WHAT DOES WRITING and medicine have in common? They both require a steady hand, a cold eye and an open heart. A writer and a physician need to be dedicated to their craft, they need a dispassion to diagnose, to cut, to slice, to edit, but most importantly they need to be receptive to the world, and must see and notice everything. Professor at the School of Medicine at Stanford University, Abraham Verghese—who also has an MFA from the Iowa Writers’ Workshop—perhaps, is more well-versed with these similarities than most. Verghese is both a practising physician and a working writer. He has written on the AIDS epidemic in My Own Country: A Doctor’s Story (1994) and on addiction in The Tennis Partner (1998). As a young doctor specialising in infectious diseases, he chronicled the effects of the AIDS epidemic on a small town in the American heartland, Johnson City. In The Tennis Partner, a memoir set in Texas, he mapped a fraught and intimate friendship between two men who come together on the tennis court, even as their lives unspool off it. He is also the author of Cutting for Stone (2009) a saga about twin brothers in Ethiopia who are orphaned and then raised by a physician couple from India. The novel is as much about the minds of the characters as it is about the bodies they diagnose and treat. The novel dwelled on The New York Times bestseller list for more than two years, and many million copies sold. In 2015, the then US President Barack Obama presented Verghese the National Humanities Medal.
Verghese is now out with his second novel The Covenant of Water (Grove Press; 736 pages; ₹899), which spans a century and three generations. Born in Ethiopia, in 1955, to Malayali teachers, he completed his medical education at Madras Medical College and has since worked in the US. Speaking from Stanford, Verghese details the parallels between being a writer and a doctor, “I don’t think of myself as wearing two different hats. I’m just one person, and I do some things in the daytime and some things in the evening. And it’s the same lens that you bring to both enterprises.” He applies Occam’s Razor principle to writing and medicine. “I’m trying to find one explanation for multiple observations rather than list multiple things,” he says. This theory gives precedence to simplicity: of two competing theories, the simpler explanation is preferred. As a physician and a writer, he perseveres to observe, and not judge.
My memories of water in Kerala are very strong, and it seemed to be the dominant metaphor, says Abraham Verghese
Share this on
Much of The Covenant of Water was written over the last few years. But the genesis was a handwritten letter Verghese’s mother had sent his niece back in 1998. His niece had asked Mariam Verghese, “Ammachi, what was it like when you were a girl?” She replied by writing a 157-page note, packed with memories and sketches. Verghese parsed through his mother’s stories for the novel, but as he writes in the acknowledgements, “More precious to me were the mood and voice that came through in her words”. He supplemented her stories with his own recollections of summer holidays with his grandparents in Kerala, and his later visits when he was in medical school in Madras and more recent trips over the last decade.
Not having lived in Kerala for long periods, did “give him pause”. He was born and brought up in Ethiopia, before it “imploded,” and this allowed him to embark on his first novel. But what he might have lacked in lived experience, he made up with copious research on the state.
His home is close to Kottayam and his memories of the state are tinged in blue, echoing the novel’s title. He recounts, “My memories of water in Kerala are very strong, and it seemed to be the dominant metaphor.” His family would travel from his paternal grandfather’s home to church by boat. “You get all dressed up and stand in this giant canoe and get pulled across the short distance. Or if there was enough water in the paddy fields, you could float right down to the church!” He adds, “To some degree it explains something about the Malayali character. We all are incredibly nosy about each other because our lives just flow into each other. There is this fluid connectedness that we can’t escape.”
In fiction you have this great licence to do anything you want, but you have to work much, much harder to keep the reader’s interest. So even though you have this great liberation you also have a bigger load to carry, says Abraham Verghese
Share this on
AT CLOSE TO 800 PAGES, The Covenant of Water can feel like a tropical Gone with the Wind, complete with noble and flawed characters searching for a foothold, as the events of history blow around them. The book opens in 1900 in Travancore, the night before a 12-year-old girl is to be married. This child bride will become the Big Ammachi of the Parambil household, who nurtures the soil and people on it. The novel ends in the late ’70s, when Big Ammachi’s granddaughter Mariamma, a doctor, learns the true meaning of “Every family has secrets, but not all secrets are meant to deceive.” One of the secrets is that in every generation, going back seven, at least one member has ‘drowned’ mysteriously, making them all stay clear of water.
Through three generations, and 100 years, the reader is taken from a Travancore of wood fires to a household listening to the news of the world on the radio. With great finesse, it charts the many social and economic changes in Kerala, from the adjustments in the relationship between the “thamb’ran” (landlord) and the “pulayar” (workers), to the rise of the Naxal moment. While focusing on the histories of the Parambil tharvad the book also tells the story of Digby, an orphan from Glasgow who becomes a doctor in Madras.
It is a big novel that does a lot, and does it well. It recreates the watered lands of Kerala, where life sprouts out of every crevice. It provides an agricultural history by detailing how coffee must be grown and jackfruit should be planted. It tells of floods and famines, war and starvation, leprosy and smallpox in cinematic detail. It chronicles violent and sudden deaths, how grief can destroy, and build bridges.
