Award-winning author Dr. Abraham Verghese just released his latest and long-awaited book –  The Covenant of Water – which is already topping bestseller lists. The sweeping family saga will capture your imagination with its storytelling, rich language, and imagery. 

This immersive, evocative story follows three generations (1900 to 1977) of a family in Kerala that harbors a medical secret. It pays respect to the quiet but strong lives of our Ammas and Ammachis (mothers and grandmothers) who lived in faith.

I interviewed Dr. Verghese, who also is a physician and Professor at Stanford University Medical School. Our thoughtful conversation ranged over many topics – the story, history, culture, faith, medicine, and the importance of storytelling in our lives. 

Abraham Verghese chats with India Currents writer Anjana Nagarajan-Butaney after his talk about his new book, The Covenant of Water, at Kepler’s in Menlo Park, Calif. on June 1, 2023. Photo: Sree Sripathy for India Currents/CatchLight Local.

The Covenant of Water demonstrates the power of stories to touch and heal the human spirit, just like his faith in medicine to heal with touch and science. It is “a good story – well told,” that will stand the test of time.

Listen to the full audio interview here.

Anjana Nagarajan-Butaney: Dr. Verghese, I’ve absolutely loved all your books. I’ve read them all multiple times. This book reads like an ode to your love of medicine, the way you love to practice medicine and your love of literature. But they also say geography is destiny. Do you believe that ? You grew up in Africa, you have lived in the US, you studied in India, and you have your deep roots in a small community that’s tightly knit in Kerala. How do you think geography and your identity shaped you?

Abraham Verghese: I think the best example is my own family. My parents were born in Kerala and educated there. But they came of age with their college degrees, just as India became independent from Britain. There were no jobs there. And so separately, they answered this ad for jobs in Ethiopia and landed up there. And that changed their destiny completely. And it really is the story of the Indian diaspora. If we would all not be so many far-flung places, if India had been able to accommodate all our aspirations and ambitions. 

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And then because I was born in Africa, I think my destiny was completely different from theirs. And then at a certain point, my parents moved first to America. And I moved many years later, but it was in moving that my destiny completely changed. And I moved because my education in Ethiopia was interrupted by the civil war. And then I eventually finished in India, and I can see all those continents that I’ve lived in leaving their unique stamp on me, and in many ways in forming this novel.

Also, I should add that when you write a novel, one of the biggest decisions is – where do you set it because I think geography imposes its destiny, if you like, on the narrative. So you set a story in Pasadena, or you set the story Kottayam (Kerala) is going to be a very different set of rules that the characters have to live by. So I think that’s the sense in which I believe geography is destiny. And I think it’s Napoleon who first said that, but lots of people use that.

Abraham Verghese greets fans as he makes his way to the dais to speak about his new book, The Covenant of Water, at Kepler’s in Menlo Park, Calif. on June 1, 2023. Photo: Sree Sripathy for India Currents/CatchLight Local.

ANB: You alluded to it a little bit, but how did you get started with the book? What was the genesis? Did the research guide you? Did you have a story in your head? And did it take a life of its own? I assume you had to do tons of research.

AV: After I had written my previous novel, which was set in Ethiopia, where I felt some confidence in being able to write about my childhood home. Even though ethnically I was not Ethiopian, so to speak. I felt it, I felt I was. With this book, I think the biggest decision was where to set it and I had hesitated setting a novel in In India, because again, I didn’t grow up there. I’m very familiar with it from summer vacations and then later in medical school, but it’s not quite the same thing as growing up and thinking in Malayalam.

Abraham Verghese speaks about his new book, The Covenant of Water, at Kepler’s in Menlo Park, Calif. on June 1, 2023. Photo: Sree Sripathy for India Currents/CatchLight Local.

It was in seeing a document that my mother had written. My five year old niece asked my mother, “what was it like Ammachi, when you were a little girl?” And my mother was so taken by that question, because she was in their 70s then, trying to describe to a five year old what it was like, in a village without electricity or water. And yet, that wasn’t deprivation. Actually, as a child, I thought it was magical to see the glow of lamp light all over the house. It was much prettier than the harshness of electricity when it came. 

