The Covenant of Water, Abraham Verghese. New York: The Grove Press, 2023.

Summary: The story of three generations of the family of Big Ammachi of Parambil, the ever present reality of “the Condition” resulting in a drowning in every generation, a story both of love and the hope in advances in medicine.

Twelve year old Mariamma has been engaged in a brokered marriage to a forty year old widow, the owner of a 500 acre estate near the town of Parambil. Her mother tells her, “The saddest day of a girl’s life is the day of her wedding….After that, God willing, it gets better.” I began reading with a sense of foreboding of what would happen to this girl in the house of this man. And I was surprised. At the wedding, he runs away, mortified that she is a mere child. But they wed. And he leaves her to her own room, and lets her learn the management of the household, lets her mature, lets her bond with his son, JoJo, and lets her realize that he has loved her by providing her time to come to love him. And so begins this incredible story spanning three generations within the Mar Thoma Christian community of South India.

When JoJo falls into what is little more than a puddle and drowns, she learns of “The Condition.” It explains the distance of the house from the river, the fact that her husband will not travel on the water. She is shown a genealogy. Every generation has a death from drowning. And JoJo’s name is added. Eventually Mariamma, who has become Big Ammachi, a capable manager of her household, bears another child, a girl with a developmental difficulty leaving her a perpetual child. Baby Mol brings perpetual love and an uncanny prescience about events. Fifteen years pass, and at a point of giving up hope, Big Ammachi has a son, named Philipose.

Philipose has the condition. Sent to college in Madras, he soon quits due to deafness that impedes his ability to follow the lectures. On the carriage home, he meets Elsie Chandy, an artist, and is smitten. They’d had a brief encounter when Philipose risked his life carrying a dying child on a river barge during floods to the nearest hospital, and was given a ride home by Elsie and her father. He strives to educate himself and becomes a writer, producing a column, “The Ordinary Man” widely followed throughout the country. Eventually, through a broker, Elsie’s family agrees to the marriage. It seems like a beautiful love affair, that sadly ends with the tragic death of their child Ninan. They blame each other and Philipose, injured trying to rescue Ninan, falls into opium addiction. Elsie leaves but returns when she learns Baby Mol is pining for her, and in failing health. Philipose and Elsie are intimate once and it is soon evident that Elsie is pregnant. As she approaches delivery, she has a seizure. Big Ammachi assists in a difficult breech birth, nearly costing the mother her life.

The baby is named Mariamma, after her grandmother. Soon after her recovery, Elsie disappears after going to the river to bathe, her body never found. Philipose sorts out his life, becomes an exemplary father, and continues his writing work, turning over his estate to Shamuel, and eventually, Shamuel’s son Joppan, to operate. Big Ammachi has dreamed of both a hospital in Parambil, and that her grand-daughter would become a doctor and find the cause of “The Condition” that plagues her family.

The book also involves a parallel plot line in which a young Scottish doctor, Digby Kilgour, goes to India to acquire surgical experience. Working for an incompetent superior, he has an affair with the superior’s wife, ending in a tragic fire that only he survives, with his right hand badly burned. A couple, grateful for an earlier medical intervention on his part, shelter him and connect him with a doctor working with lepers, who operates on his hand. He is helped by a young girl who helps him recover fine movements in the hand through drawing. Through much of the novel, we wonder what the what the connection of this plotline is with the main plotline of Big Ammachi and her family. Hang in there. There is one.

The story spans the period from 1900 to 1977. India goes through huge transformations through this time that serve as a backdrop for the novel, from a British colony par excellence to an independent country, seeking to modernize amid political ferment, with the electrification of the countryside and advances in medicine and modern technology. We get some sense in the novel of how this presses against traditional caste divisions, particularly in the relations between the family of Big Ammachi and Shamuel and his son Joppan.

I found the writing particularly engaging. It felt to me that Abraham Verghese writes with the same reverence for his characters that he has for his patients (he is a Professor and Vice Chair of the Department of Medicine at Stanford). One senses a deep sympathy for his characters, even as they struggle with tragedy, estrangement, and the vicissitudes of life and death. He portrays a community shaped by faith, love, and purpose. And he conveys the noble possibilities of the medical profession, evident in Rune Orquist, the doctor of a leper mission who operates on Kilgour’s hand, and in Mariamma, and the professors who train her. To read Verghese is to read a consummate story weaver who has thought deeply about the human condition in its frailty and fallibility, in the powerful bonds upon which our lives and loves depend, and in the hopes and holy aspirations that represent the best in human striving.