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'The Covenant of Water' is the story of an Indian family haunted by a medical mystery

ARI SHAPIRO, BYLINE: Abraham Verghese is a physician and an author whose books always reflect some part of his life. His new novel is called "The Covenant Of Water." It's his first in more than a decade since the bestseller "Cutting For Stone" in 2009. "The Covenant Of Water" is dedicated to Mariamma, his mother.

ABRAHAM VERGHESE: When she was in her 70s, my niece, who is her namesake, asked her - Ammachi, what was it like when you were a little girl? And my mother was so taken by that question that she wrote, longhand, in her wonderful penmanship, a hundred-page document, you know, with tales of our relatives and stuff we'd all heard as children growing up - much embellished, of course.

SHAPIRO: That record of generations inspired him. This book is also about the lineage of one family.

VERGHESE: And about a secret that goes back many generations, which is that members of the family, going back every generation, have drowned - drowned in the most unusual places - shallow puddles, lagoons, lakes - in a land where everybody swims.

SHAPIRO: That land is at the southern tip of India, where Verghese's own family originated. The novel revolves around that unusual drowning condition - a medical mystery that unfolds alongside dramatic changes in technology and politics over nearly a century. Early in the epic, Verghese offers a sort of roadmap for the story that's about to unfold. Here he is reading from the book.

VERGHESE: (Reading) The grandmother is certain of a few things. A tale that leaves its imprint on a listener tells the truth about how the world lives. And so unavoidably, it is about families - their victories and wounds and their departed, including the ghosts who linger. It must offer instructions for living in God's realm, where joy never spares one from sorrow. A good story goes beyond what a forgiving God cares to do. It reconciles families and unburden them of secrets whose bond is stronger than blood. But in their revealing, as in their keeping, secrets can tear a family apart.

SHAPIRO: That paragraph almost feels like a mission statement for this book. And some 700 pages later, you can check off almost every phrase of that paragraph as foreshadowing something that happens in the plot. So tell me your rules for what makes a good story. Does it line up with what we hear in that paragraph?

VERGHESE: Yes, I think that - I mean, not to say that I knew the story entirely going in, so it was very much a process of discovery, but the principles to me remain the same - that stories must offer instructions for living, if you like. Stories must speak to a kind of truth, and they only resonate if they do that - if they echo with our own challenges, our own lives and the things that we should have done or could have done - the regrets we have and the things that we now know we should do. So I think novels are always a form of atonement, and they're also a form of instruction.

SHAPIRO: I've heard other novelists express similar sentiments, but none who are themselves a full-time doctor or medical school professor. You work full time as a doctor. You're on faculty at Stanford Medical School. And every book you've written, both fiction and nonfiction, including this one, have dealt with medical themes. Is there something that writing helps you process or understand or perceive in your day job, or vice versa?

VERGHESE: Yeah, I think the medicine and the writing sort of play off each other. You know, what I find is that the writing helps me to process and digest some of the things that are most troublesome that I witness at work, so it's a method of - as Richard Selzer, one of the original doctor writers, used to say, it's a way of taking the world in for repairs.

Conversely, I think that the craft and discipline of writing has helped me sort of pay more attention and perhaps make more of people's stories. And these days, as a consulting physician, it's rare - when knowledge is so easily accessible, it's rare that I come to the bedside and make a magical diagnosis when my juniors don't. If I contribute anything, it's very often because I'm listening to the story in a different way. I have a larger repertoire of stories to match this patient's story with, and it might lead me to ask more questions. So that is sort of the wealth I bring - is a wealth of story that helps me recognize this particular story.

SHAPIRO: I'm imagining here, but it seems to me working in a hospital, particularly through HIV and through COVID, so much must seem arbitrary and meaningless and incomprehensible. And when you write a novel, particularly with medical themes, nothing is arbitrary. Nothing is meaningless. Everything is there for a reason. And I wonder if that helps provide some kind of order to the chaos of real life.

VERGHESE: Yeah, I think that that's very true. I think that novels allow me some sort of control in a life where I have very little control. So at least this world, to some degree - not completely - I say to some degree because there is a point where my characters almost dictate what's going to come next in the...

SHAPIRO: They take control of the story.

VERGHESE: They take control of the story. Or at least they tell you, this thing you planned - there's no way I would do it. Get out of here, you know?


SHAPIRO: That must be frustrating as an author.

VERGHESE: No, it's actually delightful. It's the moment that you know you've struck the truth. You've hit the gold mine with this particular character.

SHAPIRO: Yeah. There's one moment late in the book where a character who is a doctor is looking at a brain that is going to be dissected, and the brain belongs to a member of her family. I'm being vague here so I don't give away plot details. And you write that it looks like any other brain, but it isn't. It holds his unique memories, his stories, his love for his family. As a doctor, do you struggle with bridging that divide between the mechanical elements of a body and the unknowable whole of a person?

VERGHESE: Absolutely. I think it's sort of the daily struggle. You know, in a sense, we, as physicians, are acutely aware of mortality. We're surrounded by it. And whereas I think the rest of the world might live in denial of that, we are acutely aware of it, and yet we also have to practice our own form of denial in order to go on. We can't let our empathy get so overwhelming that we stop making good decisions. So you practice a sort of distancing. But in the dark of the night, in your own home, often, that all just falls away, and you're deeply affected by the thing you just saw. And that's where I think the writing helps to make sense of that - to process that, you know?

Life is a terminal condition, as John Irving says in "The World According To Garp." And, you know, if there's one commonality between life and this novel is that, you know, life ends, and that gives life a particular poignancy. I mean, roses would be weeds if they lived forever. What makes a rose beautiful is that it blooms, and then it's gone.

SHAPIRO: Abraham Verghese new novel is called "The Covenant Of Water." Thank you so much for talking with us about it.

VERGHESE: It's my honor. Thank you so much for having me.

(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.

Ari Shapiro has been one of the hosts of All Things Considered, NPR's award-winning afternoon newsmagazine, since 2015. During his first two years on the program, listenership to All Things Considered grew at an unprecedented rate, with more people tuning in during a typical quarter-hour than any other program on the radio.