So my mum began to write a series of anecdotes about our community and her childhood and illustrate it with little sketches of common objects and dresses. And in revisiting that document, even though those stories didn’t really pop up in my book. It was just a reminder of the richness of any community but our community because it’s the one I know. The richness of tradition of faith from St. Thomas the Apostle in 52. AD and, and yet it’s a faith with rituals that have a lot of Hindu traditions that have still been retained. And the desire to stay within that community that results in marriages and all the premium that’s placed on the reputation of a family. So it had all the elements of a good place to set a story. 

And I think if I hesitated, it was because I didn’t know it quite as well as someone who’s native born. But I tried to make up for that with a lot of research and by enlisting the help of the wonderful experts who had that authority, and they weren’t necessarily writers, but they had the authority that they could inform someone like me trying to write about it. So that’s really how it came about.

Abraham Verghese reads from his new book, The Covenant of Water, at Kepler’s in Menlo Park, Calif. on June 1, 2023. Photo: Sree Sripathy for India Currents/CatchLight Local.

I only had the geography and I had a sense that I wanted this to be about a family over several generations because I’m drawn to those kinds of stories. I think that I always feel like stories are instructions for living and it’s only in the span of three generations that you get the kind of wisdom that you’re seeking. Not always, but I’m drawn to that. And I also had early on that the family would carry an inherited condition that would be passed on. 

It’s always fascinated me how in medicine, even today, we have things that we have a label for, but we don’t understand. In 70 years, that label will be replaced by something much more accurate. So I love the idea of having this conceit run through the novel of an inherited condition that gets ultimately unraveled by the sweep of time, nothing else.

ANB: In a story this long, how do you break it down into chapters? Did you name chapters first? Did you write the story and then break it down into chapters?

AV: I wish I had an outline of everything that was going to happen. I envy the writers who do and I actually had a whiteboard which started the whole novel. But the thing is, you start writing, and the character develops, and then you put the character under pressure. So one of the maxims, or axioms of writing is that characters are defined by the decisions they take under pressure. 

I would put this character under pressure, and they would sort of let me know that that’s not what they were going to do. What I had planned for them wasn’t what they would do, and I knew I’d have to change direction. A lot of things like chapter headings and the way that book is segmented come much, much later in the process. When you finally see the whole thing, then you can start to shape it.

Abraham Verghese speaks about his new book, The Covenant of Water, at Kepler’s in Menlo Park, Calif. on June 1, 2023. Photo: Sree Sripathy for India Currents/CatchLight Local.

ANB: In the book, when Koshy Saar introduces literature to Philipose and says 

“Fiction is the greatest lie that tells the truth about how the world lives” – it struck a chord in me because my husband (who mostly reads nonfiction) was challenged by my daughter when she was in high school, to read a piece of fiction every month, because she said it builds empathy and teaches you how the world works.

How do you view your dual worlds of writing and practicing medicine? Does doing one make you better at the other? Why do you think it’s important to read fiction?

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AV: First of all, I think I always find it remarkable that we are educated by stories when we grow up – stories from the youngest age, and then the stories get more complex, or they get fixated on Batman, Superman. At every state, stories are how we learn about the world. And it always puzzles me that when we want to become adults – serious people are like, “Oh, I only read biography and nonfiction.” 

I love to tease my colleagues who are like that by saying – you know, you’re a serious kind of person – Uncle Tom’s Cabin,  if you heard this book, it changed America. It ended slavery, not a politician, not an army. But one book captured the public’s imagination. Or the Citadel in the UK. That book, a fictional book, about medical conditions in a small Welsh mining town caused the National Health Service to be born. So fiction is terribly important to, just as your daughter said, to increase your empathy, your imagination. Our lived lives are so narrow, and the only way to walk in someone else’s shoes is by the vehicle of something like a book. 

If we want to teach end of life in medicine, we could point someone to a palliative care textbook or if you want them to really feel it, you point them to The Death Of Yvan Ilyich by Tolstoy – a story that makes you feel what it’s like to suddenly get a death sentence. Or if you want to teach child abuse, you point them to the novel Bastard Out Of Carolina by Dorothy Allison, where you will feel what child abuse is like. I’ve always subscribed to the fact that fiction is important. 

Abraham Verghese speaks about his new book, The Covenant of Water, at Kepler’s in Menlo Park, Calif. on June 1, 2023. Photo: Sree Sripathy for India Currents/CatchLight Local.

