Abraham Verghese works on a grand scale. At over seven hundred pages, The Covenant of Water deserves the word epic for its reach, ambition and the number of characters and plotlines it weaves together. This is not a novel for the faint-hearted. It requires concentration, memory, stoicism in the face of blood and guts, and trust that the author’s demands on the reader will be repaid. Mercifully, by its conclusion it exemplifies a quote from the opening chapter: ‘faith is to know the pattern is there, even though none is visible’.

Set in the southern Indian state of Kerala, and running from 1900 to 1977, the novel is strung on a single theme. The family at its heart suffers from a long history of drowning, even if it’s only in a puddle. Barely talked about, this predisposition is known as The Condition. When the central character, Mariamma, who marries into the family, first learns about it in the most devastating of ways, she calls on God to cure it, or ‘send us someone who can’. What follows is the slow, infinitely complicated working out of that plea.

In this part of India there is no shortage of water to drown in. As Verghese writes, ‘Push a spade into the soil anywhere in Kerala and rust-tinged water wells up like blood under a scalpel.’ The old house on the estate at Parambil, around which the story