Portrait of a friendship

SUSAN RAM

The Tennis Partner by Abraham Verghese; Chatto & Windus, London, 1998; pages 345; 16.99 (hardback) (special price in India: 8.50)

A FEW days before I sat down to read this book, a British medical practitioner, Dr. Harold Shipman, was sentenced to life imprisonment for murdering 15 elderly women patients. With the trial over and the jury released, the Manchester doctor's extraordina ry past erupted on newspaper front pages: how past suspicions about his conduct had never coalesced into any full-fledged inquiry; how his thirst for killing, his fascination with the power over life and death, might have led him to dispatch scores more of his patients (150 according to some estimates) - placing him in a league of his own among British serial killers. But it was not Dr. Shipman's career of murder, with its strong misogynist overtones, that brought him to mind as I read The Tennis Pa rtner. It was rather the revelation that back in the 1970s, when he was a newly qualified general practitioner (or G.P.), Shipman obtained by deception supplies of the pain-killing drug pethidine, to which he was addicted. At the time, the newspaper story had it, he admitted his addiction, saying he was "seriously depressed and confused".

Abraham Verghese, a U.S.-based doctor with a similar power over life and death, believes his profession to be particularly, if not uniquely, vulnerable to drug (including alcohol) abuse. The danger for doctors, he says, lies not so much in the long hours , the stress or even the ease of access to controlled substances. It lurks rather in the essential loneliness of their professional ethos and world, in the routine suppression of intimacy and denial of feeling. Within the culture of modern medicine, sugg ests Verghese, there is "a silent but terrible collusion to cover up pain, to cover up depression; there is a fear of blushing, a machismo that destroys us... We trust our colleagues, we show propriety and reciprocity, we have the scientific knowledge, w e learn empathy, but we rarely expose our own emotions."

In The Tennis Partner Verghese chronicles, in a prose style that combines clinical precision with lyricism, a doctor colleague's battle to come to terms with a turbulent inner life and hold his cocaine addiction at bay. One senses in Verghese's wr iting a determination to break the mould, to smash through accumulated professional convention and complacency with an unstoppable outpouring of feeling. This, he tells us, is what it actually feels like at the other end of the stethoscope. This is how I , a doctor, cope not just with professional challenge but also with failed personal relationships. This is how I grapple with my daily routine, with a myriad tragedies, big and small, with the flush of my victories, with the heartbreak and the loss.

In an earlier and much acclaimed book, My Own Country (1994), Verghese presented, in beautiful prose redolent of feeling, his experience of working among AIDS victims in a small town in Tennessee. The time was the mid-1980s, America's "plague year s" where AIDS sufferers were still routinely stigmatised and shunned, the more so in the Bible Belt of the deep south. For Verghese, a doctor of Indian origin (his parents, Syrian Christians from Kerala, worked for many years in Ethiopia, where he grew u p), his status as an outsider seemed to offer his patients a point of connection: many of them were young men returning from big city America to die amid their families in a community they had once regarded as "home". What was striking about Verghese's n arrative was its ability to look both inwards and outwards. This was no simple compilation of case histories. Carefully structured, artfully incorporating novelistic techniques and devices, and disarmingly frank in its exposure of the author's own griefs (specifically his crumbling marriage) the book transformed its grim subject matter into something life enhancing, echoing long in the reader's memory.

In his new book, Verghese conjures up the magic again. The setting has shifted: several years have elapsed and the doctor and his family have moved to El Paso, a town at the westernmost point of Texas, on the very threshold of Mexico. Newly appointed to a senior post in internal medicine at the town's teaching hospital, Verghese, ever the outsider, soaks up the mountainous splendour and the human variety that surround him. In this border town, mainstream America, with the casual ugliness of its freeways , marts, condominiums and advertising hoardings, comes face to face with larger realities: mass poverty just across the Rio Grande, desperate people not to be held back by porous frontiers. Here, "foreignness" seems less of an issue than it did in rural Tennessee. "One took a different view of foreignness when many of one's patients were wading across the river for care. By county edict, the hospital didn't ask for proof of citizenship. A billing address sufficed."

In this new setting, with his marriage now a shell beyond reclamation, Verghese seeks to give expression to his lifelong passion for tennis. As a boy growing up in Ethiopia, he had turned to the sport as a means of escape from a suffocating home life, im bibing the artistry and grace of his tennis instructor, Mr. Swaminathan. A moderately talented club player, he became an aficionado, following the fortunes of his idols: Laver, Lendl, Pancho Segura. His need now is for a tennis partner, but among El Paso 's medical fraternity, golf is the sport of choice, or rather convention. Then he discovers that one of his students, an Australian called David Smith, once played professional tennis. The two test each other out across the nets, and a friendship is born .

AT one level, the book is a chronicle of friendship, set down with meticulous, at times frightening attention to detail. Early on, Verghese reveals the secret of his unnerving ability to recall not just the gist of conversations but also precise inflecti ons, mannerisms, and the minutiae of body language. Back in his Ethiopian childhood he developed the habit of jotting things down, obsessively recording the texture of life and the passing moment in dozens of notebooks. The practice would flow into his c areer as a doctor: in El Paso, he urges his students to maintain their own notebooks and to "observe everything. If you get on a hospital elevator, don't get off without making at least one diagnosis on your fellow travellers."

With observation powers of this acuity, it does not take Verghese long to realise that his new tennis partner is battling with a drug habit that undermines his personal relationships and threatens to destroy his career as a doctor. But the problem is now in remission; David has been given a fresh start, and hope builds as he performs strongly in his final year of medical studies. Through their encounters on the tennis court and in the hospital wards, Verghese and David construct a friendship apparently rooted in intimacy and the ability to talk openly of insecurities and sadness. Here, the playing of tennis transcends mere physical activity to become, for both men, a form of therapy, an attempt to impose order "on a world that was fickle and capricious ".

When David's drug habit resurrects itself to reclaim him, Verghese reacts with a desperate evaluation of his own role. Could he not have foreseen the relapse and done more to prevent it? Was he not in some degree responsible? Sustained reflection, encoun ters with the women close to David, and the very process of writing the book allow him, towards its end, to draw some tentative conclusions. But, with the game ended and the tennis court silent, the reader can only share his sense of loss. "I had no soli tary ambition with the tennis itself," Verghese tells us. "Yet it was terribly important to keep playing with David, to play beautifully, to play exquisitely, and with great care, as if the universe rested on the flight of a ball.'

As in his earlier book, Verghese applies his novelist instincts: like the tennis games with David relived in intimate detail across the pages, his prose leaps back and forth, summoning flashbacks, fastening on to the small but telling detail, projecting volleys into the writer's personal life. Out of this emerges not simply a portrait of a friendship but also an evocation of its context: the hospital, the experience of home life, the larger community beyond. Delving into his notebooks, Verghese shares w ith us the little ideas and insights that are, for most of us, a fleeting and unremembered part of the passing moment: supermarket signs "beckoning like listless whores from both sides of the freeway", or how, when we move to a new locality, the vocabula ry shifts in turn, presenting us with new words that feel "as strange as a new filling on a tooth." Through his eye for detail, his refusal to succumb to the fading memory, his capacity for reflective engagement with everything about him, Verghese sets b efore us, and invites us to celebrate, the pain and the beauty and the essential fragility of being human.