But the fact is, you get into medicine, and it’s so technical. It’s so left-brain that your right brain can atrophy. I find that for me to answer the second part of your question, the practice of medicine, the art of looking at patients is trying to gather from their story, make something special out of it, or gather facts from their body, reading the body, these are all the same skills I bring to writing. You’re sort of using the same lens, at least I am. So it’s not two different hats. I’m using the same lens, as I approach the story and the characters. 

And I think that the skills of medicine don’t hurt you when you’re writing. But conversely, I think the writing often helps me process the medical stuff that I’m seeing, especially nonfiction. So I’ve always had the sense that if I’m assigned a piece of nonfiction to write about, I can go walk by the river and flesh it out in my mind. But there’s something utterly mysterious when you sit down to write, as you know, what comes out can be completely different than planned. And so I feel like I’m writing in order to understand what I’m thinking. So that’s how writing and medicine feed on each other.

ANB: You have mostly lived outside India. As a man, how did you get into the mind of a young girl who is 12, who gets married and learns how to cook, the mango season, cooking with clay pots and how to make a good fish curry? How do you get into that mindset of a young woman who’s learning to come into her own?

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AV: Tremendous question. I think, first of all, I had a great amount of help from my cousins and friends, who were helpful. I think I had as my model my grandmother who married at a very young age and came into this household and never left until she died. That was her world. And, I think too many novels are populated by women, who, as mothers are flawed or as mothers are evil. I really wanted to pay tribute to the quiet heroism of these Ammachis – who the world will never know and yet, in their lifetime, their influence on their children to make them take advantage of opportunities they never had. The stability they bring, the faith they bring, the way they cobbled this all together – there’s something so admirable about that quality. And so I knew that they wanted to describe that and I talked a lot to my mother, my aunts and my cousin’s to get at the nitty gritty of that experience. 

Abraham Verghese reads from his new book, The Covenant of Water, at Kepler’s in Menlo Park, Calif. on June 1, 2023. Photo: Sree Sripathy for India Currents/CatchLight Local.

ANB: Your mother’s life didn’t play as much of a part as your grandmother’s did?

AV: My mother was clearly outside of India for the most part but she remembered so much about her childhood and could explain lots of details to me. But there’s also an abundance of historical material that I was able to search, both in anthropology literature, but also individual narratives and oral histories. There is just the richness out there.

ANB: Are you a man of faith? Does it play a part in your practice of medicine? And especially in your writing of the character of Amamachi – how were you able to pepper the story naturally, organically with her Bible sayings and the way she talks?

AV: I’m not sure that I personally am an example of any kind of faithfulness. But, you know, the definition of faith is belief in the absence of proof and I think I was always moved by the fact that people like my grandmother – they just took this as something necessary, they never debated it the way our generation did. And, as a consequence, it was a powerful force in their life. Gave them so much strength that, if you didn’t embrace it the way they did, then you lack something. I do not necessarily embrace it quite as much as they have, but I’m impressed with it. 

Like my father, I happen to be recording this from Boston, where I’m at my brother’s house and, father, who’s 97 lives here. On Saturday night, he was watching the church service, from the church where he went to a little boy – where his father was, where he became a deacon, where his father is buried, and brothers buried. He was married in that church. To see the depth of his association with that church, that service, that congregation even though he’s a continent away, I was certainly moved by that. 

And I think, in my writing, I’m not trying to proselytize or, bring people to faith or away from the faith, but I’m trying to celebrate the richness of the faith that whatever it is, whatever faith that is that people have, and also the degree of empowerment it brings to people who truly subscribe to it,  whatever their faith is, and that’s all I was doing.

Abraham Verghese speaks about his new book, The Covenant of Water, at Kepler’s in Menlo Park, Calif. on June 1, 2023. Photo: Sree Sripathy for India Currents/CatchLight Local.

ANB: It has always struck me that in India,  irrespective of what your religious faith is, the average person’s depth of faith is very strong. When my mom was in the hospital, people would just stop by and say I’m praying for her. Sisters will say that, the peons in the office, and it’s just natural. They’re not faking it. And there is a beauty in that. It’s hard for me, because I’m always, like you said, questioning everything. I wish I had that.

AV: As a physician, when a patient has a serious illness, and has a strong faith, my sense is that they have a better support system for what lies ahead. And oftentimes, it is unimaginable how much they can draw on that. To face whatever it is, be chemo or even the prospect of immediate death. So it’s powerful for them, something that I’ve always thought is beneficial when you have it, but it’s certainly not the doctor’s role to try and impose it on you.

