Review: Abraham Verghese. The Covenant of Water. Grove Press, 2023.
Abraham Verghese’s 2023 novel, The Covenant of Water has had a very successful year. It has been on the New York Times bestseller list, won prizes, [1] been reviewed and written about extensively and captivated both nations comprising the author’s primary readership – America and India. Verghese is by now well-known among writers inhabiting the intersecting circles of Indian writing in English, popular science writing on issues of health and medicine and STEM researchers engaging with key issues in the Humanities. Verghese was born to Indian parents in Ethiopia, completed his medical education in India before emigrating to America in the 1980s. He is an infectious disease physician and professor of medicine at Stanford University, where he is one of the founding members of PRESENCE, an initiative that seeks to centre human experience in the practice of medicine. A winner of the National Humanities Medal in 2014, Verghese’s citation for the distinction sums up his appeal across Medicine and the Humanities: “His range of proficiency embodies the diversity of the humanities; from his efforts to emphasise empathy in medicine, to his imaginative renderings of the human drama.”[2] Over the past year, The Covenant journeyed through numerous podcasts, news articles, interviews, literary festivals and bookstore events as the newest vehicle for its author’s abiding message: the physician heals by discovering the patient’s story, not the symptoms of disease.
The Covenant of Water contextualises several medical themes by offering a detailed history for the characters and situations that represent them. The Parambil family, who are at the centre of the novel, carry a genetic disorder that causes a fatal intolerance of water over several generations. In telling the story of Digby Kilgour, a Scottish surgeon who arrives to practise in british-occupied India in the early 20th century, Verghese charts a fascinating social history of colonial institutions like the Indian Medical Service and the Christian Medical College in Vellore. Para institutional practices of medicine are equally suffused in the novel. Mariamma, a third-generation character in the Parambil family, the first to go to college and training to be a doctor, gains her medical apprenticeship at the nearly defunct medical mission hospital near her rural Parambil estate and with noone better qualified than the estate farmhands whom she trains to assist her in surgical procedures. Mariamma cracks the medical mystery afflicting her family not only owing to her medical training but with key pieces of evidence from her father’s journals and the town’s most renowned matchmaker’s scrupulous records of family histories. Digby’s presence in the novel’s colonial India allows for the exploration of the stories of other foreigners whose lives intersected with the subcontinent’s medical history, especially medical missionaries. Rune Orquvist is a Swedish surgeon whose leprosarium and its efforts to rehabilitate those afflicted by the disease is eventually taken over by Digby. Rune and later, Digby’s treatment of those cast out by society parallels their own alienation from the professional practice of medicine under the Indian Medical Service. Digby and Mariamma are mentored in the early years of their medical apprenticeship under the watchful eyes of nurses whose professional acumen, bedside manner and knowledge of local cultures outshines that of senior medical residents and doctors.
In following the story of individuals living between the years 1900 and 1977 in India, Verghese brings into conversation medicine and several other key contexts that shaped lives during this transformative period. Big Ammachi, whose perspective as a child bride sets the narrative action in motion in the 1900s in Travancore at the start of the novel, inhabits a divided society whose oppressive hierarchies are such a part of the fabric of life that they are naturalised. Her husband, the thamb’ran builds the Parambil estate in coastal Travancore in the image of caste relations everywhere else in rural colonial India: he controls the land and by extension, employment in the region and over the course of a couple of decades, establishes a colony comprising members of his own family, families of craftsmen that have helped build the estate – goldsmiths, stonemasons, potters – and the families of the landless pulayars whose labour runs the estate. In the 1920s, Big Ammachi’s son Phillipose learns for the first time that his playmate Joppan, the son of his father’s pulayar Shamuel, is not his social equal in the eyes of the estate’s newly appointed schoolmaster. This is the start of a thread in the novel that contextualises different life outcomes for Joppan and Phillipose, both the first generation to learn to read and write in their respective families. While Joppan is able to finish school and later, college with Big Ammachi’s intervention, Phillipose reaches Madras Christian College only to find out that he has a case of nerve-related deafness that will not allow him to continue his education at a university-setting.
The Covenant of Water has been criticised for its hope-led and rose-tinted engagement with the socio-political landscape of India. [3] While Joppan’s story may not be representative of landless labourers in colonial India and a landlord’s benevolence alone may not ensure the pulayars’ education, The Covenant of Water illustrates a novel perspective on social class, a commitment to helping others and the medical profession. It is Joppan, rather than Philipose, who eventually articulates the importance and necessity of a professional education when Mariamma returns to practise at Parambil and the one who becomes indispensable to the work of healing rather than the running of the estate. The resolution of several narrative arcs in the novel necessitates either cooperation across social and cultural lines – British and Indian, landlord and labourer, the doctor and astrologer – or suggests a blurring of lines that has always existed either through forgotten, intertwined histories that return to haunt the characters’ present or a predestined coming together across seemingly insurmountable barriers. Several individuals in Verghese’s novel never hesitate in embracing the work of lifelong care for someone ailing in the family or waver in their commitment to fostering relationships across ideological boundaries. The work done by physicians in the novel (articulated in the novel through several riveting scenes of lives saved and lost during health emergencies) is subsumed within this larger and more general impulse to care that drives several characters.
The most representative example of this kind of intersection Verghese sees between the work of medical care and healing across social divides is in the account of Lenin Evermore. Like the perspective of the pulayars, carried by singularly representative voices that are ill-at-ease in the society whose narrative portrayal dominates the novel, Lenin’s story is meant to signify the life of a Naxal in newly independent India. Lenin’s close relationship with the Parambil estate allows characters like Mariamma to witness first-hand, the many societal and personal impulses for joining forces with the Naxalite movement in Kerala. While the novel argues for a kind of predestination in a character growing up in Lenin’s circumstances and the pull towards a revolutionary movement and a consequent rejection of the security afforded by societal structures like education, employment or even marriage, it undercuts this sense of “choosing” a life of rebellion by exposing a universal dependence on healthcare. A chance encounter between Lenin’s mother and Digby Kilgour (she is pregnant at the time with Lenin and has suffered an injury that could be fatal to both mother and child) plays a crucial role in ensuring Lenin’s very existence. Lenin’s life is spared yet again as an adult when he is on the run from the authorities, by timely medical intervention carried out in secret at Rune’s leprosarium by Mariamma. Mariamma is able to restore Lenin’s health (seen to be destroyed by life in the forest, and from frequent run-ins with state authorities unafraid to use violence) long enough to escort him to the Christian Medical College in Vellore where he receives more professional care. Being institutionalised at Vellore also affords Lenin a “public” arrest, thereby guaranteeing his safety even as several other Naxalites faced the threat of execution upon capture by government authorities. The medical institution and the work of restoring health and preserving life emerges as the most enabling frame for the narrative outcomes of characters in Verghese’s post-independence India.
Notes
- In 2023, The Covenant won the Golden Poppy Award for fiction and the Viking award for fiction with a sense of place.
- The White House citation for the 2014 National Humanities Medal, available at the National Endowment for the Humanities page: https://www.neh.gov/about/awards/national-humanities-medals/abraham-verghese
- See for example, Andrew Solomon’s review in The New York Times which finds that Verghese’s view of India does not achieve the “plangent intimacy” of Vikram Seth’s A Suitable Boy or the “dark and fantastical complexity” of the country portrayed in Rushdie’s Midnight’s Children. Available at https://www.nytimes.com/2023/05/02/books/review/covenant-of-water-abraham-verghese.html.
Neeraja Sundaram teaches Literature at the School of Arts and Sciences, Azim Premji University, Bangalore.
Header Image: Grove Atlantic
