Coixet, who shot the picture in the rarely filmed suburbs of Vancouver, never once lets the material escape from her. Her cast is unusually integrated: among the many extraordinary performances are the doctor (Julian Richings) who cannot bear to tell his patients they are dying, Mark Ruffalo as the lover, and Ann's new neighbour (Leonor Watling), who, in a virtuoso scene, delivers one of the most moving speeches I have witnessed all year.