Intended for healthcare professionals

Views & Reviews Between the Lines

Moon Tiger and Mr Smith

BMJ 2011; 343 doi: (Published 14 September 2011) Cite this as: BMJ 2011;343:d5734
  1. Theodore Dalrymple, writer and retired doctor

Books evoke memories unpredictably and therefore all the more powerfully. The Moon Tiger of Penelope Lively’s novel of the same name is the brand of mosquito coil that the protagonist uses while she is in Egypt during the war; it brought to my mind the years when I never slept without such a coil by my bed to keep the mosquitoes—culicine rather than anopheline—at bay. (I still caught dengue.) The brand was Double Happiness rather than Moon Tiger, but no one has ever described with more loving accuracy than Mrs Lively the slow smoulder of a mosquito coil as it leaves its delicate spiral of grey ash.

The protagonist, a former war correspondent of fiercely independent mind called Claudia Hammond, who goes on to write successful books of popular history, recalls her life as she lies dying slowly, aged 77, in hospital. It is common wisdom that your life passes before your eyes like a video as you die, but I am not sure how this can be verified. My life certainly did not appear before me in this fashion on the only occasion I was ill enough to be thought close to death; but I was still a young man who perhaps did not really believe that he was dying. Alternatively, I wanted to protect myself from seeing the expense of spirit in the waste of shame that so many lives can be made to seem.

The author of Moon Tiger manages brilliantly to convey from the inside, as it were, Claudia Hammond’s fluctuating level of consciousness, which varies between complete lucidity to a hallucinated immersion in scenes of her past life, among which is a reliving of the only love of her life, a young army captain killed in the battle of El Alamein. After my mother’s death, I discovered that she had kept the letters, tied in fading red ribbon, of her first fiancé, a fighter pilot killed in the defence of Malta.

From time to time, nurses intrude on Claudia Hammond’s deathbed reveries, treating her with insensitive condescension. They assume that someone who does not or cannot talk cannot hear or understand. Even when they know that she is conscious, they speak to her in an infantilising way: “Upsy a bit, dear, that’s a good girl—then we’ll get you a cup of tea.”

Because it was written a quarter of a century ago, there is one humiliation that the nurses do not inflict upon their patient. Although when her visitors arrive they will say in front of her that, “it’s one of her bad days, you never know, with her,” they still never call her by her first name. They always address her respectfully as Miss Hampton. Nowadays it would be by the first name or, worse, a diminutive of the first name.

We are told, and even taught, that this informality is friendly and patients like it. But an acquaintance of mine became Mr Smith rather than Bill the moment he crossed over from being an NHS patient to being a private patient, which suggests that modes of address still mean something even today. Unsolicited informality is therefore an expression not of friendliness, but of power and a desire to keep people in their place.


Cite this as: BMJ 2011;343:d5734

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