In Abraham Verghese’s second and latest novel, The Covenant of Water, a twelve-year-old girl is married off to a forty-year-old man. This is in the Travancore of the 1900s, where children as young as nine enter matrimony, but the crucial commentary on the situation, the elephant in the room, comes from an expected source – the widowed groom at the altar, who hasn’t yet seen his new bride. When he does, he is appalled. “But this is just a child,” he says in bewilderment before storming out of the church. His fleeting tantrum doesn’t stop the marriage, just as the book doesn’t dwell on this, because with its tale that spins faith and history together with medicine, The Covenant of Water is interested in exploring a simpler theme: “in their revealing, as in their keeping, secrets can tear a family apart.”

Verghese’s two novels are often preoccupied with the emotional quagmires human lives are thrown into when they’re overshadowed by family intrigues. Perhaps the predilection to family history holds him in good stead, since Verghese’s work, both nonfiction and fiction, commands near-unanimous acclaim, and his books have tended to become instant bestsellers. His 2009 novel, Cutting for Stone, spent years on bestseller lists and has been translated into over twenty languages. The Covenant of Water was hailed as the biggest event in publishing in 2023 from the United States to India. In all his works, Verghese, a physician as well as an author, is firstly a medical practitioner, who uses literary devices to probe and illuminate the solvable mysteries of the human condition.

Verghese is also a writer of the Indian diaspora, but one whose work doesn’t seek to dissect notions of the homeland. His writing is not concerned with themes of identity, displacement or the search for home amid the alienation of the self in the West – something the novelist Salman Rushdie refers to as looking for “imaginary homelands, Indias of the mind.” Even though Verghese’s narratives are immersed in India, the themes that often dominate the work of diasporic writers are largely absent from his work. Perhaps this is because Verghese himself hasn’t experienced a sense of displacement, in line with the observation by the writers of India and the Diasporic Imagination (2011) that “it’s uncertain whether more recent migrants suffer from the sense of displacement in the same way.”

Born in Ethiopia to parents from Kerala, and having built his life and career in the United States,Verghese considers himself “a perennial outsider”. He once remarked that being an outsider “gives you a view, a way of seeing the world that has become almost a tic in my writing where I’m always looking on the outside in. Even when it is home.” His first novel. Cutting for Stone, is suffused with a sense of Ethiopia as home. Verghese has admitted that he strongly identifies with Ethiopia, “having grown up there”.

When Cutting for Stone came out, more than a decade ago, Indian diasporic literature had already established a stronghold in the West. V S Naipaul, the genre’s colossal figurehead, had been extraordinarily prolific for decades, but it was only in the 1980s, with Rushdie’s Midnight’s Children and its anti-Raj nostalgia, that diasporic literature began to be widely read in India and the United Kingdom. In the United States, Bharati Mukherjee won the National Book Critics Circle Award in 1988 for The Middleman and Other Stories, and the floodgates of recognition well and truly opened with Jhumpa Lahiri’s Pulitzer win in 2000 for Interpreter of Maladies.

“Post-colonial history becomes a backdrop for ‘The Covenant of Water’ which acknowledges that some of the significant struggles of independent India went under the radar in the south of the country”

The sense of displacement that delineated diasporic literature early on gave way to more diverse themes. As Rushdie remarked, “There are different ways of being Indian, which do not necessarily have to do with being rooted in India.” But it is Verghese’s novels, straddling multiple geographies and lacking the typical diasporic interiority, that most strongly defy familiar categorisation: they are global novels, written for the Western audience, populated by complex non-white characters.

Family secrets intertwine with faith and religion in Cutting for Stone, whose narrator, Dr Marion Stone, was born in the Mission Hospital in Addis Ababa. He is one of a pair of twins, the result of a forbidden union between an Indian nun, Sister Mary Joseph Praise, and a British surgeon, Thomas Stone. Burdened by guilt for having failed Sister Praise in denying his role in her pregnancy, Stone abandons his twins, who eventually come under the care of Dr Ghosh and Dr Hema.

