The Tennis Partner

The Tennis Partner is a memoir about author Abraham Verghese’s friendship with medical student David Smith. The main source of conflict in Abraham’s relationship with David, as well as David’s other relationships, is his cocaine addiction. Substance addiction, and the nature of the disease, are thus one of the book’s central threads.

The prevalent theory in the US is that addiction is a disease, but unlike purely physiological ones, it is a disease that includes a behavioral component. Withdrawal symptoms, increased tolerance to the drug, and the physiological effects of the drug on the mind and body compel the user to keep using. However, it is the actions of the user that activate the addiction and prolong the illness. Thus, addiction treatment involves an important balance between objectivity and empathy. Dr. Talbott embodies this in the Prologue of the book when he reminds David that he has a disease, and therefore he can feel guilt for his actions, but he ought not to feel shame.

Still, as with any illness, physical or mental, management becomes difficult if the patient does not recognize the need for treatment or follow through with treatment protocols as directed. So, too, is the case with addiction. In David’s case, he initially complies with the steps needed to get better, but eventually, as pressures in his life compound, he begins to drift away from them. He gets trapped in a cycle where his disease worsens his non-compliance, which worsens his disease, and his story eventually ends in tragedy.

Abraham is not new to substance addiction. He has seen it numerous times before through his work in internal medicine and has treated patients like Gato and Angelina Cortez for secondary illnesses that are a result of intravenous drug use. However, David is the first Abraham is close to who is battling addiction, and the memoir reflects his emotional experience observing the progress of the disease, not as a doctor but as a loved one.

David is a source of comfort and companionship to Abraham at a difficult time in the latter’s life. Abraham does not foresee a relapse coming partly because Abraham’s perception is clouded by their friendship, but also because it takes Abraham a while to understand that David’s addiction is an illness. This is why he does not immediately report David the first time David relapses, and why Abraham feels personally hurt and betrayed by David’s actions. The others in David’s life—the doctor supervising him, Dr. Lou Binder; his sponsor, Jim; and even Gloria, to some extent—have a more dispassionate view of the situation. Dr. Binder and Dr. Talbott, in particular, understand addiction to be a disease and treat it accordingly. This is why Dr. Binder gives David multiple chances to continue his medical education despite his relapses. Even after David runs away the last time, Dr. Binder’s efforts are concentrated on bringing David in for a detox, rather than punishing David or washing his hands off the young man.

An important aspect of the experts’ approach, however, is not absolving David of all accountability for his actions, either. Each time David returns to Texas Tech, there are stricter protocols in place that he needs to comply with if he is to keep his seat. The urine screenings, multiple meetings, and check-ins with his sponsor are not meant to punish David but to manage his illness; the loss of his emergency medicine residency is more a preventive measure than a punitive one. Nevertheless, these steps ensure that David experiences consequences for his actions while trying to ensure that he stays clean.