ANB: I thought it was interesting how Digby as a Catholic Scott, who couldn’t fully live his life in Scotland, had to gain surgical knowledge by joining the Indian Medical Service. Does that kind of reflect your medical path in the US?

AV: I hadn’t thought about that in that fashion. I think it was true of the time.  So there were many young physician types from the UK who joined the Indian Medical Service in part because doors were closed for them in the UK, but also because this was a great opportunity for them to really build skills. You know, the parallel with my experience in the US is slightly different, but I think it is very relevant to your readers. 

Every year, thousands of physicians from abroad come to America and they come only because there’s a need for that annual influx. All the residency programs in inner city hospitals would simply not survive because America has found this very cost effective way to provide good care to indigent patients through training programs, in county hospitals, especially inner city county hospitals. But you enter at the second level. This is the only place you can apply to,  you really can’t be applying to anywhere else. And if you make your way to some other elite institution, it’ll be down the road, after paying your dues.  It is more level after you specialize but it never entirely goes away. So that the average American patient has no idea why there are so many foreign physicians, but it’s like anything else in America –  if America has a need, people around the world provide whether it’s basketball players or corn detasslers. Whatever you need, gig workers or IT workers, the world provides. And so in that sense, I think there are some parallels with Digby.

ANB: Your book takes us on a journey of great change in Kerala for over three generations. And you allude to some of the changes that are not so good, like opium and toddy. But talk a little bit more about communism. Why do you think communism took such a stronghold in Kerala? The same oppression of the lower caste happened all across the country, but especially also the states around it. But what is in the psyche of a Malayali that you think that is different –  that they took to communism with such fervor?

AV: Not just Kerala but in Bengal too.  I think it’s clearly related, not just to the experience of oppression, which was universal, but to literacy.  So how much you could have people who are put down, but who could also find ways for their suffering to be articulated by others that they could then read and identify with.  

It’s amazing, communism in Kerala, often was based on a document by Stalin and only because that was the one thing translated into Malayalam and copied repeatedly and in every jail. So they would say, he went into jail as a drunkard, and he came out a communist. I really think literacy had a great deal to do with it. And the fact that there were intellectuals of the upper class who really empathized with the downtrodden, and made it a point to bring that literature to the people whom it affected. That was very, very important I think.

ANB: What is your allegory for the title of the book? I have many theories, including the geography of Kerala. But I’m curious why you chose the title. To me it’s an ode to Christianity and your faith. The day it hit me the most (but I saw it in many places) is the day Ammachi dies, and she has a bath before bed. And she talks about this water that is your covenant with you, with your soil, your life.

“This water that is our covenant with You, with this soil, with the life You granted us.”

It comes through in so many ways, the title of your book throughout the story, but did you have a central theme? Did you come up with the name of the book afterward?

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AV: It was afterward. I had a working title before that. I think that I have always believed the title should be a bit mysterious. And the author doesn’t necessarily have an explanation. So I think my theory is that writing in general is that the writer provides the words the reader provides their imagination. Somewhere in the middle space in the reader’s head is this unique, fictional mental movie happening. And that movie is very different from one reader to another  – each one has their own movie. This is why when you go to the movie version of the book, then you’re always disappointed because of what you had in mind.  But for the same reason, I think titles can echo in different ways for different readers.

I actually wasn’t thinking formally of Christianity when I use the word covenant because it’s very much of an Old Testament term. It’s very much in the Jewish journey. And that element of water either renewing and baptizing in water is true of Christianity, but it’s also true of many other religions –  you wash your feet before you go in.

A one-level covenant also represented this family’s covenant to keep this secret. So there were levels and levels of what the covenant could have meant, and I think the reader can take their pick, I don’t have the key.

ANB: Later in the book, when Mariama goes to college and Ammachi says to her, “I’m always with you, even when I’m long gone, you carry my name.” This made me stop and think because we all have a culture of naming our children after our ancestors, and I always thought of it as a kind of vanity and in many cases, patriarchy. But now when I read that, I thought, maybe it’s got to do with blessings –  that you then carry the blessings of your grandparents or great-grandparents. What do you think about it?

