A motif of smoking illuminates Dr. Livingstone, Mother Miriam, and the relationship between them. Doctor Livingstone smokes cigarettes throughout the first act. In her first meeting with Mother Miriam, for example, she apologizes for not asking whether she could smoke inside the convent. This is a subtle rebuke to the organized religion that the convent represents: Dr. Livingstone does not want to seek permission because to do so would be a tacit acceptance of religious authority. In this subtle way, she asserts her animosity toward the Church. Notably, she does not offer to put the cigarette out, nor does she stop smoking in Act I. She waves the smoke away but then continues to smoke, almost as though she is inviting Mother Miriam to censor her, thus vindicating her belief in the oppressive and censorial nature of religion. In this way, the motif develops the theme of Science and Religion as Competing Arbiters of Truth.

Dr. Livingstone’s discussion of smoking in her first conversation with Mother Miriam also represents the mistaken way in which she approaches the case. She enters the situation with a combative attitude, viewing Mother Miriam as the embodiment of the organized religion that Dr. Livingstone detests, only for Mother Miriam to challenge her preconceptions. In this case, Mother Miriam responds to her smoking by turning the conversation into an empathetic discussion of the dangers of addiction. Mother Miriam is a more nuanced character than Dr. Livingstone believes; there was a time when she was not a nun and when she smoked “two packs a day” (9). This comment shifts the nature of the conversation from symbolic rebuke to mutual understanding. Later, they return to the subject of quitting cigarettes, and Dr. Livingstone discusses the difficulty she faced in doing so. Rather than give up smoking, she gave up matches, she explains, but this only resulted in her smoking even more. Her “ingenious plan” backfired, and she cannot even “eat without a cigarette in her hand” (49). Mother Miriam offers her sympathy, and then the two women discuss which of the Christian saints might have enjoyed tobacco. Their light conversation reveals the extent to which the Agnes case has brought them together. They are more alike than they realized, and smoking becomes a way in which to chart this similarity across the play.

Despite her apparent addiction, Dr. Livingstone stops smoking in Act II. By this time, the case has intensified to such a point that it has almost replaced cigarettes as an addiction, implying that Dr. Livingstone is so invested in helping Agnes that she does not feel the addictive pull to smoke. More broadly, the change reflects the steps she has made toward healing. Her smoking is intrinsically linked to her pain, not merely because it is self-destructive but also, as she explains to Agnes, because she began smoking to cope with her mother’s death. Smoking thus becomes a substitute for confronting all her buried trauma—her ambivalence about motherhood, her sister’s death, her early experiences of religion, etc. Her experiences with Agnes force her to revisit this trauma, loosening smoking’s hold over her while also opening her up to new possibilities. Thus, in her closing monologue, she describes herself as a “doubting, menstruating, non-smoking psychiatrist” (75). The qualities that she believed defined her at the beginning of the play, such as her atheism, her childlessness, and her cigarette smoking, have been changed by her experiences with Agnes. The pointed absence of a cigarette throughout Act II shows that this is a change that is already in progress during Agnes’s lifetime and then becomes a change in Dr. Livingstone’s fundamental identity after Agnes’s death.