Kozhikode: Spanning three generations, Abraham Verghese’s The Covenant of Water is set in Kerala before, during and after India’s independence from colonial rule. While one family – dealing with a inexplicable ‘Condition’ that makes them prone to drowning and fearful of water – is at the book’s heart and centre, it parallelly follows the lives numerous people they interact with and are touched by, both directly and indirectly.
Verghese was born in Ethiopia to Indian parents who had migrated from Kerala. He grew up to become a physician, and has become a celebrated doctor in the US. The Covenant of Water is his fourth book and second novel. Grief, complex family relationships and friendships, and a recurring return to medicine – both the questions it can answer and those it can’t – run central to the sprawling novel.
At the Kerala Literature Festival 2025, marking the first time Verghese was talking about the book in the state where it is based, the author spoke to The Wire about his connection with and understanding of geography, his mother’s manuscript about growing up in Kerala, what it’s like to be a doctor during a crisis, and more.
Themes around medical practice, particularly surgery, run through both your novels. How does your work as a doctor influence or bleed into your writing?
Well, I’m not a surgeon myself, I’m an internal medicine physician. But surgery is inherently dramatic, you know, it’s also got some rich history. I almost went into surgery and then, for many different reasons, I wound up going into something else, but I always felt like sad that I was turning my back on the wonderful history of surgery. People say you should write what you know, so medicine is what I know, and it finds its way into everything I write.
Abraham Verghese
The Covenant of Water
Grove Press, 2023
You also explore the social aspects of medicine in your work, including how sometimes people may prefer to look to divine intervention or other forms of care rather than medical practice. You also look at how the medical profession can fail people. What inspired that?
I think medicine is always supposed to be concerned with the whole human. A very famous physician, William Osler, said many years ago, it doesn’t matter what disease the patient has, it matters what patient has the disease. Because disease is unique to each individual in the way it expresses itself, in the way that they deal with it. So you can’t really deal with it at the level of just a cell. You’re talking about a human being with feelings and fears, so you have to address that.
You’ve talked about a manuscript that your mother wrote, about growing up in Kerala, and how that helped you set The Covenant of Water in Kerala. What was she describing, and how did that impact your writing? Is Parambil [the fictional village in the book] based on her writings?
I felt for the longest time that I didn’t have the authority to write about Kerala. I didn’t grow up here; I would come here every summer for vacations, but it felt to me, and especially because Malayalis are so critical, that I just didn’t have the authority to write about this. And yet when I look back, I had been coming every summer, I went to medical school in Madras.
But my mother wrote this manuscript for her five-year-old niece, her namesake, who wanted to know what it was like when she was a five-year-old girl. And my mother was describing an era the tail end of which I’d seen – no electricity, no water, but it wasn’t a deprivation. There was actually a richness to that, the way the house would be lit with lamps in the evenings.
And so, all she did, my mother, was list a few colourful anecdotes, stories that she told us, but now they became more embellished, and she illustrated them as some drawings. When I saw that manuscript again, I mean she wrote it maybe 15 years before that, but when I saw the manuscript again, I just had this epiphany that this is such a rich community, Kerala, such a unique geography, within it the different players – the Syrian Christians, the expatriates, everybody around, the society had a richness that I thought, this is a great locale for a story.
So that manuscript gave me the faith to go on. I didn’t necessarily use anything concretely from there, but I certainly called on it.
There’s part where a character in The Covenant of Water quotes someone else as saying that ‘geography is destiny’, and then he says for himself it’s more like ‘geography is personality’. For someone like you, who has lived a life across many geographies, what does it mean for geography to be destiny or personality?
That’s a quote from Napoleon, Napoleon said that geography is destiny, meaning France’s position in the world had everything to do with its destiny. But for me, it was personally something very meaningful. My parents left Kerala because there weren’t any jobs, they went to Africa. It changed their destiny. Because they went there, I was born there. And my destiny is very different from theirs. So I think with every change in geography, destinies change.
Your book is set in Kerala, but like you said you’ve never lived here, though you visited regularly as a child. What is it like now, to come back here to talk about the book?
It’s really fascinating, because I was fully prepared for Malayalis to be highly critical, because they’re critical people. And so to my astonishment, it’s been quite the opposite, where people have acted as though this book is explaining them to the world in a way that they have wanted to be explained. So they’re picking it up as a something that they’re proud of, which is just wonderful to see. It’s a really unexpected turn. It doesn’t stop them being a little critical here and there when they can.
Your first book, My Own Country, was around the spread of AIDS and the AIDS epidemic in Tennessee, and now we’re marking five years since the COVID pandemic was announced. Working through both as a doctor, did you see parallels? Or were things very different?
I think there were a lot of parallels. The biggest difference was that there wasn’t the stigma of shame and secrecy that went with HIV [during COVID], but there was the same degree of fear of the unknown. The other difference was I was now a very senior doctor and there was a whole new generation at the front line. They were experiencing personal fear, which is something you rarely have as a physician. But historically, physicians were dying left and right of smallpox or typhoid, whatever. It was very poignant to see.
I think the saddest part for me was to see people dying alone, they couldn’t have their families visit, we were all gowned and masked that we couldn’t really be as personable as we might have wanted to, so it was a difficult time.