“Crushing is there,” a character says in the novel, underscoring the ubiquity of turmoil and hardships. Verghese attributes the many tragedies in the novel to a physician’s truth. He says, “Many physicians are much more aware of how tenuous this thread is to relative good health, which in any moment can quickly change. Most of us live our life denying our mortality and are unaware of, or unwilling to think about, a sudden end or a change in the current status. But as a physician, I’m much more aware of it, and it is not a morbid thing. It lends some poignancy to your existence, it makes you realise how precious each moment is. There is nothing more but this moment.”
The first moment you embark on a new novel, you have to invent yourself all over again. So, I don’t feel like there was anything I learned from my previous books, except a respect for the process, says Abraham Verghese
Share this on
The disease and death that he portrays in the novel reflect the times it was set in. His mother’s brother died when he was 12 of typhoid, and she was just a few years older. His father lost his oldest brother to rabies after he was bitten by a dog. Verghese says today we too often choose not to acknowledge the tragedies that did (and do) pockmark our lives.
While this is clearly a ‘large-sweep’ novel, which maps the growing opposition to the British and the bombing of Madras during World War II, its greatest strength lies in its unpacking of human relationships. The stoic and silent bond between Big Ammachi and her much older husband is rendered with subtlety and acuity. Big Ammachi is always looking for a page to read, whereas her husband is a man of the treetops who can read the land, but not words. Initially, they share little in common, as she is a child, and he a widower with an infant son. But over time, she becomes an equal partner and a mother to his children. The tragic relationship between Big Ammachi’s son Philipose and his artist wife Elsie is also brought to page with vividness. As Elsie once laments to her writer husband, “All I wanted was your support so I could do my work. But somehow you always seem to think you’re giving to me even when you’re taking it away.”
Halfway through our Zoom interview, Verghese rises from his chair (his phone has pinged him to stand up, too much sitting is unhealthy). He readjusts his camera so a large whiteboard on his side comes into focus, revealing the blueprint of The Covenant of Water. He often strayed from it, discovering his characters as he wrote them, but in the middle of the board he points to the rough sketches of Elsie and Philipose. Philipose— who disappoints his mother, wife and son—was the most difficult character to create. He says he did want to create Philipose as “an idiot of a husband” but he didn’t want the reader to spurn him entirely. He adds, “In many ways, he would come closest to elements that are autobiographical in the sense that I haven’t always done the right thing and I haven’t always succeeded in my well-intentioned relationships and parenting. And so, there was a lot of him in me acknowledging the deficiencies in my own character. He was a very fascinating character to work on and break my head on, to be honest.”
As you get older, you realise your presence, your concern, your care, your time is really what is needed sometimes, when there is nothing else to offer, says Abraham Verghese
Share this on
WHILE VERGHESE HAS tended the seed of the novel for more than a decade, much of The Covenant of Water was written during the pandemic. He says, “Covid was particularly poignant because here I was writing about illness and tragedy in the 1900s. And observing a modern-day tragedy and realising that there were some striking commonalities. We haven’t changed as human beings over two centuries.” As an infectious disease specialist, Covid was a busy time for him, but he says, with candour, it was much busier for his younger colleagues. Covid was also a time when his two sons moved back home, which was “wonderful” for him, but “hard” for them.
Like Cutting for Stone, The Covenant of Water also has many medical procedures spelled out in forensic detail. In Madras, Digby realises that he will perform the same surgeries he did in Scotland, but here pathology is “magnified”. Here he will encounter tumours the size of watermelons and lepers who do not realise when a finger falls off. The Covenant of Water also goes beyond the procedures of hospitals and theatres to detail home births. Big Ammachi becomes the default midwife for the children born in Parambil and a difficult birth is described in all its grit and gore. “She gathers her gnarled fingers into a bird’s beak, then insinuates them into the birth canal. Her fingertips ease past the baby’s bottom, spreading out, worming their way up, the space so tight that her joints scream.”
In his practice, Verghese is particularly interested in the Bedside Exam, Patient-Physician relationship and Story and Ritual of Medicine. He is known to focus on healing, when so much of medical care risks being outsourced to technology. In a TED speech, he once said, “My epiphany is even when we doctors could not cure, we could heal.” When one is new to medicine, one gets caught in the “hubris” of one’s own ability to cure everything. But time and experience will humble anyone and reveal one’s limitations. He adds, “As you get older, you realise that your presence, your concern, your care and your time is really what is needed sometimes, when there is nothing else to offer. When medicine has nothing else to offer, is the moment that you can begin to offer all the non-technical stuff, as people have done, since the start of antiquity.”
A few of the women characters in The Covenant of Water, especially a matriarch like Big Ammachi, personify this belief. They might lack degrees, but they have wisdom and experience in plenty. Verghese says, “There was that parallel I found in the characters that I most deeply cared about is that they had this quality of always being there,” adding, “Big Ammachi represents the broadest healing qualities that one could have, but she also represents mothers, mothers everywhere, they all have those qualities instinctively.”
The Covenant of Water has only just set sail into the world. And Verghese is curious to see the book’s reception in India and abroad. As a doctor who has written fiction and nonfiction he says, “I identify more as a novelist, and that’s really what I’d like to keep doing.”