THIS book is weighty on all counts. The print version, at more than 700 pages, is voluminous. While the themes and storylines are hefty and profound, the reading is easy and immersive. Abraham Verghese has crafted an epic saga, worthy of all the acclaim that it has received since its publication in 2023.
This bestseller, set in India, charts the life, loves, and laments of a family from 1900 to 1977 — years marked by great political and social change in the country. At the outset, we are planted in the small village of Parambil, in Kerala State, at the very south-western tip of the Indian subcontinent. The central character of the book is a 12-year-old bride, Mariamma, betrothed to a widower who is 28 years her senior. Over the decades, she becomes the matriarch of the family and principal influencer of the community, known affectionately by all as “Big Ammachi”.
Parallel to that track, although decades ahead in time, runs a separate story. We are introduced to Digby, a young and newly qualified Glaswegian physician. He lands in Madras (now Chennai), keen to escape the class-ridden medical Establishment in Scotland, and begins a career as a general surgeon in a country where the modern health-care system is embryonic, and resources are scarce.
Surgical practice is a mixture of adaptation and ingenuity. Digby’s life and work eventually intertwine with those of Big Ammachi, and three generations of her family. This poignant journey records change, tragedy, suffering, illness, and adversity, interlaced with joy and triumph. The ultimate destination is restoration and healing. The road is bumpy.
The author employs his long experience as a senior doctor in a US medical school, his profound sense of empathy, and his creative-writing genius to weave an evocative masterpiece. His writing reflects not just developments in medical science, but also the potent spiritual and humanitarian interactions in health care as he blends scientific insight with compassionate storytelling.
He was born in Ethiopia to Orthodox Christian parents who worked as teachers in Kerala. Displaying a passion for the region, its history and geography, its society and culture, he enables us to live and breathe Kerala’s very essence, from the mountainous interior, filled with tropical rainforests, tea plantations, and biodiversity, to the coastal dunes and lagoons, where we bathe in muddy backwaters and rivers. We smell the spices and curries, grapple with local customs and language, and are discomforted by the inequalities of the caste system, the colonial power structures, and the political unrest that followed independence and Partition.
Water is everywhere. It envelopes Big Ammachi and her family. It brings life, and it brings death. Throughout the decades, she seeks answers to her family’s inherited medical “condition”, which involves a fear of drowning. She yearns for an end to the genetic manacles constraining her husband and his offspring. She charts her family tree, and the progression of this affliction, until things come full circle. Her physician granddaughter (also named Mariamma) starts to find answers, but no easy solutions.
Latterly, the physician at a leprosy hospital near by, Digby, too, is locked in a medical battle of his own. Through his own isolation, we experience the isolation that this devastating disease brings to his patients. Through his attempts to restore function and value to their lives, he begins to receive the same.
© Christopher MichelAbraham Verghese is Professor for the Theory and Practice of Medicine at the Stanford University School of Medicine, California, in the United States
Faith and belief are vital components of the story. The context is the ancient East Syriac Christian Church of St Thomas. According to tradition, the apostle established several churches along the Malabar Coast, introducing Christianity to the region in about AD 52, long before it reached Europe. The descendant Mar Thoma Church, to which the Parambil family and local community belong, sought to reform and modernise the ancient practices with simplicity of worship and a focus on the Bible, and with emphasis on education and service to the community.
All these facets are visible in the life and faith of Big Ammachi in her struggles and her joys. In her life are resonances with Job; with the travails of the Israelites journeying to the Promised Land; with the deluge of the Flood; and with death and rebirth in the water of baptism.
Indeed, spirituality more generally is deeply rooted in family relationships and the natural world. Water becomes both a literal and a symbolic element of life, loss, and resilience. The characters grapple with questions of fate, suffering, and healing in a journey toward acceptance and understanding of forces beyond their control. The novel proclaims a holism of healing in body, mind, and spirit.
Written completely in the present tense, the book is given a heightened sense of immediacy. Events can move at breathless pace, but chapters could be separated by years — even decades. Take note of the dates at the top of each chapter as the years fly by.
As you plunge into this saga, contemplate the human condition, count your own blessings, and go with the flow.
The Revd Nick Goulding is Professor Emeritus of Pharmacology and Medical Education at Queen Mary University of London.
The Covenant of Water by Abraham Verghese is published by Grove Press at £10.99 (Church Times Bookshop £9.89); 978-1-80471-045-6.
THE COVENANT OF WATER — SOME QUESTIONS
- The author uses vivid imagery and symbolism throughout the novel. What images or scenes stood out to you most, and how did they contribute to the emotional or thematic impact of the story?
- With reference to the title The Covenant of Water, what covenants, explicit or implicit, do you see in the story? How do they shape the characters’ actions and sense of duty?
- Medicine is key to this story. The author as physician explores healing in terms of empathy and compassion, as well as in the scientific and technical. Is the balance right here, and is it right in our own experience of health care?
- How does the novel explore the intersection of faith and daily life? Are there moments in the book where characters wrestle with their faith, and what does this reveal about them?
- How does the spirituality and faith of the main characters influence their attitudes and actions to the discriminatory caste system? How do the roles and responsibilities of members of the lower castes evolve over time?
- Female characters play significant roles within the family and community. How does the author portray women’s agency and influence, especially within a traditionally patriarchal setting?