Moreover, the girl changes the subject quickly to having another beer. While the man in the story remains utterly insensitive to his girlfriend, her state of mind is less clear. On the one hand, her self-esteem seems dreadfully low. She repeats, "I don't care about me," and she asks the man if getting the operation will make him happy. When she states, "I don't care about me," she could also mean "I care about you more," but she never says that." She utters the finishing lines of the story: "I feel fine...There's nothing wrong with me. I feel fine." Her words most likely indicate her further suppression of her anger and true feelings. However, the girl might also have come to a decision about ending their relationship. It is entirely possible that her hill-gazing has inspired her to make major changes in her life. After all, the open-ended story does not indicate whether the girl goes through with the operation or not. She smiles, not just at the waitress but also at the man. Her smiles could be entirely fake but they might also be an indication of her having reached a powerful realization about herself, her goals, and her identity.

The title of the story presents phallic imagery that parallels the man's patriarchal attitudes. The opening line of the story, "The hills across the valley of the Ebro were long and white," is far more serpentine and phallic than it is representative of a pachyderm. References to the surrounding trees evokes pubic hair. Moreover, the girl mentions how the hills resemble skin: "the colouring of their skin through the trees." A phallus is what brought the couple into the uncomfortable spot of discussing -- albeit in a roundabout way -- abortion. The hills are depicted as being bare with "no shade and no trees," which would suggest the lack of prophylactics. Emphasis on the phallus corresponds with the sexism that permeates the man's attitude. He condescendingly repeats phrases to his girlfriend as if she did not understand him the first time; he patronizes her by claiming to love her and even says, "I don't want you to do it...

The man's self-centeredness is repeated in actions like grabbing his own glass of Anis at the bar without the girl knowing. The man also makes the final move by taking the bags to the tracks. Furthermore, the words, "You know I love you" ring entirely false, especially since the girl never deigns to echo his sentiments. As she gazes off at the hills, she becomes less and less enamored with her lover and his patriarchal manner.
As her reaction towards patriarchy, the girl exudes admirable stoicism. Her adventurous spirit is what inspired him to order the Anis at the bar, for she was the one who initially wanted to dry the new drink. She possesses an indestructible spirit, evident in her daydreaming: "We could have everything...we can have the whole world...we can go anywhere." Jig tells the man to stop talking, her reaction against his morbid trivialization of a major life decision.

Using deft symbolism, metaphor, and subtextual speech, Hemingway crafts an atmosphere laden with tension and sadness. The couple in "Hills Like White Elephants" lack genuine intimacy, their moments of joy fleeting as a class of beer. Faced with the decision of whether or not to settle down and have children, the relationship is called into question. The couple drink while waiting for a train on the "other tracks," indicating a crossroads in their lives. Through the dialogue-driven and symbolic short story Hemingway encourages the reader to explore personal values, related to abortions, sexism, and heterosexual relationships.