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The Sea Inside (2004) and Million Dollar Baby (2004). Two Oscars to medicine

José Elías García Sánchez and Enrique García Sánchez

Departamento de Medicina Preventiva, Salud Pública y Microbiología Médica. Facultad de Medicina.

Universidad de Salamanca (España).

Correspondence: José Elías García Sánchez. Facultad de Medicina. Alfonso X El Sabio s/n. 37007 Salamanca (España).

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Last February 27th, like every year, the Academy got dressed up to present the Oscars to the best 2004 cinematographic works. The Kodak theatre, next to the old Pueblo de Nuestra Señora la Reina de los Angeles del Río de Porciúncula, opened its doors. The guest gained access to the ceremony by walking on the red sparkling carpet. They paraded among the aroused fervour of spectators, cameras, flashes and microphones. In general, they were smiling, beautiful and competed in elegance. The nominees had feelings in between expectancy and hope. The Awards continued until they arrived at the best film for the Best Foreign Language Film, which was Spanish this year, Mar adentro / The Sea Inside, by Alejandro Amenabar. The apotheosis was reached when they announced that the Oscar for the Best Motion Picture was for Million Dollar Baby, by Clint Eastwood.

Medicine has to thank the members of the Academy for having the deference to recall her in this 77th edition of the Oscar awards. It does so quite frequently. On this occasion it was twice rewarded and they did so for a sole disease, tetraplegia. Not in vain do The Sea Inside and Million Dollar Baby deal with tetraplegia.

In both movies, it is surprising that the central argument is the same. As a consequence of a cervical trauma, the protagonists suffer a fracture of the cervical vertebras and a section of the backbone. The generalized motoric incapacity that characterizes this disease forces them to request to their relatives to help them to die, and they agree in the end.

Euthanasia (eu good and thanatos death in Greek) for the occidental societies, is at this moment a subject of debate if not of confrontation. It is one of the controversial issue that politicians have on their desks. For euthanasia detractors it is an ethical problem, for its defenders a right and for medicine a bioethical subject, with toxicological and forensic implications. For these reasons, this argument is cleverly chosen, it catches our attention, it unleashes passions and involves the spectators emotionally.

Tetraplegia and euthanasia are not at all new subjects for the cinema, needless to remember in 1981 the release of Whose Life it is Anyway? by John Badham, in which a famous sculptor remains quadriplegic after an car accident. All through his struggle he realized the situation in which he remained and implored his life to be taken away, and this came to pass.

The Sea Inside takes its origins from the title of a poem written by Ramón Sampedro. It recreates a real life, the last times in life of this Galician who remained quadriplegic after jumping into the sea and hitting his head on the ground. The trauma produced a fracture in the region of C7. Less than in car crashes, the falls, voluntary or accidental, are a frequent cause of this type of damage. Sampedro has been played by Javier Bardem, in a neatly interpretation that won him the Goya award 2004 for the best actor.

The excellent characterization of the character was a success of the English make-up artist Jo Allen and the Spanish hairdresser Manuel García. These professionals were nominated for the Oscar for Best Achievement in Makeup. The work of professionals is essential in this type of film, as much as the research done by the actors about the characters’ pathology they are interpreting.

Million Dollar Baby is based on the book Rope Burns: Stories from the Corner by FX Toole. The argumental development is very different, a boxing trainer, tormented by their life and fearful for their pupils, Frankie Dunn (Clint Eastwood) encounters a woman, Maggie Fitzgerald (Hilary Swank) who wants him to train her. When she can finally dispute a world title, in the end of the round, she is hit by her opponent, falls down and hits the stool that Frank had put out and fractures C1 and C2. The trainer is facing what he had always feared, a terrible consequence of boxing, the tetraplegia of his pupil. Hilary Swank interpreted magisterially the role of this boxer. The Academy rewarded her with her second Oscar as best leading actress, she received the first one for Boys don’t cry, by Kimberley Peirce.

It is obvious that Maggie’s spinal damage is also higher than Ramón’s as she needs assisted respiration. In both movies we face some of the medical problems of tetraplegia, the way to feed Ramón or the ever increasing complications of Maggie. This woman, because of her disease, develops a gangrene on her left leg, which makes an amputation compulsory and pressure ulcers. The cinema offers image and sound but not the scent, Maggie points out that her gangrene “smells”.

If we consider the evolution of the disease, they have two different tetraplegies, in The Sea Inside it is chronic, taking more than 25 years and in Million Dollar Baby it is acute, only a few months.

In The Sea Inside, a friend and neighbour of Ramón, Rosa (Lola Dueñas) agrees to let him die leaving in his reach a glass, containing cyanide of potassium, with a straw. On the contrary, in Million Dollar Baby, Franky’s participation is direct as he removes the endotracheal tube, switches off the respirator and gives Maggie intravenous adrenalin.

In The Sea Inside there is a character who is the opposite of Ramón Sampedro, Julia (Belén Rueda, she won a Goya award for the Best New Actress) the lawyer who defends judicially his wish to die. She represents him until her strange degenerative disease makes it impossible for her to continue. This disease can be, for dialogues, symptoms and visible signs in the movie, a “CADASIL” (the acronym for Cerebral Automosal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy). It is a hereditary cerebrovascular disease transmitted in an autosomal dominant pattern. CADASIL is characterised, mainly, by recurrent stroke, dementia and migraine. It is caused by point mutations in a gene on the short arm of chromosome 19.

Christopher Reeve, known to many people as “Superman”, died on 10th of October 2004, a little after of the release of The Sea Inside in Spain (3rd of September) and before the release of Million Dollar Baby in the United-States (15th December 2004, in a restricted form). Since May 1995 he was suffering a tetraplegia. What the kriptonite did not succeed to do, the horse fall did as it resulted in his fracturing in the region C1 and C2. Although quadriplegic, he interpreted characters with his disability like in A Step Toward Tomorrow (1996) by Deborah Reinisch and in Rear Window (1998) a TV movie directed by Jeff Bleckner, a remake of Rear Window (1954) by Alfred Hitchkock. Christopher Reeve was a tireless fighter in the search for a remedy to his disease. The sanitary personal has to thank him because the most important side of medicine is to find a treatment for a health problem. His life, and especially his last years, is not different from the stories told in The Sea Inside and Million Dollar Baby. The story of Christopher Reeve has got strength to be a cinematographic script. In the end, doesn’t Hollywood like to recreate its protagonists and even award the characters that interpret them?


  1. Tournier-Lasserve E, Iba-Zizen MT, Romero N, Bousser MG. Autosomal dominant syndrome with strokelike episodes and leukoencephalopathy. Stroke. 1991; 22: 1297-1302.
  2. Tournier-Lasserve E, Joutel A, Melki J, Weissenbach J, Lathrop GM, Chabriat H, et al. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy maps to chromosome 19q12. Nature Genetics. 1993; 3: 256 - 259.

Translated by: Estefanía Tovornik Pérez

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