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We commonly assume that cancer afflicts the aging or aged, but approximately 16 percent of breast cancer deaths involve women under the age of 50. How can or should an alarming death sentence be confronted in midlife? The personal challenges posed by incurable disease unfold in an absorbing documentary about movie-making, “A Woman Like Me,” which opened in New York in October and became available on Netflix this January.

The co-directors of “A Woman Like Me,” Alex Sichel and Elizabeth Giamatti, consider the roles played by temperament, spirituality and art as two vigorous women attempt to reconcile themselves to a terminal prognosis. The film portrays Ms. Sichel confronting metastatic breast cancer by making two movies.

The first is a documentary of herself in the hospital with medical personnel and at home with her family. Ms. Sichel, who received the diagnosis just before her daughter started kindergarten, is shown dealing with her ambivalence about the traditional therapies she undertakes. Her parents, sisters and husband struggle on camera with their ambivalence about the holistic therapies she also undertakes.

Braided with the documentary, the second movie Ms. Sichel makes is fictional: The actress Lili Taylor plays a buoyant alter ego, Anna, who must respond to the same dire diagnosis. The fictional narrative of “A Woman Like Me” centers on a happier version of Alex Sichel so she can watch someone stepping lightly through her fraught terrain.

For example, Anna sits with a friend in a restaurant and interrogates the waitress. Is there dairy in the vegetarian dish? Are there gluten-free options? Her friend orders the cavatelli, Anna steamed kale without salt. After a pause, though, she changes her mind; she will have the cavatelli as well as a glass of Cabernet. In the near future, she says, she does not want to look back on “pointless good behavior.”

In contrast, Ms. Sichel presents herself in a series of tortured conversations with a variety of advisers as she hurtles between fear and hope on an emotional roller coaster. She visits a meditation center and consults a Buddhist teacher, but equanimity often eludes her. Intermittently sad and angry, yet terrified of dying angry, she tries to find serene memories, only to recall her sorrow at her grandmother’s death, whereas Anna remembers her grandmother’s cooking.

“A Woman Like Me” hints that some people may be endowed with a disposition that facilitates their making peace with their imminent demise, although maybe those people exist only in fiction. Yet both stormy Alex and sunny Anna try to learn how to acknowledge their looming mortality. In especially poignant scenes, Alex and Anna must come to terms with their grief at losing their young children and also with their children’s future grief at losing them.

Anna copes with cancer most dramatically when she rehearses her death with her husband. Enlisting his help, she promises to refrain from moaning, but wants to know what his final words to her will be. And then she encourages him to drape a white sheet over her head. Anna’s directing the scene with her husband tells us something about Alex Sichel’s decision to spend the last year of her life co-directing a movie.

Like Anna’s rehearsing, Ms. Sichel’s movie-making is a testament to creativity and to the multiplicity of the self. Ms. Sichel refutes what cancer will inevitably make of her by imagining what she makes of it. In “A Woman Like Me,” she offers a defense of cancer art as a way of envisioning and practicing mortality. Throughout the film she espouses the efficacy of Buddhism, but the creator of Anna provides us proof of the value of story-telling.

If Alex Sichel could not become a sunnier person, she could envision herself being one. Through this endeavor, she and her co-director, Ms. Giamatti, illuminate what it means to live with incurable cancer not, as Ms. Giamatti put it during a phone conversation, in a “Halcion or Hollywood” manner, but in all its messy and contradictory intensity.

After watching the movie, I was upset at learning that Ms. Sichel died on June 23, 2014, at the age of 50, and then I was surprised at my distress since the end of the film makes it abundantly clear that she was suffering advanced disease. Yet somehow I could not believe that this engaged and engaging woman was dead. My reaction also testifies to the power of art, for Alex Sichel and her double Anna continue to touch and instruct people like me by showing us characters like ourselves.

If we cannot attain complete and lasting tranquility in the face of a death sentence, we can nevertheless conceive of a series of precarious, provisional moments of acceptance. Story-telling serves not as an escape from the reality of disease but as an assertion of the self against what will eventually happen.

Terrible as cancer is, it has prompted people to produce astonishing art. The power of this meta-movie resides not in retrospective platitudes about women with metastatic disease but in its representations of their urgent exertions to imagine the unimaginable.

Related:

• “Living With Cancer: Deciding About Dying”
• “Living With Cancer: Alone and Ghosted”
• “Living With Cancer: Curses and Blessings”

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