“A newcomer is unencumbered by his past, his mistakes and secrets unknown. This is the great promise of moving: that if you fold your life into a U-Haul truck and put it on the road, you will be given a clean plate with which to approach the buffet.”

Abraham arrives in El Paso and reflects on the beauty of a fresh start. He is in this frame of mind because of the marital conflict he has been experiencing, which is headed towards a divorce. Thus, El Paso represents a chance for Abraham to start over in multiple avenues of his life. For David, however, who has returned to El Paso just a few months before Abraham’s arrival, this is not the case; his mistakes and secrets are common knowledge, and weigh him down over time.

“When I lifted my stethoscope off the patient, a dark, bilious wave swept over me, carried me to the exact state of mind that I must have had as a child: a precocious anxiety that could only be obliterated by constant activity, by the metronomic tattoo of the ball.”

The first time Abraham listens to a heartbeat through a stethoscope, he is immediately reminded of the rhythmic back-and-forth of a tennis ball. The memory also triggers the same childhood feeling of anxiety which was only soothed by playing tennis. This passage displays the strong role that tennis played in Abraham’s early life in helping him stay grounded and survive conflict. The conditioning is strong enough that an audio trigger in a seemingly unrelated field—medicine—is enough to evoke strong emotions years later.

“I loved this separation-and-reunion feeling. It reminded me of what I loved about medicine: how a patient’s words and the clues the body gave you were coordinates for a disease lurking below.”

In a stand-alone chapter, Abraham describes how Wimbledon once used a white tennis ball that occasionally disappeared from view on television. He draws an analogy between the act of keeping track of the ball and diagnosing an illness. Abraham constantly sees parallels between tennis and medicine, and this passage displays his equal passion for and expertise in both. As the author, Verghese also uses such anecdotes as a narrative technique to emphasize or highlight events taking place in the main storyline.

“I had paid as much attention to the marriage, if I had kept notes on love if I had tuned my act each time there was a discordant note, a flubbed move, if I had recorded the things that worked, perhaps we could have saved the relationship.”

Abraham comes across his old tennis notebooks in which he kept meticulous notes about the sport and his own game. His reflection in this passage points to multiple things: The deep and enduring passion he has for the sport, which began young in life; his capacity for diligence and dedication; and his inherently introspective nature which allows him to see and take accountability for his actions.

“It was so much easier to be angry with her than with myself. She had been the steady, consistent one in the marriage. It was my ambition, my profession, and my arrogance that kept me bouncing off walls, made me impossible to live with.”

Abraham recognizes that the anger he feels towards Rajani, his wife, is misdirected. His words can be applied to David’s situation in relationships as well: Both Gloria and Emily were steady and consistent presences in David’s life, while his insatiable desire for excitement, through sex and drugs, is what made him impossible to be with. In this way, Abraham and David share similarities in their journeys of Navigating Loneliness and Conflict in Relationships.

“[W]hat I did not see in him off the court was the confidence or the poise I had assumed came with a tennis life. Its absence was the most striking thing about David.”

While Abraham admires the grace and skill David exhibits on the tennis court, he finds it remarkable that the same poise has not carried over into David’s life off-court. Besides establishing how tennis symbolizes life itself in the book, this passage also hints at how David’s approach to tennis is vastly different than Abraham’s. The game has a different role in David’s life, and so a different effect on him than it does on Abraham. This connects to the theme of The Power of Ritual.

“[T]here is a belief in India that it’s your family, your upbringing, and your education that determine who you are, and parents try to match those qualities for their son or daughter. That’s what you bring to the marriage. After that, it’s your commitment that counts, not some magic chemistry that guarantees it will work forever.”

Rajani comments on the importance of commitment in marriage when explaining to David the context of her and Abraham’s marriage. Rajani’s remark points to Abraham’s past infidelity, which contributed to the end of their marriage. However, it also foreshadows David’s experience with relationships. His constant infidelity breaks him and Gloria apart. David chases the thrill of chemistry with many others, including Emily, and is unable to see that what sustains a relationship is commitment and consistency. He exhibits this pattern in all aspects of his life, including tennis and medicine.

“Occam’s razor is a great principle, […] but you have to be careful not to overdo it. You must make sure that the truths you are trying to tie together are, in fact, true, true and related.”

Abraham explains to his medical students how Occam’s razor can be overused in diagnosis. This idea comes back later when David begins to misperceive and misrepresent the events in his life vis-a-vis his relationships. He acts as if his moving in with Emily is a function of Gloria breaking up with him. While the former succeeded the latter, the events are actually unrelated—David had decided to move in with Emily before Gloria even knew about her. Perceiving the two events as “true, true and related” is David’s way of absolving himself of accountability.

