What does it mean when the best romantic comedy of the year puts its female lead in a coma?

A hit at Sundance that's just getting a commercial release this week, The Big Sick begins with all the narrative trappings of the genre. Kumail Nanjiani, a successful Pakistani comedian, plays, well, Kumail Nanjiani, a somewhat less successful Pakistani comedian, who hooks up with an audience member named Emily, played by Zoe Kazan. They attempt to keep things casual, but as quickly as that night's drive home — he moonlights as an Uber driver, so naturally his phone goes off when she calls for a ride from his apartment — they're joking and bantering. He looks at her in the rearview mirror and it's clear that they won't be able to stay away. But then, after about 40 minutes of romance, Emily is abruptly hospitalized and placed in a medically-induced coma.

This is not a problem with the movie — it is more or less the premise, as Kumail, whose relationship with Emily has been damaged by his parents' devotion to the tradition of arranged marriage, plays awkward host to Emily's parents (Ray Romano and Holly Hunter). Nanjiani, who co-wrote the movie with his real-life spouse Emily Gordon (based on their actual courtship), squeezes the discomfort for a lot of laughs. But the turn into hospital waiting rooms doesn't really deny The Big Sick its status as a romantic comedy. In fact, it places it in a new tradition consistent with the presence of producer Judd Apatow: It's a rom-com without a girl.

Not literally, of course; Kazan is in plenty of the movie, and she's as innately charming as ever. She has the ability to appear so desperately open-hearted that her character's happiness becomes uncommonly important. There are also women in Apatow-directed-or-produced features like Knocked Up, The 40-Year-Old Virgin, and Forgetting Sarah Marshall, and the many movies influenced by them, like That Awkward Moment or Mike and Dave Need Wedding Dates. Some of the female characters in these movies are interesting, well-written, and/or funny. But they share or sometimes cede the spotlight; these are romantic comedies about guys.

A decade or so ago, a reorientation of the genre's narrative around men was a novelty that broke the rom-coms away from forced zaniness and lavish wedding fantasies. But the dude takeover may have convinced studios that the distaff versions weren't worth producing anymore. In retrospect, a pair of friends-with-benefits rom-coms from 2011, No Strings Attached and Friends with Benefits, feel like a turning point, halfway between Apatow coming-of-age raunch and tidier, glossier romance. There have been few wide-release female-centric rom-coms since then — the kind of movies that Kate Hudson, Reese Witherspoon, or Meg Ryan used to make. By the time Amy Schumer played with this formula to great effect with Trainwreck, there were so few studio rom-coms that it was more often described as a female version of an Apatow comedy (not least because he directed it).

In one sense, this is a positive step, coinciding as it does with the rise of female-driven general comedies. Back in the '90s, movies like Bridesmaids, The Boss, The Heat, or Snatched, among others, might not have been retrofitted into outright rom-com, but they certainly would have at least featured more prominent male love interests. There are other things women can do on screen besides fall in love, certainly, and newer comic stars like Melissa McCarthy and Amy Schumer seem to recognize that.

It's also not as if great romantic comedies have disappeared. Two of the best of recent years, Obvious Child and Sleeping with Other People, are no less masterful for their limited theatrical releases. Still, it's odd to see a genre traditionally aimed at and starring women get turned over to male self-improvement.

The Big Sick isn't a total bro-down, but it features plenty of Apatow hallmarks: the group of comedian friends who trade riffy insults; the weirdo roommate; the tributes to the essential messiness of domestication. Structurally, its rearrangement of relationship hallmarks is clever: Instead of Kumail meeting his girlfriend's parents over a zany weekend getaway, he meets them through a situation defined by Emily's absence — and winning them over becomes part of his realization that he might need to win her back, too, if he gets the chance. Romano and Hunter are very funny as the unexpected quasi-in-laws, as are Anupam Kher and Zenobia Shroff as Kumail's traditionalist parents. This is a charming, culturally specific movie.

But as a romantic comedy (which seems to be part of the movie's identity), it does feel imbalanced. By necessity, Kazan stops providing tension of her own through dialogue or action, and as heartwrenching as her situation is at first, the narrative falls into place a little too easily without her. This isn't the first time Kazan has been pushed out of her own movie by a smart conceit; it even happened in one she wrote, Ruby Sparks, where she played a fictional character made flesh, dating her writer creator. The movie was too busy making its point about toxic "nice guys" to let its own characters come to life.

That's not a problem with The Big Sick, which comes to life just fine. But it's a little unsettling to consider that what might turn out to be the best romantic comedy of the year depends so heavily on a girlfriend in a coma.