The Stone twins grow up against a backdrop of political turmoil and military rebellion in Ethiopia, and survive it all, but the family’s own turmoil splits them apart. Ghosh, on his deathbed, beseeches Marion to find his father and deliver a message: “I want to let Thomas Stone know that whatever happened I always considered myself as his friend.” Marion leaves Ethiopia, albeit for a different reason – the political situation grows even more volatile after Eritrea’s secession.

The novel’s title alludes to a phrase among the list of promises the Greek physician Hippocrates articulated in his fifth-century manual for medical practitioners to not, in trying to ease a patient’s pain, push beyond their own abilities at the risk of causing more harm than good. The Stones, the novel’s protagonists, are surgeons themselves, and the book is replete with surgical procedures involving pregnancies, fistulas and gallbladders.

Verghese is a gifted storyteller. In both of his novels, characters discover they are in possession of life-altering secrets about their families, and set out in pursuit of answers that could upend their lives. Verghese employs modern medicine as a complement to his story-telling, generously borrowing from his expertise as a renowned practitioner of the trade.

In Cutting for Stone, one of the twin brothers later encounters their biological father in New York City. In The Covenant of Water, a saga that follows three generations, undiagnosed diseases intersect with family legends as characters grapple with tragedies in the Kerala of the 1900s, when there were largely only superstitions and unproven medicinal cures to fall back on.

As much as modern medicine forms the backbone of Varghese’s narratives, his work is also about how humans interpret it. In both his novels, Verghese uses the imagery of medical procedures to create narrative tension.

“Writing and medicine are not separate,” he once said. “My writing emanates from this stance that I take, looking at the world, and the stance is purely from being a physician – it’s one of observing, cataloguing, being in wonder and awe of what I see.” Unlike most doctors turned writers, who tend to write dispassionately about illnesses, Verghese includes a spiritual component in his fiction. This raises an important question – are modern medicine and spirituality compatible? “Every illness has a physical deficit as well as a sense of spiritual violation,” Verghese has remarked. “You break your leg and … there’s also a great sense of, ‘why me? Why now?’ Medicine has done a great job of taking care of the break, but not as good a job of dealing with the sense of violation people feel with illness.”

More than his fiction, it is Verghese’s non-fiction that sometimes draws from his immigrant experience. His first book, which evolved from a 1991 short story he published in The New Yorker in 1991, is called My Own Country: A Doctor’s Story. This is set in rural Tennessee, where he arrives as a young immigrant doctor to a town suddenly in the throes of the AIDS crisis. The book was a runaway hit, and was adapted to the screen by Mira Nair in 1998. But rather than just mining Verghese’s immigrant experience, My Own Country overlaps it with the emotional strain of working as a physician in the battle against a hugely stigmatised disease – his pregnant wife fears that Verghese might catch HIV.

Verghese’s 1998 memoir The Tennis Partner focuses on his friendship with a tennis-playing student, David Smith, and how the shared trauma of mental health issues and matrimonial estrangement intersects with their relationship. The game moors them to reality:

In the way we controlled the movement of a yellow ball in space, we were imposing order on a world that was fickle and capricious. Each ball that we put into play, for as long as it went back and forth between us, felt like a charm to be added to a necklace full of spells, talismans, and fetishes, which one day add up to an Aaron’s rod, an Aladdin’s lamp, a magic carpet. Each time we played, this feeling of restoring order, of mastery, was awakened.

Verghese is a modernist in the tradition of the everlastingly pertinent giants of Russian literature – Anton Chekhov and Leo Tolstoy, among others. But he credits the English writer William Somerset Maugham’s bildungsroman Of Human Bondage in particular as a source of inspiration. (Perhaps not coincidentally, Maugham also trained as a physician before he chose a writing life.) As a postmodern realist, and a storyteller in the traditional sense, with a penchant for writing dreamy and elaborate sequences, Verghese’s treatment of subjects is largely narrative-driven, with only a loose allegiance to a sweeping plot.

