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“The Covenant of Water”: An Appreciation

I heard about “The Covenant of Water” through a YouTube video on CBS Mornings where Oprah Winfrey announced the book as her 101st selection for her eponymous book club. The video also carried a short interview of Abraham varghese, the author. I am familiar with Abraham Verghese’s writing through his autobiographical “My own Country“ and the best seller ”Cutting for Stone”. I bought the Kindle version of the Covenant as soon as it was released on the 18th May.

Abraham Verghese, MD, MACP, is Professor and Linda R. Meier and Joan F. Lane Provostial Professor, and Vice Chair for the Theory and Practice of Medicine at the School of Medicine at Stanford University. He received the Heinz Award in 2014 and was awarded the National Humanities Medal, presented by President Barack Obama, in 2015 (1).

Born in Addis Ababa in 1955, the son of Indian parents recruited by Emperor Haile Selassie to teach in Ethiopia, he began his medical training in Addis Ababa. When the emperor was deposed, Verghese completed his medical education at Madras Medical College. After graduation, he left India for a medical residency in the US (1). He became professor of medicine and chief of the Division of Infectious Diseases at Texas Tech Health Sciences Center in El Paso, Texas. He is at present Professor for the Theory and Practice of Medicine at Stanford University Medical School. He also holds the position as Vice Chair of Education of the Stanford Department of Medicine (2).

His passion for writing made him take a break from his medical career and join the Iowa Writers Workshop at the University of Iowa, where he earned a Master of Fine Arts degree in 1991 (3). In a TED talk, he passionately argues for the necessity for personal contact with the patient, the necessity for empathy and the need for physical examination.

His first book, “My Own Country: A Doctor’s Story” describing his life as a young immigrant doctor dealing with the AIDS epidemic, was one of five chosen as Best Book of the Year by Time magazine. He admits in the acknowledgement section of his book that “he used the 157 pages of anecdotes prepared by his mother as an answer to the question asked by his niece”. Many passages of “The Covenant of Water” have a sentimental hue.

The Story

The book begins in 1900, as Mariamma, an impoverished 12-year-old girl in the Travancore princely state in southwest India, reluctantly agrees for an arranged marriage with a widower 30 years her senior. She dedicates herself into her duties as the Mater Familia of the Parambil family. and begins to care for her stepson Jojo and as the years go by and she bears a child, Baby mol. With time, she becomes known as Big Ammachi (big little mother), a name given by her stepson JoJo.

The first indication of the peculiar affliction of the family is when Jojo dies drowning in a ditch. Her husband shows her the Parambil family tree, a catalogue of the malady that has shattered the family. She call the parchment the Water Tree where each death is marked by a sign of a cross over water. She refers to this generationally recurring death in water as the “Condition”.

In 1923, Parambil family has another child, a male, Philipose. Big Ammachi’s husband dies suddenly. Philipose tries to learn swimming, but gives up. By 1936, Parambil becomes a district village. In 1943, Philipose joins the Madras Christian College, though he had to leave the college because of a hearing problem. Philipose starts writing a popular column in a news paper. Following his success as a writer, Philipose marries Elsie. Baby Ninan arrives in 1946. Elsies’s “Portrait of Lizzie” winds a gold medal at the Madras exhibition. Baby Ninan dies in an accident. Little Mariamma is born in 1951 and soon after, Elsie disappears, many believing that she had drowned herself. After a while she returns and after a while gives birth to a little girl, Mariamma.

Mariamma grows up and joins the medical college in Madras for her studies. Philipose, while travelling by train to Madras, meets with an accident and gets drowned. The body after post mortem at Madras is taken to Parambil by Mariamma. She had mentioned to her professor Dr Uma the “condition” and she is advised to bring back the ‘Water tree’ to Madras. Dr Uma along with a neurologist opens up Philipose’s brain and discovers that he had a variant of neurofibromatosis called von Recklinghausen’s disease. The signals to locate his orientation and position in space never reaches the brain. In water, without a firm contact with the ground, he would lose all sense of orientation, leading to drowning. After completing her studies, Mariamma joins the hospital sponsored by the Parambil family.

Parallel to this is Digby Kilgour’s story, which eventually would intersect with the Parambil story. Digby’s struggles against the British medical establishment with its violent bias against Irish catholic physicians made him join the Indian Medical Service in 1933. Operating weekly at the General Hospital is the surgical education that Digby sought. He finds love in Celeste, his boss’s wife, who, however dies in a fire in Digby’s studio, in which Digby also suffers burns. He goes to the AllSuch Estate near Cochin belonging to Franz and Lena whom he had befriended in Madras. His hands, which had lost their functionality in the fire are brought back to life by the Swedish doctor Dr Rune Orquist, who had established a leper clinic nearby. Elsie who had disappeared from Parambil, finds her way to Rune’s establishment, because she suspected that her early exposure to leprosy had infected her. The younger Mariamma eventually finds that her mother Elsie, who had disappeared from home was with Digby and that Digby was her father.

About the Book

Somewhat pedagogical streak runs through the book. Verghese has to explain everything: the caste system of India, the medical benefits of spices and how the Europeans followed the Arab traders to the fragrant coast, how fish is cooked in its fiery chilly sauce, procedures in a surgery etc.. Verghese’s writing about medical conditions, recurring many times in the book, clearly reflects his profound understanding of the human body and the story attains credibility because of that.

Verghese’s literary influences come clear with the references to Anton Chekov, George Elliot and Charles Dickens. His historical development of the story reminds one of “A Tale of Two Cities”. It will be quite natural for comparisons to be made with Arundhati Roy’s The God of Small Things. The close blending of the sociopolitical and historical with intense character portraits achieved by Ms Roy is never so in the Covenant.

Verghese’s characters somehow are lost in the details of the story that they remain shadowy, undefined. Ammachi, who is introduced to us as a child-bride, is loving and loyal, but never quite appear as the mater familia. She could have made a strong, memorable character given the matriarchal traditions of Kerala. So does Philipose, her literary son, who had to face the tragedy of losing his wife.

The book opens with a map of the state of Kerala with its regions, ranging from the high ranges of Wayanad to the towns of Travancore-Cochin region to Trivandrum in the south. Is Verghese advising us that we should read it as an epic fantasy?. Is the water which causes a member in each generation to die in its embrace like an evil ogre? The narrative Verghese has created, at least in form, fits this definition, though his obsession with explaining everything lead us away from the mystique of a fantasy. Nevertheless, Verghese reveals how everything is organically connected, like the waterways of Kerala.

Covenant also charts the history of diseases and their treatment in India from the pre-independence days to the present. The book explains how medical science and people’s attitudes about medical conditions evolved progressively.


While announcing the news of the selection of Covenant by the Oprah Winfrey Book Club, she said: “I felt transported; I felt like I lived in a different land for a while. I felt expanded, I came away humbled that someone could have a Mastery of words the way Dr Verghese does and I just think this is an offering to the world”. At a time when India is beginning to be seen by the world through a dark lens because of the emergence of the strident Hindu nationalism and the associated Islamophobia, it may expose them to a part of India with people deeply rooted in humanity. The arranged marriage that begins the book is a happy one; such marriages succeed more often than one would expect.


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