AV: It’s interesting – until you said that I never quite thought of it that way. You know, I thought it’s vanity as well or tradition. I carry my grandfather’s name. And, I never thought about this but, in a way, it’s a very symbolic way of carrying this legacy forward. I never thought about that. 

I’ve been sent a master’s thesis by people on my previous book, Cutting For Stone on what my theme was, what my politics were, and I always think, wow, if only I had that kind of vision. But it’s not incorrect. I don’t ever argue with that because if the reader took away that, then that’s true for them. It’s not for me to say that it is not there.

My goal is always very simple, a good story, well told and everything else that happens in the process is a byproduct of that. If I’m trying to push forward a political theme, then it becomes a polemic. It becomes too much expository writing and you lose the reader.

ANB: Why did you bring the elephant Damodaran into the story? What was your thought behind his coming and going throughout the storyline? It was interesting to me because elephants are amazing mothers but you made Damodaran a male elephant, connected to both Ammachi and her husband. 

AV: It was such an integral part of my childhood to see them, they are such striking creatures, and I always thought that they had very human qualities, especially in the eye. The eye was so beautiful and rich and gentle. And they seem to be slowed-down humans, and the ubiquity of the god image of Ganesha. So it felt like a very real character to me, and I just liked the idea of running with it to the point where he has this major role in the family.

Actually, I’m trying but I don’t insist the reader see this – to have Big Ammachi think that her husband has now occupied the elephant in a way, especially in the way the elephant acts with Philipose, the next generation.

ANB: When Mariamma started Medical College in 1968, a third of her class was women, which was normal in India, but unheard of in the United States at that time. Even when I came to college here in the 80s to study engineering, there were more women going to study engineering in India than here. Do you have any thoughts on that? I think of your mother who went by herself to Ethiopia in the late 40s – think of her courage.

AV: I think it’s because unless the parents held them back, the opportunities were the same for men and women in the professions and the education also helped that certain medical schools like Vellore (CMC) were all women. It was only a women’s medical school and then it began to let in men.I am not sure why that was. I think it’s also because there was a time when Obstetricians and Gynecologists had to be women, so there was more of a sense of the importance of that. But it is puzzling. In fact, my editors pushed back here saying, that many women in that era, is that right? I said that’s absolutely right.

ANB: In the end of the story, when the truth comes out, and they say “the great lie that tells the truth is revealed.” “And what defines a family is not blood, but secrets.”  Do you think this is the genesis of any good story?

AV: Possibly, I call it a secret other people can call the conflict and resolution. I do think you really can’t have a story where nothing’s happening. There’s always something at stake, something to be revealed, something to be obtained. 

But to me, secrets were a particularly potent thing in the life of that community because arranged marriages are such that the slightest thing that taints the girls’ or boys’ reputation, usually more the girl than the boy is enough to change your whole fortune. I think that once I latched on to the idea of this being a secret, and then then I began to expand on that.

ANB: The book is over 700 pages long and is already topping bestseller lists. In this day and age when everybody, even people our age have such a low attention span, what do you think captivates the human spirit for the love of good storytelling? And what does it mean for content creators when everybody’s trying to break the thirty-second capture dilemma? 

AV: Honestly, I was worried because it’s a big concern for publishers and for booksellers – the amount of space that it occupies and the price of the book. But I had a brilliant editor, Peter Blackstock, who also edited Shuggy Bain and Sympathizer. At one point, he said, a book needs to be as long as it needs to be. And we never discussed length, we were only talking about the story. 

I find it very gratifying to see the way the book is being picked up. I hope this means that the pendulum is swinging back, because I think, as a nation with a short attention span, it’s really worrying. The most satisfying feedback I’ve been getting from strangers is –  I looked ahead to see how many pages I had left. And I was disappointed that I only had 200 pages left then in other words, they wanted it to continue, you know. So if it’s a good story, that length shouldn’t matter. And if you find yourself trying to read to finish, then you know, something’s missing there. 

A sold-out crowd waits to hear Abraham Verghese speak about his new book, The Covenant of Water, at Kepler’s in Menlo Park, Calif. on June 1, 2023. Photo: Sree Sripathy for India Currents/CatchLight Local.

Anjana Nagarajan-Butaney is the Donor Engagement Advisor at India Currents and Founder/Producer at She brings her passion for community journalism and experience in fundraising, having...