Blue Valentine

(2010)

Directed by Derek Cianfrance

Written by Derek Cianfrance, Joey Curtis, Cami Delavigne

Produced by Lynette Howell, Alex Orlovsky, Jamie Patricof, Carrie Fix

Starring Michelle Williams, Ryan Gosling, Faith Wladyka, Mike Vogel, John Doman

The Weinstein Company, Silverwood Films, @radical.media, Hunting Lane Films, Motel Movies, Cottage Industries

Rating:  R

Nursing rating		Rating guide: excellent = 4 stars; good = 3 stars; fair = 2 stars, poor = 1 star
Artistic rating

Ultrablue

Derek Cianfrance's Blue Valentine offers a bleak but compelling look at a broken love. Cindy and Dean live, if you can call it that, with their six-year-old daughter in Scranton, Pennsylvania. The movie mixes scenes of the couple's current alienation with flashbacks to the time when they fell in love. This flicking of the joy-pain switch can be punishing, but with great acting and mostly fine writing, the movie has the grainy, mysterious power of an ultrasound image that you don't quite want to see. When Cindy met Dean, she was a smart college student with dreams of becoming a physician. Now she is a beleaguered working mother who seems trapped by her life, and especially by Dean, who has become a devoted father but a sour, verbally abusive husband who hangs around smoking cigarettes when he is not painting houses. He wants only what he can't have anymore:  Cindy's love. She works at an obstetrics office, and some elements of the film suggest she is a nurse; others suggest she may be an ultrasound technician.

Although this is not a major studio release, the film has won critical praise, and Michelle Williams has been nominated for an Academy Award for her portrayal of Cindy. So the movie may be influential in reinforcing the stereotype of nursing as a job that ambitious women have to settle for if they can't become physicians. The film does not show how Cindy got into her work, but it clearly does not light up her life, and it seems like a job she took after she got pregnant and had to drop out of college, rather than a fulfilling profession that would itself require college training. And as Cindy might agree, even small flaws in an important image can make a big difference.

Blue Valentine has been received as the story of Dean's lack of ambition and inability to grow in the way Cindy wants, of a working class man who is ultimately found wanting by a middle class woman. Dean really wants nothing more than to be a husband and a father, yet his devotion to those very goals seems to be a key source of his decay. Dean alternates between pleading and controlling; he is undone by his own inability to revive Cindy's love. We do gradually understand what Cindy once saw in him. Dean did not finish high school, we learn, but he did show a deceptive charm and an impressive capacity for self-sacrifice. He actually cared how Cindy felt, which seems to have been a fairly unusual experience for her. Dean is still an attentive and loving father. But his wit has become small and mean, and at times he acts as much like another child for Cindy to handle as he does a fellow parent. And she does want something more than she has. She doesn't really seem to like or respect Dean any more, and there is a deadness in her interactions with her family that her fatigue does not fully explain. Her few efforts to reach out to Dean are so half-hearted that they almost seem designed to fail--and her rejections of attention from other men have some of the same quality.

The depictions of Cindy's current job at an obstetrics practice are ambiguous. She seems to practice as an ultrasound technician, but there are also suggestions that she is meant to be a nurse. Cindy wears a patterned scrub top and solid scrub pants to work. At one point, we see her doing an ultrasound on a pregnant woman. When Cindy asks if the woman wants to know the gender and the woman says yes, Cindy suggests that having a baby must be surprise enough (as, we know, it was for Cindy). Cindy also seems to be on call for certain hours, as an ultrasound technician might be. And some reviewers have described her that way (1, 2, 3, 4, 5, 6, 7). However, in one scene, Cindy tells a physician colleague that a patient is having pain, which might be more consistent with the nursing role. And at another point, this physician seems to refer to her as his "best nurse," a line that appears in a copy of the script located online, but it is not entirely clear. In real life, some physicians do refer to any females the physicians believe play an assisting role as "nurses," although those females are not actually nurses. Whatever the intent, many filmgoers will believe that she is a nurse (as many reviewers have: 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15). It is also possible that Cindy is both a nurse and an ultrasound technician. In any case, it is pretty clear that Cindy works for the physician.

Some clinical scenes show the physician urging Cindy to consider helping him open what sounds like a new practice some distance away. At one point, he says he understands that it would be quite a trip back and forth from her current home and a burden for her family to move, so he magnanimously suggests she get an apartment near the new location where she can stay when she is working. He notes that she will not be lonely because she can hang out with him, have dinner, and so on. Cindy gets it. She tells the physician that she is married and that she thought he wanted her help with the new location because she is good at her job. She sounds hurt, but not really shocked. The physician stumbles and stammers in reply, and so it does seem that his overtures were mostly or completely about physical attraction. Later, Dean shows up and does something that endangers Cindy's continued employment at the practice.