For this reason, even as he is a contemporary postcolonial writer of the diaspora, his work doesn’t subscribe to the style of his peers – there are no traces here, for instance, of the acerbic cynicism of Rushdie. While his work only cursorily embraces the postmodern social realism characterised by the works of diasporic literary superstars such as Jhumpa Lahiri and Rohinton Mistry, Verghese is even less interested in the kind of interiority that the Indian novelist Vikram Seth attributes to his characters. Instead, Verghese exhibits an all-encompassing attention to narrative – hence the families whose lives are entwined with mysterious diseases and illicit childbirths.

In Cutting for Stone, after Dr Stone delivers his twins, Verghese describes his first impulse: “Stone wanted to run away, but not from the children or from responsibility. It was the mystery, the impossibility of their existence that made him turn his back on the infants. He could only think of Sister Mary Joseph Praise … of how she’d concealed this pregnancy, waiting, who knows for what.”

In The Covenant of Water, after realising that the series of drownings in her family across generations is not coincidental, Big Ammachi finally gives it a name: The Condition. “She has named this thing that she has sensed from the time the marriage was proposed: the whispers about drownings running in the family, the house built away from water, his distaste for rain, his strange way of bathing – the very things that afflicted their son.”

Verghese writes in the preface, “The Covenant of Water has been a long time in the making, not just because it is ambitious in its scope and inherent intricacies, but also because I have a fulfilling day job as a doctor and teacher of medicine that feels to me connected in an umbilical fashion to the act of writing and creating at night.”

Across its 700-plus pages, the novel spans a quarter of a century in time, largely in rural Kerala. The book begins with the marriage of the twelve-year-old girl to the middle-aged widower. The girl, who later becomes Big Ammachi, and her family, become the crux of the story. Suddenly finding herself within the confines of a large house and saddled with a stepson, Big Ammachi sees her life soon become laden with secrets.

The Affliction, as Big Ammachi names it, affects the family’s men, who have a peculiar relationship with water even when it does not claim their lives. As she becomes the primary carer for her stepson – much the way Dr Hema comes to raise the abandoned twins in Cutting for Stone – the novel uses her as a device to narrate unfolding personal and political histories.

From gently flowing waterways to unpredictable monsoons, water is a menacingly omnipresent force here. Verghese’s novels emphasise the theme of interconnectedness. While medicinal surgery is what intertwines the characters of Cutting for Stone, how water connects all of humanity is exemplified throughout The Covenant of Water. Explicitly, towards the end of the novel, the narrator observes: “This is the covenant of water: that they’re all linked inescapably by their acts of commission and omission, and no one stands alone.” But peel away the verbosity of the narrator, and there’s an answer to every existential conundrum in The Covenant of Water: almost all the ailments plaguing humanity are medical, the novel reasons, and hence curable, at least for the most part.

With detours to Glasgow and Madras, where we meet Digby Kilgour, a Scot who takes up a job as an Assistant Civil Surgeon in the Indian Medical Service, and with occasional tertiary narratives about colonial India, The Covenant of Water also successfully blends in with post-colonial history. In prose suffused with orientalism, Digby wonders about the Tamils he meets when he lands in Madras: “Muthu’s white teeth are a beacon in his coal-dark face; his forehead has three horizontal streaks of ash – a vibuthi, as Digby learns later, a sacred Hindu marking that Digby will soon observe him apply each morning.”

Digby, whose fortunes were significantly lesser back home in Glasgow, finds it hard to stomach how Tamils are treated. “He’s ashamed to realize that here in British India, he’s white and that puts him above anyone who is not.”

Big Ammachi’s family is exposed to the political upheavals of the time – the Indian independence movement, followed by the reformative political movements in Kerala that paved the way to a democratic communism in the state. Meanwhile, her son Philipose, who also grows up to be water-averse, becomes a writer for a column titled “Ordinary Man” in the Malayala Manorama newspaper, after abandoning his studies in Madras. Philipose marries Elsie, a talented but tortured artist, and the marriage is cut short after the latter is found to be missing and presumed drowned in a river. Philipose assumes the responsibility of raising his daughter, Mariamma, who grows up to be a doctor studying at Madras Medical College.

