The DO Book Club, Sept. 2024: ‘The Covenant of Water’

Perhaps the pre-eminent physician author of literary fiction at this moment is the multitalented Abraham Verghese, MD. While holding an endowed chair at the Stanford University School of Medicine, he has managed to gift the rest of us with another long-awaited book, the multigenerational family saga entitled “The Covenant of Water.”

One cannot just sit down to casually read this work. It takes a full commitment over many days and possibly weeks to consume the more than 700 pages. The effort will be well-rewarded, as the novel delivers an enchanting combination of spirituality, early medical practice, Anglo-Indian history, romance and family devotion. As if that is not enough, a stately and amiable elephant makes recurring appearances at the family home.

In much the same way as his first novel, “Cutting for Stone,” did, Dr. Verghese portrays two of his lead characters as physicians training in the early 20^th century. This version of medical training fully depends on the arts of history taking, physical diagnosis and keen observation. No sonograms or MRIs were available to assist. Dr. Verghese loves to tell the tales of the old-time docs sleuthing out a difficult diagnosis.

Before antibiotics, anesthesia and aseptic technique, the narrative of medicine was a horror show that the author relates with relish. The labor and delivery room tales included here are as realistic and harrowing as being right there at the bedside. Today’s readers will wonder how any women and their infants actually lived through the dangers of childbirth.

Additionally, the treatment of leprosy and its devastating consequences loom large in the narrative. Dr. Verghese uses his extensive training and interest in infectious diseases to explain leprosy and the painful isolation of the people who suffer from this disease, which still exists in parts of India.

The tale of Marriama

The story’s primary line follows young Marriama, who later is called Big Ammachi, as she leaves her family home and enters an arranged marriage to an older man, Big Apachen, at his estate in Parambil. Her path to becoming an iconic homemaker, wife, mother and grandmother underlies much of the plot and power of this book. She is literate, progressive, religious and generous in every way. Dr. Verghese comments that he based her character on the stories told by and about the women in his own family.

For many generations, members of Ammachi’s family have suffered with what they refer to as “The Condition.” In every generation, several people drown even in situations that do not seem too dangerous. Finding the answer and underlying cause of this affliction becomes the life’s purpose of the latter generation’s protagonist, a young physician also named Marriama.

The novel moves back and forth in time and geographic locations to introduce the circumstances of a wide range of characters whose role and importance are not immediately obvious. Like every generational saga, there are mysteries and family secrets.

Dr. Verghese reveals, “Every family has secrets, but not all secrets are meant to deceive … What defines a family isn’t blood but the secrets they share.” (p. 762)

Sharing Indian culture

What stands out most of all in Dr. Verghese’s lyrical prose is his absolute love letter to the area and people of the Kerala state in India. The descriptions of the swelling rivers, monsoons, vegetation and the unique characters who live there will captivate readers long after they finish the novel.

Mostly, it is the water itself that becomes a force of biblical meaning and metaphor in the author’s creative hands, as he describes: “The water she first stepped into minutes ago is long gone and yet it is here, past and present and future inexorably coupled, like time made incarnate. This is the covenant of water: that they’re all linked inescapably by their acts of commission and omission, and no one stands alone. She stays there listening to the burbling mantra, the chant that never ceases, repeating its message that ‘all is one.’” (p. 753)

Dr. Verghese also creates a love letter to books, reading and writing through one of the main characters, who becomes immersed in all three. The character, Philipose, proclaims, “Fiction is the great lie that tells the truth about how the world lives!” (p. 256)

Life is fragile in the novel and the propensity for tragedy seems so cruel. The rewards of tackling this tome are many. I found myself highlighting many passages in my e-reader. For those of you unsure about the time commitment necessary to read this one, I have heard from reliable sources that the audiobook version, narrated by Dr. Verghese himself, is an outstanding work of performance art.

When Oprah Winfrey chose the book as the 100^th title for her famous book club, the expectations for the book were huge. The doctor’s first two nonfiction works, “In Another Country” and “The Tennis Partner,” are also well worth finding in your local library or bookstore. The seven years that the author used to perfect this epic story were well worth the wait.

The fiction of “The Covenant of Water” holds many truths about love, forgiveness and the fallibility of humans. Physicians reading the book will once again be enchanted by the great mysteries of the practice of medicine.

Related reading:

The DO Book Club, July 2024: Summer beach reads with a medical twist

The DO Book Club, June 2024: ‘Autobiography of Andrew T. Still’