“I’m finding rituals to live by now. Gloria is central to my life, my well-being. So when we fight it’s like the whole world ends. But I want to tell you, the tennis with you has the quality of a ritual, a good one. […] I see you as…stable. Someone with long-term goals…I see you as someone who’s accomplished what I’m seeking to do.”

David explains The Power of Ritual in his life, especially when battling addiction. For him, Abraham represents the ideal: An accomplished doctor whom David believes to also have a complete home and family. However, David lacks the consistency to commit to both the rituals and the dream he has for his future. He abandons his rituals and rushes into performing aspects of his dream—moving in with Emily, for instance—before he is truly ready to live it. This proves counter-productive in the long run.

“Their visit gave me a different view of the apartment, showed me possibilities in a place that before had held nothing but dread for me.”

Abraham is unhappy about having to move out, especially into a bare, tiny apartment. However, his sons’ excitement at having another place to call their own helps Abraham reframe his perspective on the place. Abraham’s family, and especially his sons, are an important emotional anchor for him during a time of personal turmoil. They give his life joy and meaning and keep him protected from making the kind of choices David makes to cope with pain.

“I understood now that he could never be the one to end it. For him to renounce her or to lose her was to renounce himself, his dream house, his dream. And if she renounced him, it would take away the last vestige of self-esteem, a self-esteem that I could see was not formed by his talents as a tennis player, or the fact that he was a doctor-to-be, but mainly by the fact that he had attained Gloria.”

Abraham slowly begins to understand the allure Gloria holds for David. Rather than the person she is, it is what she represents that is important to him. Because of this, David remains emotionally tied to and affected by Gloria long after their breakup. Abraham also understands that David bases his self-worth on the wrong things: Not his talents and accomplishments, but his sexual and romantic conquests. This is a further indication of David’s sex addiction, and how time with his romantic partners being one of his rituals was a fundamentally flawed idea.

“I had the illusion that I knew everything David was up to. There were a lot of women who were attracted to him, ready to give him a come-on, but I assumed that nothing came of this, that it was just banter, and that he was loyal to Gloria. It was an assumption that suited me, suited my sense of order.”

Abraham discovers that David’s problems with Gloria are because of his persistent and repetitive infidelity. Abraham recognizes that the idea he had of David’s faithfulness was a misperception on his part—it suited him to believe this of David, as it fit into Abraham’s worldview and the idea of who his friend is. This is the nature of Abraham’s relationship with David for a long time, right until the latter’s first relapse; it is only then that all of the misperceptions Abraham has of David are completely shattered.

“I understood now that this was why I had dragged David here. If our tennis partnership was special, different, sacred, like a marriage, we had finally found a setting to match.”

Abraham finds a beautiful, private tennis court, and he takes David to play there. The setting of this tennis court symbolizes the nature of Abraham’s relationship with David. This passage displays how Abraham views their friendship as something “special” and “sacred.” However, the exclusivity and seclusion of the court also underline the secrecy and isolation that their relationship spells for Abraham.

“He was unaware of me. As I studied his face, what I saw on it was unadulterated shame. He had felt shame before he made the call, and more shame now that the call was over.”

Abraham observes how David looks desolate and ashamed after his phone call to his parents. David never talks about his relationship with his parents, although it is clear that there are deep, unresolved issues there. He makes references to a void he felt throughout childhood, and when his mother falls critically ill, he is inexplicably angry at her. However, David’s refusal to address these issues or open up about them to anyone in his life contributes to the constant feeling of isolation and worthlessness David feels. This only further fuels his addiction.

“I had moonlighted in ERs for years during training and I enjoyed (if one can use the word ‘enjoy’ in such a terrible context) the adrenaline rush of dealing with trauma. But I missed the sense of continuity of care. I missed watching a disease unfold, witnessing the outcome, good or bad.”

Abraham describes how he was affected by his time in emergency medicine and why he chose internal medicine over the adrenaline high. He observes that one’s temperament leads one to make certain choices, and Abraham and David’s respective preferences for different fields in medicine are an indication of this. Abraham understands the adrenaline rush of dealing with high-stakes cases in the ER; however, he is drawn to a field that requires more thought, introspection, and continued care. For David, however, nothing will suffice but the ER. Internal medicine feels like an anathema to him, and he is deeply unhappy with this being the only option left to him. It indicates his refusal and inability to engage slowly and deeply with distressing situations.

“But what he wasn’t candid about, what he didn’t mention to Emily, what he had adroitly sidestepped with me and most of all with himself, was what Gloria’s expectations were. He most definitely had not come clean with Gloria.”