Even as it edges close at times to tropical melodrama, Verghese’s prose can be pared down as much as indulgent. The chapter ‘Still Life with Mangoes’ – the title is borrowed from the French artist Paul Gauguin’s 1893 painting of the same name – is among the highlights of Varghese’s imagination. Where Gaugin’s painting shows a languorously tropical dreamscape, Varghese’s chapter annotates the beautiful tragedy of death when it embraces two ill-fated lovers.

“It’s dusk when she pushes through the door to Digby’s quarters, startling him. He’s in the studio, bare-chested, cleaning his brushes with turpentine. A paraffin candle throws a ghostly light on the still life he has arranged: an eccentric earthen pot and three mangoes on the wooden worktable.”

Perhaps no other writer features medical procedures in his fiction like Verghese does. Gory C-sections, gangrenous gall bladders, stomach resections, hydrocele scrotums, giant goitres, baby’s hands accidentally breaching the womb before delivery – all have been part of his fiction as much as his nonfiction. One of the most intensely gripping scenes in The Covenant of Water involves childbirth.

It is almost an embarrassment of riches, and sometimes these lengthy digressions involve procedures being explained in near-lurid detail. No doubt they help in furthering the narrative and aid character development, but where does one draw the line on how much is too much when a medical practitioner is also a fiction practitioner? A visceral description of childbirth in the middle of the book leaves little room for the imagination: “The umbilical cord dangles below the child like a white serpent, pulsating and twitching with Elsie’s every heartbeat, the knots of veins under the gelatinous surface distended and angry.”

When asked about medicine’s role in his storytelling, Verghese recently said: “my pet peeves and passions in medicine make their way into the book but I wasn’t proselytizing. I also feel that medicine isn’t something outside of our experiences. Medicine is really life … and some of our most important and transitional and life-threatening moments, and even our ultimate demise might occur in a medical situation.”

At times, the blend of medical wisdom and literary prose reaches extremes of self-indulgence. In one instance, a leprosy patient loses a finger working at a sawmill and doesn’t notice he’s lost it because leprosy causes numbness in one’s hands. In another, Digby encounters a gangrenous gallbladder in the operation theatre: “In the theatre, as soon as Digby opens the abdomen, he sees what he feared: a distended, angry-looking gallbladder with dusky patches of gangrene. There’s your dyspepsia, Claude. He makes a small hole in the engorged sack. A sludge of yellow pus, green bile, and small pigment stones spills out…”

One chapter generously describes a classroom scene in a lab where a cadaver is dissected by first-year medical students, the professor informing them of basic vocabulary needed in the profession – medial, lateral, superior and inferior, anterior and posterior – alongside an introduction to the handbook Gray’s Anatomy.

Verghese employs the same punctiliousness while describing the volatile political landscape of Kerala in the 1960s. Where the book touches upon indentured labour in farms owned by rich landlords, it veers into a retelling of the origins of communism in Kerala, where children are christened with names like Lenin Evermore. In kallu shops, “one went in for public drunkenness and came out a sober Communist.”

Post-colonial history becomes a backdrop for the novel which, while touching upon many major events, acknowledges that some of the significant struggles of independent India went under the radar in the south of the country – for instance, the violence of Partition.

“Perhaps no other writer features medical procedures in his fiction like Abraham Verghese does. Gory C-sections, baby’s hands accidentally breaching the womb before delivery – all have been part of his fiction as much as his nonfiction.”

From this, the question of whether The Covenant of Water is a postcolonial historical novel takes on an interesting aspect. The academician Hamish Dalley makes an important point in his book The Postcolonial Historical Novel: “Genre is realist insofar as it asserts the epistemological claim that fictional narratives about history ought to be treated as serious interpretations of the past, open to dialogue with rival accounts and archival sources.” He adds, “In other words, the historical novel’s realism arises from its commitment to norms of plausibility and verisimilitude that frame narratives as meaningful contributions to knowledge.”

