Howard Ratner, the protagonist of the supremely tense new thriller Uncut Gems, receives one of the most memorable introductions in film history: Colon first, as seen through the camera probing his innards as part of a colonoscopy. This is an image rich with meaning. Does Howard’s barren digestive track reflect that he’s emotionally empty inside? Is his butt-first intro a playful clue that Howard is, at his core, an a—hole? Or maybe directors Josh and Benny Safdie, want to signal the audience that they plan to examine Howard’s life with the thoroughness of a gastroenterologist as they check a digestive system for lumps. Whatever the intention, there’s a lot going on in Howard’s innards.

Howard’s gut doctor is only the first and most pleasant person up Howard’s ass in Uncut Gems. Mind you, he deserves the discomfort. In purely technical terms, Howard (Adam Sandler) is a f—-up. His wife Dinah (Idina Menzel) even calls him a f—-up to his face. She means it, and she is correct. He’s already destroyed their marriage by shacking up with one of his jewelry-store employees, a sweet (but perhaps not-entirely-faithful) younger woman named Julia (Julia Fox). Howard tries to pretend there’s still hope for him and Dinah; he schleps out to the burbs to tuck his kids into bed, and he keeps stalling for more time before they announce their separation to their families. But Dinah knows the the score; Howard’s a f—-up.

Sleeping with one of his employees is the least of Howard’s problems at work. He seems to owe money to everyone else in Manhattan’s Diamond District — mostly gambling debts — and he’s long since run out of Peters to rob to pay Paul. His only shot at getting his head above water is the giant, uncut opal he just smuggled out of Ethopia. Howard believes this stone will fetch a million bucks at auction. First, though, he needs to get the stone to the auction, a difficult task since Howard — who, again, is a f—-up — reluctantly loans the gem to NBA star Kevin Garnett (playing himself), who falls head over heels with the rock when Howard shows it to him in an ill-advised moment of egomania.

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Howard’s decision to lend KG the opal has a cascading effect, and sends him pinballing through NYC as he tries to retrieve his jewel, avoid his debt collectors (including a truly frightening one played by Eric Bogosian), and scrounge the cash he needs to place even more bets. Along the way he digs himself into a hole so deep it makes the mine in Ethiopia where the opal came from look like a puddle on Sixth Avenue. In almost every situation Howard makes the wrong choice — but each makes absolute sense from his warped perspective, making it very easy to get sucked into his titanic struggle for survival.

All the bad choices, one on top of the other, turn Uncut Gems into a magnificent work of sustained suspense. From basically the first few seconds of that introductory colonoscopy, Howard is in grave danger that he will never escape for the next 130 minutes. Although the tension sometimes eases, there are way more sequences where it amplifies by several magnitudes — like a testy Passover seder where one of Howard’s disgruntled relatives shoots daggers into him with his eyes during a recitation of the ten plagues of Egypt. There are also several extensive set pieces set around the outcomes of actual NBA playoff games from 2012, so if you’re up on recent Boston Celtics history, your experience of the movie may be spoiled to some extent. Still, while everyone is talking about how Joker is potentially dangerous, I would be much more worried about Uncut Gems, which could definitely give someone a panic attack with its relentless drama.

Uncut Gems, which made a “surprise” appearance last week at the New York Film Festival ahead of its December premiere, isn’t just a thriller, though. The Safdies have crafted a complete experience here: A pointed critique of the “American Dream,” a wry portrait of Jewish assimilation in the 21st century, a cautionary tale about gambling addiction (that also doesn’t shy away from showing how seductive sports betting can be), and an unflinching character study centered around the best performance of Adam Sandler’s career. Sandler has certainly been good in films before, but this is his most complete work: The one that finds a way to channel that venomous rage and punchable personality that fueled his early comedy hits into something deeper and sadder — while still being hysterically funny.

Uncut Gems maintains a lot of what defined the Safdies’ earlier efforts, including an interest in addiction and street-level drama, along with an incredible eye for casting authentic Noo Yawkuhhs, but this is their step into a new stratosphere. For two hours, they sweep viewers up in poor Howard the F—-Up’s plight, in a way that is both exciting and sensitive — not only to Howard but to many of the people in his orbit, including Julia and Kevin Garnett, who could have a future as an actor if he wants it. The anticipation builds and builds and builds, and then ultimately arrives at an ending that feels completely shocking and slightly inevitable. That doesn’t make it any easier to stomach.

Additional Thoughts:

-More Uncut Gems cast standouts: Lakeith Standfield as Demany, Howard���s hookup for clients in the hip-hop community, Judd Hirsch as Howard’s father-in-law, and New York sports talk radio legend Mike Francesa in a self-referential cameo as Howard’s bookie.

-Although the cinematography is rarely showy, I loved the way director of photography Darius Khondji lit the scene inside a club bathed in blacklight. Both Howard and Demany seem to be wearing the same color shirt, and yet Demany’s glows iridescent orange and Howard’s remains as dull as dirt, underscoring their social status in that world.

-Seriously, Sandler is incredible in this movie. Give him an Oscar nomination.

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