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Million Dollar Baby (2004)

Starring Hilary Swank, Clint Eastwood, Morgan Freeman, Anthony Mackie, Jay Baruchel, Mike Colter

Directed by Clint Eastwood

Screenplay by Paul Haggis

Based upon stories by F. X. Toole

Malpaso / Ruddy Morgan Production

Rated PG-13

Nursing rating

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

Artistic rating 3 1/2 stars

"Million Dollar Baby" is another of Clint Eastwood's flinty meditations on wounded people fighting to protect what they hold dear in a very cruel world. It centers on a burned-out L.A. boxing veteran who reluctantly agrees to train an aspiring female contender from a Missouri trailer park. There are tired plot elements and weak minor characters and scenes. But the film is still powerful and persuasive, thanks to some good writing, great acting by the leads, and Eastwood's restrained direction. Unfortunately, it includes a minor but awful portrayal of rehabilitation nursing, which is sacrificed to the larger need to show the central characters struggling with the choices fate presents.

Frankie Dunn (Eastwood) is an expert trainer and manager who owns a rundown Los Angeles boxing gym. A curmudgeon protecting his private regret, Frankie still trains contenders, but doesn't seem to have what it takes to go for a title. His estranged daughter returns his letters unread, and he endures needling from friend and gym sidekick Eddie Dupris (Morgan Freeman), a wise former contender who has lost an eye but can still see what matters. Enter Maggie Fitzgerald (Hilary Swank), a scrappy 31-year-old waitress determined to have Frankie train her. Frankie at first refuses, but of course is won over by her grit, then by her knack for knocking people down. She's essentially a female Rocky, minus the slobbering masochism.

Note: In order to discuss nursing's role in this film, we must reveal plot elements that you may not wish to know, including the ending. If you do not wish to learn these, please stop reading here.

As Maggie wins fight after fight, she and Frankie develop a father-daughter relationship, and they follow a fairly predictable road to a big Las Vegas title bout. But just as Maggie seems poised to win, the villainous champion knocks her down with a vicious after-the-bell blow. Maggie falls into her corner stool, and her neck is fractured. She is a quadriplegic with no apparent hope of improvement. The devastated Frankie stays by Maggie's side from her initial care in a Las Vegas hospital to a long term rehabilitation facility in Los Angeles. He--and he alone--tries to keep her spirits up, but after she loses her leg to bed sores, she asks him to help her die. She has gained the respect she craved, but her physical decay is clouding her sense of it. Frankie resists, struggling with his Catholic faith and his desire to keep Maggie alive, but after she tries to do the job herself by biting her tongue, he finally gives her a massive injection of adrenaline. One of Frankie's training mantras has been that Maggie must always protect herself, something he evidently has become adept at over the years. Of course, Maggie has failed to protect herself, just as Frankie has in opening up to her. Yet it was only by doing so--by opening themselves up to failure and hurt--that they ever got anywhere. Behold, the dilemma of life.

In "Million Dollar Baby," the health care system is an extension of the stool on which Maggie fell, an indifferent vehicle of fate. It means her no harm, but it can't help her much either. Health care workers rarely appear, so that virtually all of Maggie's interactions are with Frankie. At one point in Las Vegas, as Frankie prepares to bathe Maggie, she notes that there are nurses to do it. He responds that they're "amateurs." But this really has no more to do with nursing than his bitter remarks that the physicians are inept because they can't fix her have to do with physicians. After Maggie has bitten her tongue, a nurse informs Frankie that they have sedated her so that she can't do it again. This is the only care-related comment by a nurse in the whole film. No nurse ever speaks to Maggie--no emotional support, no advocacy for better care of the bedsores, no discussion of her condition or rehabilitation, no arranging of psych. consults before or after the suicide attempt, and no discussion of end-of-life issues with caregivers, which may well have allowed Maggie to terminate life-sustaining treatment (the ventilator) without the need for euthanasia. Physicians don't come off much better; the only physician interaction occurs when one almost cheerfully tells Maggie that she may lose her leg because of the bed sores. The rehab. scenes could probably occur, but they do not provide a fair overall picture of a modern rehab. facility, and especially not of rehab. nursing.

Of course, the film is not really interested in the health care workers, and they are unlikely to figure much in most viewers' impressions. But nursing is central to rehabilitation, and the film's message of caregiver indifference is clearly at odds with what rehab. nurses actually do. Indeed, what Frankie does is probably closer to nursing than what we see any other character do. (We weren't expecting Clint Eastwood, R.N., but at this stage of his career, anything seems possible.) Frankie is the one who briefly suggests Maggie consider going back to school using a breath-controlled wheelchair. However, he doesn't really pursue the school idea, and though he cares deeply for Maggie, he doesn't seem to disagree with her assessment of her condition.

The film has been criticized for offering a hopeless vision of paralysis and for encouraging euthanasia. The movie does seem to present quadriplegia as a process of slowly wasting away. Had the film shown a nurse or therapist at least try to help Maggie explore her options, it could still have been plausible--and maybe even more tragic--that someone like her, who lived only for boxing and may not have been able to envision a life without intense physical activity, would make the choice she did. Not everyone is Christopher Reeve. But the movie could have used some credible health care effort to help Maggie.

The compelling interactions of "Million Dollar Baby"'s main characters make it a good film. Its small failures of nuance, including its treatment of rehab., keep it from being a great one.

Reviewed by Harry Jacobs Summers
Nursing Editor: Sandy Summers, MSN, MPH, RN
Reviewed March 22, 2005

You can write a letter about the movie here:

Clint Eastwood, Director
Million Dollar Baby
Warner Brothers Pictures
4000 Warner Blvd.
Burbank, CA 91522-0001
Or you can put your letter on Warner Bros. web form, but snail mail is probably more reliable.

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

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