excellent Jacqueline Bisset), and Jess have the best intentions, but they don't always know what she needs or how to act around her. And half the time, Milly doesn't know, either.

Collette and Barrymore are a convincing pair, with Barrymore generously ceding much of the gallows humor to Collette, whose character laughs in the face of death even as it chases her to hospice. That's another thing people do under duress: Make jokes, lighten the mood, show a little resilience. The plotting may be phony in sections, especially an absurd birthing-room sequence that's scaled to hit the fullest range of human emotions. But the core of their relationship feels genuine and true in smaller moments, like when they're trading in-jokes or speaking in an intimate shorthand that only they understand.

The one persistent issue with Miss You Already is Catherine Hardwicke's direction, which keeps pressing for intensity when a lighter, more carefully modulated touch might suffice. This problem has dogged Hardwicke (Twilight) since her debut feature, 2003's Thirteen, turned the trials of adolescence into cause for mass hysteria. Her handheld camera is such an active character in Miss You Already that it almost seems to goad the characters on, spoiling for a fight, and it's enough to knock many scenes from naturalism to melodrama. A movie about cancer doesn't need the stakes amplified more than they are already.

The deliberate rough-around-the-edges quality of Miss You Already is liability and asset: Whisking Milly and Jess off to the Moors for a double-homage to Wuthering Heights and "Losing My Religion" is just one of several odd detours the film takes, but Hardwicke's willingness to get into the vomit, tears, and viscera of Milly's cancer treatments has a boldness and integrity to it. For better or worse, we're on this rollercoaster ride, too.

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