Thursday Book: Snowblind and lonely in El Paso

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The Independent Culture
LONELINESS PERVADES this book, seeping from its pages like mist. There is the loneliness of the author, a doctor whose marriage is collapsing, arriving to take up a senior hospital post in a new town. There is the loneliness of the student who becomes his tennis partner and who, it turns out, nurses a nasty cocaine habit. And there is the loneliness of medicine, a profession that makes huge demands of its practitioners' reserves of empathy and compassion but does not reciprocate when they are themselves in need - creating the paradox of "the humane physician who shows little humanity to himself".

Abraham Verghese is an accomplished writer whose own vulnerability gives this book a controlled emotional power. He has arrived in the Texan border town of El Paso with his wife and two young children but finds himself as needy as the intern, David Smith, whom he befriends. A passion for tennis is what they share and their twice weekly games soon become an anchor for both their fractured lives.

Smith is an injecting cocaine addict, the most serious kind, who has already been through rehab and is attempting to complete his medical degree for the second time. He is mercurial, moody, manipulative but also childlike with a neediness that demands protection. Verghese acts as his mentor off court while Smith, an ex-tennis pro, serves as Verghese's coach on court.

The relationship becomes increasingly important to both of them. Neither has other friends in the town and when Smith moves in with his girlfriend, Verghese acknowledges his jealousy. When Smith breaks up with his girlfriend and feels his world crumbling, it is to Verghese that he turns for help. But he is already beyond help and the drugs that have haunted him throughout the book exact their deadly toll.

Although this is ostensibly the story of Smith, a man whose addiction finally destroyed him, Verghese's own story is engrossing. Their friendship, though intense, was also oddly superficial. Verghese knows nothing of Smith's drug history until Smith confesses one night. He fails to pick up the signs of his deteriorating mental state that presage his return to "using", although to his girlfriend they were obvious. Like many, especially male, relationships this one worked precisely because it skirted round issues that both partners recognised were too painful to confront.

Verghese, the author of My Own Country, the widely praised account of his experience dealing with Aids sufferers, is at his best when writing about himself. By agreement with his estranged wife, he moves out of the family home and finds an apartment nearby, so he can still see his sons regularly. But he does not furnish the new apartment. There are no chairs, no table and no bed. He chooses to sleep on the floor and, when his boys visit, they eat pizza off a cardboard box which he re-inforces with tape. His minimalist existence accentuates his position as the outcast, the condition he shares with his psychically-matched tennis partner.

As an Indian born in Ethiopia, whose chief memory of childhood was the hostile silences between his mother and father, Verghese was the lonely, inward-looking child who became the sensitive and vulnerable adult. Tennis was what kept him sane, batting a ball against the side of a shed, soothed by the mesmerising thunk-a-thup. His parents may have wondered if he was autistic, he says.

Loneliness, understood as a state of mind rather than a social situation, is at the heart of addiction and obsession. In tennis, Verghese says, he found a way of imposing order on a world that seemed fickle and capricious, and he believed Smith had, too. "People we knew and saw in the hospital led lives that to us seemed complex, unnecessarily encumbered, frivolous even: family reunions, office parties, the ski vacation... We led our solitary but parallel lives on the border, looking in, waiting for the event that would transform us completely."

The transforming event for Verghese is Smith's relapse. When he is shipped off, still wearing his operating theatre gown, to rehab for the second time, it is the cue for Verghese to forsake his ascetic existence, move into a new apartment, and shop for wind chimes and the other accoutrements of modern suburban life.

It was as if, he says, a curtain had been drawn back. This book is an elegiac tribute to a friendship whose horrific end may in some way have allowed the recovery of its survivor. Although it is not mentioned in the narrative, we see from the acknowledgments that Verghese has since met and married his second wife and had a third son. For him, rehabilitation is complete.

Jeremy Laurance