The NephJC Summer Book Club celebrates a decade.
Every summer at the NephJC world headquarters we like to slow down and read something a bit longer than a scientific manuscript. And every summer it is the least attended chat of the year.
This summer for the first time we are reading something much longer than a manuscript. This summer for the first time we are reading fiction, the big lie that tells the truth. This summer we read Abraham Verghese’s The Covenant of Water.
Join us on Twitter, August 20 at 9 pm to discuss this book. Hashtag #NephJC
What a tale. Covenant is a multi-generational, multi-continental, sprawling novel about family, secrets, love, frailty, faith, and drowning.
I hoped, when I started listening to the book, that the water in the title would make it a good connection to nephrology…not so much, besides some edema and an episode of eclampsia, there is little nephrology in the medicine. But the book rises above this obvious and avoidable handicap to be a truly wonderful and meaningful text.
The New York Time Book Review takes it shots at Covenant in a fairly harsh review.
First impression, it is quite long. 724-pages, 10-parts, and 84-chapters long. 31 hours and 16 minutes by audiobook. Verghese starts the story at the beginning of the 20th century and carries it over three generations into the 1970s. Verghese is an infectious disease physician and professor of medicine at Stanford. The story has a steady drum beat of medical drama and anecdotes that drew me in and I think will allow NephJC participants to find common interest in the story, especially the anecdote about the use of human urine to make ink.
Despite the lack of nephrology, the medicine is fascinating. I delighted in seeing diseases that in my world only exist in textbooks come to life as the formidable giants they were for the characters in the early twentieth century. Congenital iodine deficiency syndrome, formerly cretinism, was the subject of a question or two on my pediatric boards, but I never saw a case. Baby Mol, an important character, suffers from this (though it is unclear how much suffering she actually goes through). Likewise, I have never seen a case of leprosy. Only 200 cases a year are reported in the United States. Globally, the leprosy burden has plummeted from 5.2 million cases in the 1980s to fewer than 200,000 in 2020. Leprosariums, a key setting in the book, are closing around the world. Verghese does a wonderful job illustrating the medical, social, and psychological aspects of Hansen’s disease without falling into a dull lecture.
Much of the medicine is during the pre-antibiotic error, and physicians repeatedly express frustration with limited therapeutic options available to them. In multiple scenes a doctor is able to diagnose and label a condition without having the tools to intervene or change its natural history. This is a frustration that every doctor is familiar with and every doctor hopes that following generations will see less and less.
There is a fair amount of surgery in the book, which make sense as surgery advanced dramatically in the 1900s before pharmaceutical success emerged in the later half of the century. And obstetric medicine, unsurprisingly, makes repeated appearances in a book about women and families.
The central mystery of the book, as described in the publisher’s summary:
Spanning the years 1900 to 1977, The Covenant of Water is set in Kerala, on South India’s Malabar Coast, and follows three generations of a family that suffers a peculiar affliction: in every generation, at least one person dies by drowning—and in Kerala, water is everywhere. At the turn of the century, a twelve-year-old girl from Kerala’s long-existing Christian community, grieving the death of her father, is sent by boat to her wedding, where she will meet her forty-year-old husband for the first time. From this unforgettable new beginning, the young girl—and future matriarch, known as Big Ammachi—will witness unthinkable changes over the span of her extraordinary life, full of joy and triumph as well as hardship and loss, her faith and love the only constants.
This peculiar affliction is explained in the third act by our final hero, a woman who leaves the small village of Parambil, for Madras Medical College. The explanation is not obvious but is satisfying and logical. Just as with the general surgery and leprosy, Verghese lovingly describes the medicine with enough detail to engage and intrigue the reader.
At the beginning of the book, you feel like there has been little change in the way life has been for generations. That the end of the nineteenth century represents the last time that children’s lives would reliably mimic the lives of their forebears. Through out the twentieth century, using the eyes of Verghese’s characters we see World Wars, motor cars, electricity, radio, de-colonization, and democracy enter the increasingly populated and increasingly connected town of Parambil so that the lives of the children become unrecognizable from that of their grandparents. The constant change and revolution is a dramatic setting that reminded me that our constantly changing world is not new, but has been convulsing for over a hundred years.
And interweaved in the plot are gorgeous observations and perfect prose. a few readers have been trading their favorite passages on Twitter.
The book is big and it will be difficult to wrestle it into a 1 hour chat, but I hope to see a few of you to discuss a book I will never forget
—Joel
Previous Book Clubs