When David starts seeing Emily without breaking up with Gloria, Abraham sees that David is being dishonest with everyone involved. Although Abraham is only now recognizing this streak of dishonesty in David, it has existed and persisted over multiple relationships and situations in David’s life. Being inauthentic is what allows David to make impulsive decisions and shirk responsibility for the subsequent fallout from these decisions. Despite his professed love for Gloria, he cheats on her with Emily; despite his infidelity, he is shocked and hurt when Gloria breaks up with him.

“David seemed ahead of himself: This appearance of the long-married couple was out of step with where he was emotionally.”

David moves in with Emily as soon as Gloria breaks up with him and disappears from Abraham’s life for a few weeks. When Abraham next sees him and visits his and Emily’s new place, despite the beauty and stability that David’s new domesticity portrays, Abraham notices that David seems trapped. He astutely notes, in this passage, that David is jumping into a situation prematurely. He is performing his life rather than living it, chasing a dream that he is not yet ready for.

“I hated to hear those words. The building blocks of his life—doctoring, recovery, Emily, money, tennis, house—were stacked in a manner that was dangerous and unstable. And to this tottering edifice Gloria had been added.”

Abraham recognizes how shaky the rituals in David’s life are. He is due to start a residency in emergency medicine, which is the wrong atmosphere for him; this could hamper his recovery, which David seems to not be taking seriously. This, in turn, could impact his finances and his living situation with Emily, and introduce conflict in his relationship. Any conflict in relationships undoubtedly has a bearing on David’s attitude and consistency on the tennis court, and this ritual, too, will fail him. Gloria’s return to El Paso is bound to upset this precarious balance in some manner.

“Some days I would rush over there, my guilt and my need for them peaking as I walked in, only to find them absorbed in a game, not willing to drop everything because Daddy had come. […] At first this was distressing, deflating. But now I saw it as a sign of stability; they knew I was there, that I was steadfast, and so they didn’t need to make a big deal of my coming or going.”

Abraham reflects on how things are changing with his sons. Their excitement at his arrival every single time is dying down, but rather than dwell on this as a distressing situation, Abraham recognizes this as a positive change. Abraham’s ability to understand stability as something good and necessary is contrasted with David’s inability to do the same. He is bored and under-stimulated by stability, needing excitement in any form, even if it arrives as conflict.

“If I was ever going to turn him in, the moment for that had passed. […] It was surprising now to realize that being his senior in the medical-school hierarchy really meant nothing. When the heat was on, as it was now, the role that we had both slipped into, that defined us, was that of friends, equals. […] It was because I was his friend that he had replied honestly when I’d asked if he had used.”

Abraham realizes that David confessed the truth about his relapse to him only because David knows Abraham will not turn him in. At this point, Abraham still views their relationship positively; he believes they are friends, and this is what invites David’s confidence. Only later will he understand that this is not a healthy situation for either of them. Abraham and David have blurred the boundaries of their professional relationship with their personal equation, and Abraham is temporarily unable to make an objective decision because of it.

“Abraham, David is like a sponge…Always taking. Relationships come easily to him and then he doesn’t know how to maintain them, only how to destroy them, how to let people down. Which is why you feel the way you do.”

After feeling betrayed by David’s actions following his relapse, Abraham speaks to Gloria, who offers him this insight. Gloria has already experienced David’s inconsistency in relationships, and his pattern of disappointing people has left her jaded. While Gloria attributes complete responsibility for David’s actions to him, Dr. Binder’s conversation with Abraham is a little different. He understands that David's actions are a function of his Disease of Addiction and is thus more empathetic and non-judgmental than Gloria is.

“The tennis felt lifeless for me that day. Perhaps after the first blush of excitement when he had returned, I had come to see how difficult it was to carry on just as before.”

When David returns from rehab, the first game that Abraham and David play together feels “magical” again; however, the magic soon dies down, and they stop playing altogether. The cessation of their tennis sessions mirrors both David’s state of mind and the unraveling of Abraham’s misperceptions about David. When David first returns, he is upbeat about his future concerning both medicine and recovery; however, this facade soon cracks, and he sinks deeper and deeper into unhappiness and pessimism. Similarly, Abraham tries to recapture their special friendship on the court when David returns, but his new knowledge of David’s history and what he is capable of now renders it impossible for them to return to their old dynamic.

“But there was no point in telling him that the problem did not lie in the merits of one specialty over another, and that he was the problem. […] I had already heard the gates slam shut; I had seen the pessimism in his face and in his attitude. In tennis terms, he was tanking the match.”

Abraham sees the futility of trying to convince David that his future is not altogether bleak, as David has already decided the opposite for himself, and is “tanking the match.” This is a callback to the chapter on Arthur Ashe and how he wins the match against Jimmy Connors in his mind before he does so on the court. At that time in the story, David made a different, healthier choice when he was tempted to use by calling Abraham immediately. Now, however, David’s mindset is a defeatist one, foreshadowing his soon-approaching relapse.