This is all a big comedown from what Cindy had planned for her life, based on the flashbacks to the time when she first met Dean and was attending college. In one of those scenes, we see her doing "research" about paraplegics by giddily wheeling herself around campus in a wheelchair. College Cindy also tells Dean that she is interested in "medicine," and at a dinner with Dean at her parents' house, it's again made very clear that she wants to be a physician. Cindy also notes that she really enjoys her biology class with a particular professor. Dean says he would like to have Cindy as his physician, because many physicians are only in it for the money. Is this a subtle suggestion that Dean is not quite reading Cindy right, because she will later turn out to be interested in something more than just helping people?

We are never told exactly what happened with Cindy's studies, and by the time of the present day events more than six years later, no direct reference is made to her physician plans. But we do know that soon after she met Dean, she accidentally became pregnant. A couple of brief scenes related to her pregnancy actually present a pretty realistic look at an obstetrics interaction (at a different practice). These scenes include a procedure by a gentle, expert physician and some support from a fairly knowledgeable nurse, who provides a few comforting comments to the distressed student. Cindy accepts Dean's offer to help her raise the child, and they get married.

It certainly seems that part of what's missing in Cindy's life now is her original career path, though she never says that directly. Cindy has chosen the same specialty area involved in the life event that apparently changed her career trajectory, but the movie makes no specific comment on that. Is she trying to deal with her own issues by working in obstetrics? To help others who find themselves in her position? We don't know, and although Cindy is very focused on keeping her job, we have no reason to think she is thrilled by it. It seems to burden and exhaust her. Some reviewers have suggested that Cindy is bitterly disappointed that she was unable to become a physician. Many people will likely conclude that Cindy had to drop out of college, and they may also assume that however she became involved in her current work, it did not involve any further college-level training. But becoming an ultrasound technician appears to require at least an associate's degree, with a good deal of health training. And of course, to become a registered nurse also requires at least an associate's degree, which commonly takes about three years to get today with all the prerequisites, though a pre-med major would probably have had some of that course work.

The ambiguity about what Cindy's profession is reflects the blurring of the lines between nurses and other health workers in modern clinical settings. To some extent, this may be the result of the proliferation of unlicensed assistive health personnel, many of whom dress like nurses and also do or seem to do work that nurses once did. Today, many workers with far less training are mistaken for nurses. In addition, many have long assumed that any female caregiver who is not a physician must be a nurse. Being considered an ultrasound technician is hardly the most serious of these mistakes, since that work requires significant college-level training; ultrasound technicians appear to be paid comparably to direct care nurses. But nursing is an autonomous profession led by nursing managers and nursing scholars with doctorates in nursing. Nurses are not assistants or technicians, and they do not report to physicians in hospitals or in a professional sense generally, though physicians may employ nurses in private practices like the one in this movie. Confusing nursing with another profession simply because both seem to consist of females in patterned scrubs who help physicians is inherently degrading.  

And of course, for those who see Cindy as a nurse, the film will likely reinforce the wannabe physician stereotype. Cindy dreamed of being a physician, but her pregnancy and her decision to marry Dean seem to have killed her dream. This is hardly the first time that Hollywood has suggested that nursing is for people, especially women, who can't become physicians, and that the modern, feminist thing is to leave that dead-end nursing job behind and move up. In Living Out Loud (1998), the lead character drops out of medical school to marry a medical student. Her husband later leaves her for a younger physician, and the character--now an unfulfilled nurse--recovers in part by returning to medical school. In both Gracie (2007) and Akeelah and the Bee (2006), the young and talented female leads learn that, unlike their bitter mothers, they are not confined to pursuits like nursing; they can actually do something important in their lives. Television has echoed these themes. Two of the three major nurse characters on NBC's long-running ER aspired to medical school, and one--Abby Lockhart--eventually managed to become a physician, a change the show celebrated as a glorious advance. And before ABC's Private Practice killed off nurse midwife character Dell Parker last year, it made sure to punch up the tragedy by having him announce that he had just been admitted to medical school.

Here it is a pregnancy that seems to ruin Cindy's physician plans, but the effect is similar--she is trapped in unfulfilling work that makes her economically and socially vulnerable. She wanted more, and the fact that she did not get it is part of the film's tragic force. The prevailing assumption remains that those interesting in health careers pursue medicine if they are smart and ambitious; if they fail, then they must accept a job in nursing or some other poor substitute.

Serious dramatic work is less likely to misrepresent nursing than Hollywood fantasies are. But as the ambiguity about Cindy's career shows, the problem is not just in our stars, but in ourselves.

Reviewed by Harry Jacobs Summers
Nursing Editor: Sandy Summers, MSN, MPH, RN
Reviewed February 14, 2011

The views expressed herein do not necessarily reflect those of the Board Members or Advisory Panel of The Truth About Nursing.