Our Friend (2019) and Advanced Ovarian Cancer

The film is told out of order, across roughly a decade. Matt Teague, a magazine journalist, and his wife Nicole, a singer and theatre performer, live in Fairhope, Alabama with their two young daughters. Nicole is diagnosed with advanced ovarian cancer.

Spoilers throughout. Nicole's illness and death are the subject here, and are described as such.

Their close friend Dane Faucheux is drifting through a job and a relationship in New Orleans. He comes to stay for what he says will be a couple of weeks, and ends up living with them for more than fourteen months. He cooks. He drives the girls to school. He absorbs the household chaos and steadies Matt, who at first keeps travelling for work.

Chemotherapy and surgery follow. Then comes the news that the disease has spread and that roughly six months remain. The final stretch at home brings pain, agitation, confusion and hallucination, with hospice support. Nicole dies at home with Matt and Dane present. Afterwards Matt writes the essay the film is based on, and Dane, hollowed out, slowly rebuilds his own life.

The real Nicole Teague was 34 when she was diagnosed in September 2012. She died at home in Fairhope in September 2014.

Matt Teague's Esquire piece is the source, and it is much harder to read than the film is to watch.

It described fistulas — abnormal openings between organs, or from an organ out through the skin — along with open abdominal wounds, wasting, and a body failing in ways that were degrading and difficult to look at. The film keeps Nicole recognisable and largely camera-ready far longer than her illness allowed.

That softening is understandable and it has a cost. Families going into this are frequently unprepared for what advanced abdominal cancer does, and a film that shows a gentler version reinforces the surprise. If you are caring for someone in that position, it is worth asking the hospice team plainly what to expect over the coming weeks, including the parts nobody volunteers.

Treatment is compressed into montage as well, so the specifics of ovarian cancer care are largely missing: surgery to remove as much tumor as possible, platinum-based chemotherapy, the pattern of remission and return, and the decisions around when to stop.

The caregiving is the truest thing in the film, and Dane is the reason.

Most of what he does is logistics rather than bedside speeches. School runs, meals, laundry, keeping a household upright. A friend who simply stays turns out to be worth more than anyone's advice, and nobody has a word for the role.

The film is honest about the cost to him. His own relationship and career are quietly dismantled while he is not looking, and there is no title, no leave entitlement and no recognition attached to any of it. It is honest too about the children living inside a house organised around illness, and about how flat grief is after the funeral, when the visitors stop.

It also shows something families are rarely warned about. A dying person's personality can change under pain, medication and disease. Agitation, confusion and hallucination near the end are common, and they frighten people who were not told they might happen.

Ovarian cancer is often called silent. That is not quite right, and the distinction matters for anyone reading this before they need it.

It usually does cause symptoms. They are just unremarkable, and they belong to a dozen commoner things. NCI lists:

• Pain, swelling or a feeling of pressure in the abdomen or pelvis.
• A sudden or frequent urge to urinate.
• Trouble eating, or feeling full quickly.
• A lump in the pelvic area.
• Gas, bloating or constipation.

NCI also notes that ovarian cancer may cause no early symptoms at all, and that when they do appear the disease is often already advanced.

What separates worth-checking from ordinary is pattern rather than severity. New. Persistent. Present most days for a few weeks. Different from your usual. Any one of those symptoms on a bad week means nothing; the same one most days for a month is a reason to be examined.

This is the part that surprises people, so it is worth stating exactly.

In 2018 the US Preventive Services Task Force recommended against screening for ovarian cancer in women who have no symptoms and are not known to have a high-risk hereditary cancer syndrome. That is a grade D recommendation, meaning the harms outweigh the benefits.

The reasoning is specific. The Task Force found adequate evidence that screening with transvaginal ultrasound, the CA-125 blood test, or both together does not reduce deaths from ovarian cancer. It also found adequate evidence of real harm: many false-positive results, which lead to unnecessary surgery in women who do not have cancer. When the only way to check an abnormal ovarian scan is an operation, a test with poor accuracy stops being harmless.

Two things follow. A cervical screening or Pap test does not check the ovaries, and never has. And women with a strong family history of ovarian or breast cancer, or a known BRCA1, BRCA2 or Lynch syndrome change, are outside this recommendation entirely and should be referred for genetic counselling, where different options apply.

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Because there is no screening test, the earliest ovarian cancer is usually found when a woman insists that something has been different for weeks. That is easier to do with a note than from memory. If bloating, pelvic pressure, early fullness or urinary urgency have been happening most days for a few weeks, write down the dates and take them to an appointment. Our Friend cannot tell you what to watch for, but screening and possible warning signs can.

This page discusses Our Friend 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].