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Key points
- "The Covenant of Water" merges traditional and Western medicine in a model that puts patients first.
- The novel is set in Kerala, in southern India, laced with canals that offer life and threaten death.
- In this multigenerational epic, a mysterious illness propels characters toward strength and understanding.
About a third of the way into The Covenant of Water, a young Indian boy begins reading Moby Dick to his family. His mother isn’t sure about the novel. She says it sounds “made up.” A lie.
When the young man reports his mother’s reaction to his teacher, the teacher replies, “It’s fiction! Fiction is the great lie that tells the truth about how the world lives.”
It’s a line author Abraham Verghese uses often in his other life as professor and vice chair for the Theory and Practice of Medicine at the School of Medicine at Stanford University. For Verghese the physician, storytelling is an essential step in healing. It opens us up to the great truth of our health.
People see their illness as a story, he says, and hearing that story can lead to a diagnosis and treatment that a harried doctor guided only by medical tests might miss.
To that end, he encourages young doctors to read and to write fiction. “Novels deliver instructions for living,” he says.
At 736 pages, The Covenant of Water is a commitment. It’s a voluminous, voluptuous multigenerational family epic teeming with characters connected by water, genes, and community. It is set in Kerala, a lush region on India’s southwest coast of the Arabian Sea, land that becomes a character of its own.
Verghese’s family is from Kerala, but he was born in Ethiopia, of missionary parents. The story was inspired by his grandmother, who lived in Kerala.
The novel starts when Big Ammachi is a 12-year-old bride. She immediately becomes mother to Jojo, barely nine years younger. Her gentle, loving husband is never given a name in the book, but is called Big Appachen, or father. Their daughter, Baby Mol, stays a mental age of 5 but has the emotional range of a savant. Their son, Philopose, arrives with great promise but needs a village to help him find his way. He marries Elsie, a gifted artist, who gives birth to Baby Ninan and almost dies in childbirth with Miriamma. Is Miriamma the one Big Ammachi has been praying for to find a solution to the illness that plagues the family? Maybe. But much must happen first.
Big Ammachie’s family suffers from what they call The Condition, an ailment that leads to death by drowning at least once a generation, even in shallow water. The problem is exacerbated by Kerala’s geography—it’s laced with canals that largely provide transportation, especially in the early-to-mid 1900s, when most of the novel is set. Big Appachen has The Condition and therefore avoids water, even if it means walking for hours instead of taking a short boat ride. Philipose has it, too, but he responds by insisting he can learn to swim. He’s stubborn, but he still can’t swim.
The book develops like that water itself, building momentum through the years, as traditional medicine merges with Western and as both integrate with the community. Finding a treatment for The Condition means listening to the people, learning their history, using traditional techniques to understand the patient and the tools of modern medicine to define the disease and search for a cure.
It’s the kind of medicine Verghese teaches, the kind that works with and for people. The kind that could transform our wobbly healthcare system.
Death is a profound part of the book, and Verghese uses it to show the necessity of truly living with and through family—biological or not. Trauma forges the people of the novel; in loss, they find love, in despair, they turn to goodness.
Verghese says the meaning of “covenant” in the title should remain a bit mysterious and, as in the rest of the novel, “the reader provides their imagination and somewhere in the middle spaces a mental movie takes shape.”
As the book unfolds, the covenant of water becomes a baptism, a rebirth, and an absolution. To coexist with the water, the Kerala community must respect its rhythms and barriers. They know water can heal, it can serve, it can kill, and it can keep secrets.
The book ends in the 1970s, a time of social progress and change. Women doctors are common, valued friends are no longer required to eat outside because of their caste, and medicine is at a crossroads. A new hospital is being built because the community envisioned, financed, and staffed it. Old ways of healing remain and, ideally, guide a new generation of doctors. It’s the kind of medicine Abraham Verghese, a son of Kerala, now champions.
Copyright 2024, Patricia Prijatel
References
Louisa Ermelino. Abraham Verghese’s Epic New Family History. Publisher's Weekly. January 20, 2023.
Robert Pearl. Abraham Verghese’s Fiction Holds Key To Unlocking Better Healthcare. Forbes. June 12, 2023.
