I would say Helena was real: for one - when Nick is awoken in the waiting area at the hospital by his colleague and told she had had an operation, it was stark reality in the scene, nothing "dreamy", nothing to suggest it was anything other than reality. I would think that that was his girlfriend Ann in bed with him. I think the greatest accolade(greater than any Oscar)that this film could receive is that it truely deserves the name of Lynch attached to it. Then Nick "awakes" in his bed with someone, or something, next to him, and goes out to the cold, hard, stone Venus DeMilo statue and professes his haunting love. The scene in room 308 at the hospital after Nick, supposedly, awakes from his dream, in itself seems like a dreamscape the flowers around the head of the hospital bed, just like the flowers around Helena's box as she sits propped up on the dinning room table the shadow that passes over the hospital room as we look down from above Helen's foggy images of the accident and ambulance. His love of whom? Venus DeMilo? His Mother? Helena? Is Helena even a real person, or an amalgamate of his twisted psyche? When does Nick really begin to dream, and when does he really wake up from his dream? Dreams within dreams. Does anyone have any thoughts on this? Who is this mystery woman? Could it be the "ghost" of his mother? In his final line of the movie, Nick says he is "haunted" by his love. Her chin and exposed chest look more like Helena (an interesting twist) than Ann's, or the Fantasy Lover/Nurse(Scorsese)character. In the final scene, as Nick wakes, and sits up in his bed, you can, very breifly, make out a naked woman with her upper face and lower body partially covered.
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