Viewed through Dalley’s definition of realism, Verghese’s interpretation of Kerala’s political history in the mid-20^th century needs additional context. The collapse of the matrilineal system among Kerala’s caste Hindus in the 1930s coincided with the arrival of Western-style education. Significant spending on education by the princely rulers who then held sway over much of the territory resulted in high literacy rates. Additionally, with Marxist and Leninist ideals being promulgated in publications like Swadeshabhimani (The Patriot), Kerala became ripe for the dissemination of communism.

In the political landscape of a newly independent India, a Naxalite movement spread through the state, intent on fighting for the rights of the oppressed-caste Pulayars, who were bound by their landlords in a slavery-like system. With something akin to clairvoyance, Joppan, from a Pulayar clan that worked for Philipose’s family for generations, says in The Covenant of Water: “Mark my words … one day Kerala will be the first place in the world where a Communist government is elected by a democratic ballot and not by bloody revolution.” Indeed, post-independence Kerala stands as an ideal of democratic communism, and has evolved a sociopolitical model akin to those of the successful welfare states of Europe.

In constructing a politically enlightened, tropical utopia around Philipose’s life, Verghese makes him a near-perfect, democratically leftist landowner – not just a benevolent oppressor – and gives him ideals that perhaps only rarely existed in the Kerala of the 1960s. But faced with the truth that kindness doesn’t absolve the landlords of being party to an unequal system, Philipose is still torn. This introspective viewpoint is excellent for the construction of a multidimensional character. Joppan refuses Philipose’s offering of a 20-percent share of the land, calling it unequal.

Philipose felt as though he’d walked into a hidden tree branch. The word “exploit” pierced him. It pained him to feel he’d taken advantage of Shamuel, a man he was willing to die for. He thought of himself and of Parambil as caste-free, above such considerations. Yet he had only to look at the face across from him and recall the thwack! of the kaniyan’s cane on Joppan’s flesh and remember the humiliation of the boy who’d shown up so earnestly for school for the children of Parambil.

It’s worth noting that the story is still told through the upper-class Philipose’s worldview and Joppan is only a vehicle for the former to carry out altruistic justice. Yet, the book’s awareness of intersectionality needs mentioning.

When The Covenant of Water picks up after Big Ammachi and Philipose, it is to follow the family’s last surviving member and Ammachi’s namesake, Mariamma, to Madras Medical College. Mariamma grows up with Lenin Evermore, the son of Lizzy and Big Ammachi’s confidante, and falls in love with the radical who was named so because, at his birth, he breached the womb prematurely by sticking his hand out. Only a medical practitioner’s imagination could have conjured up such a backstory. Lenin grows up to be a Naxalite, raising his metaphorical fist against the social atrocities of the time.

Lenin Evermore writes letters to Mariamma, educating her on the historical injustices and inequalities the landowning class has perpetrated:

She never quite understood (till reading his letter) that in Malabar, sixty-five Nambudiri Brahmin landowners, or jenmis, held territories so vast they’d never seen them all. Their tenant farmers were the Nairs and Mappilas, who made huge profits and gave the jenmis their cut. When pepper prices tumbled, the jenmis taxed the tenant farmers and even taxed the tribals—people like Kochu paniyan. That, Lenin says, is why Kerala communism began in Wayanad.

The book also points out colonialism’s two-faced treatment of tribals: “The British abolished slavery, yet they compelled the tribals to cut down their precious trees to build ships. If the British hadn’t discovered tea, the mountains would be bald. Instead, they made the tribals terrace the slopes they had lived on for generations.”

If you take too fine a postcolonial lens to it, the Kerala of The Covenant of Water is a sepia-tinted mirage, a wishful and fecund paradise where kind landowners cared for their indentured Pulayars and their children were raised side by side as equals with their masters’ children. The book offers Pulayars a voice, but it’s told through the eyes of their supposed oppressors. That unrealistic quality serves to remind us that this is, after all, a work of fantasy. But that is the point and the pleasure of Verghese’s fiction.

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Prathap Nair is a freelance culture writer based in Düsseldorf, Germany. His reporting and feature writing have appeared in major Indian and international publications.

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