This is a monumental and original family saga that is like nothing I have ever read. It is richly imaginative and packs an emotional wallop.

Taking place in Kerala, a state in South India on the Malabar Coast, it spans nearly 80 years and is brutally realistic. This isn't a sweetsie-lovey story. It's about life. Real life. And it hurts the reader sometimes! Children die, loved ones die by suicide, people are killed in somewhat brutal and violent ways, and several suffer debilitating injuries. It's a tough read because I was emotionally connected with the characters and then wham! They die or suffer. But that is the ultimate premise of this book: Finding the meaning in suffering.

Magnificently written by physician and bestselling author Abraham Verghese, this epic multigenerational novel begins in 1900 and ends in 1977, centering on the character of Big Ammachi. She is 12 years old when her father dies, leaving her mother destitute. In a desperate move, this little girl is hurriedly married off to a 40-year-old widower and father of a 2-year-old boy, who lives Kerala, a long day's journey away. She is nicknamed Big Ammachi (Big Mother) by Jojo, the little boy, and the name sticks as she grows up to become the matriarch of a large family living on the 500-acre estate of Parambil. As she soon discovers, this family has a curse, "the Condition," as they call it, that takes the life of someone every generation.

In addition, there are parallel stories that at first are seemingly unrelated. The most intriguing one is that of Digby Kilgour, a surgeon from Glasgow, Scotland, who joins the Indian Medical Service in Madras. His is also a story of joy and tragedy that eventually—surprisingly and explosively—connects with the family in Parambil, although it is a long and circuitous journey to that end.

In addition to a compelling, ever-evolving, and multilayered plot inhabited by bold and vivid characters, this is a profound work of literature that speaks eloquently and poignantly about one family's place on Earth—how they love, how they argue, how they do good, how they do evil, how they worship God, and how they make the world a better place by just inhabiting it. As you can probably tell from the title, the imagery and symbolism of water and specifically how the covenant of water links all human beings is brilliant.

This is also a love letter to medicine—to dedicated physicians, to the scientists who make the medical discoveries, to the hardworking nurses, and especially to all those who give their life to care for the sick.

Bonus: Even though it's told only in words, you'll get a tour of South India that is so vibrant and so realistic that when I Googled photos of the area, it appeared very much like it did in my imagination. The land is so much a part of the novel that it is almost a character of its own. This is truly a magical place with beautiful beaches, elaborate canals, and picturesque mountains filled with monkeys, elephants, snakes, birds, and tigers.

Two pieces of advice to make reading this 700 page book easier:
• There are dozens of characters in this novel, and even the Kindle X-ray feature is not that helpful. Go to the author's website and download the character list. Print it if you're reading the paper version of the book. If you're reading it on Kindle, I advise you to use the "send to Kindle" feature. I had this document right next to the book, so it was easy to search for or find the character. It doesn't take long before you'll know who everyone is.

• There are quite a few words in the novel in Malayalam, the official language of Kerala. In most cases, it's easy to figure out the meaning based on the context of the sentence, but I kept my phone nearby so I could Google words I couldn't decipher.

One of the best, if not THE best book I've ever read.

Outstanding in bringing a diverse set of characters together.

This is, in a word, fabulous. How can I adequately review THE COVENANT OF WATER to convey just how fabulous it is? This book is lovely from beginning to end. It's a big one, but, honestly, you'll wish Abraham Verghese had made it longer.

THE COVENANT OF WATER is mostly about a certain family in India, from the time a 12-year-old girl is made to marry a man in his 40s. He turns out to be a good and kind man, but he has a physical "condition" that runs in his family. This condition is real, by the way, and has a real name, but it is a mystery throughout this story.

THE COVENANT OF WATER also has another main character, a man from Scotland who comes to India to practice medicine. His story is dramatic, but after a time Verghese seems to forget about him. Don't worry (as I did), he'll be back.

If you have been wondering what Verghese has been doing in the years since CUTTING FOR STONE, here it is, one of the best books you'll ever read (along with CUTTING FOR STONE, probably).

"The Covenant of Water" is a story about love, loss, family, marriage, children, parenting, aging, living, illness, dignity, secrets and fears, the value of the home, dreams, death, complex relationships, and struggles with the demands of loyalty. It is a fierce and tender combination that takes the reader on a long, difficult journey that is occasionally heartbreaking and upsetting.
I can relate to this book because I have experienced tough times and sometimes I give up.
Because reading Verghese's scholastic prose was frequently just too taxing.
For me, it appeared as though two things were occurring at once the characters' forward motion and information to 'learn' about the descriptions that have been included in the plot/plots themselves.

This is a uniquely written generational saga and I enjoyed every page turned!

This book captivated me from the first few pages. I love to read foreign stories and learn about the history, customs and traditions.

This enthralling epic was worth the decade plus wait since Cutting for Stone. As a doctor - I enjoyed the clinical color- and medical accuracy- when the characters have recognizable illnesses whose diagnoses rely on the history and the physical findings rather than sophisticated technology. Medical students will learn about the sequelae of leprosy in the pre-antibiotic era, the clinical presentations of goiter, cretinism, typhoid fever, obstetrical complications, maternal hemorrhage, domestic violence and even the consequences of medical error-but never in a pedantic way/ the reader won’t feel like they’re being instructed. True also for students of history interested how Madras was impacted by colonialism, then WWII, and later how communism offered a violent path to disrupt casteism and oppressive social hierarchies is Southern India.

I strongly recommend the audio version of this book, read by the author himself, who displays not only acting talent, but facility with a wide array of accents: from Kerala, to Glasgow, to Corpus Christi, Texas. And through it all we see the truth of our shared humanity: our tragic defects and flaws as well as the forgiveness- the majestic creativity and spiritual resilience that allow us to survive the struggle, to repair ourselves and to find meaning in our existence.