It's been 14 years since Abraham Verghese's last novel, the best-selling Children of the Wide World (Salamandra), but don't take that into account for its author. After all, in addition to writing ambitious literary sagas, he is also a doctor, researcher, vice dean at the Stanford School of Medicine, and in his spare time he hosts a successful podcast. Born in Ethiopia in 1968, the son of Indian migrants, and raised in the United States, in his latest novel, The Water Pact dares for the first time to set a story in the country of his ancestors, India, a multigenerational panorama that covers 70 years of the country's history and which is anchored by a fundamental character, Big Ammachi or Mariamma, whom the reader encounters as a young 12-year-old bride who is married to a 40-year-old widower.
A critic once reproached Verghese for saying that everyone in his novels was good. It's because, he says, as much as he's observed after four decades practicing medicine, people, even when they make catastrophic mistakes, do so with the best of intentions. Oprah Winfrey fell so much in love with this novel that she dedicated not one but two special programs to it and she bought the rights for the audiovisual adaptation, which will surely arrive in series form. Two hours are not enough to cover a broad and extensive story that includes a writer and two doctors.
I have to tell you that I am impressed to interview someone who has spent more than two hours being interviewed by Oprah Winfrey.
My publisher in the United States knew that since it was an Oprah book club pick, they had to print more copies, but they weren't counting on her enthusiasm for the book. I mean, she's really gotten involved. Ela bought a lot of copies and gave them away on the beach. When we went on sale, people wanted it and there weren't enough of it. We had to run to print more. There was a crisis! She is a very warm and open person and has spoken to the most relevant people in the world, so being around her is like receiving part of that wisdom.
Did you have to reach a certain point of experience in life to write a story like that?
When I finished my previous book, I thought I had put it all in there. And it took at least a couple of years until I could start thinking about something else. So it actually took me about ten. Before I resisted the notion that my novels are autobiographical, and they are not, but in the end you have accumulated philias and phobias and everything comes out. This one is special for me. There was a review in the New York Times, which wasn't bad, but it also threw some barbs at me. One of them was that all my characters are good people, that there were no evil ones. I think this is due to my belief that people mean well. We make terrible mistakes, but we spend a lot of time trying to redeem them. No one thinks of themselves as a bad person. We are human beings trying to live our lives. In my novel, the character Philipose [Big Ammachi's son, a writer by profession] makes a fatal mistake with his wife and his son and spends the rest of his life trying to redeem himself.
It is the first time that you have set a novel in India, which is the country of your parents and your ancestors but not entirely yours. Did you have to give yourself permission to do it?
It was delicate for many Indians, who may think: what does this guy know? The truth is that I spent all my childhood summers there with my grandparents, in Kerala. And that's where a lot of my observations come from. I also went when I was studying Medicine. So it's not a foreign country for me. But, yes, I had to give myself permission and feel safe, feel like I had the right to tell this story. Some Indian journalists get a little touchy when they interview me. They ask me: did you introduce white characters to satisfy the Western reader? Well, if I write about a period from 1900 to 1970, we were largely governed by white people and all the medical service and medical schools were run by white people, so how could I not? And, on the other hand, who is the Western reader? Those same journalists who ask me surely think in English. It is the legacy of British influence, of long colonization. One important thing for me when setting the novel in Kerala was the static nature of my grandparents' village. I returned every year and hardly anything changed. But even if nothing changed, they had experienced famines, two wars, all kinds of dramatic historical situations. I liked the idea of this town as a setting for History.
In those summers you spent with your grandparents, do you remember feeling that the river, the water, was a threat? In the novel it is. In every generation a drowning occurs.
I remember feeling a lot of respect for the river. And one time the boat my grandmother was on capsized. And she was already about 70 years old and she clung to the boat. Surely that was in my subconscious, yes. I know many people who drowned by suicide or by accident. Also, in Kerala every house had a well and there is something fascinating about wells. There were some well cleaners who came once a month or so and they fascinated me.
It comes from a long tradition of writers who are also doctors, such as Somerset Maugham or Chekhov. What has medicine contributed to your books? And, conversely, has being a writer made you a better doctor?
It is true that there is that tradition but there are not as many of us as we should, if you compare, for example, with lawyers or journalists. We doctors have a great desire to explain what we have seen, we are in a privileged place, seeing life in its most serious and dramatic moments before us. And you can barely talk to anyone about it, because of confidentiality or because they won't understand you. So it's a very lonely profession. And from there you can become cynical and close off your emotions, which is not very common, or you are left with the desire to process them. I am fortunate to have found in writing a way to address many of the things that are important to me in medicine and in life. This practice of observing human beings, examining them and reading the body as if it were a text, looking for clues and putting them together to put together a story helps when writing. There is a phrase I heard both in medical school and at the Iowa writing workshop: God is in the details. Often phrased the other way, the devil is in the details. I heard it as “god” and it is certainly relevant in both fields.
Did you take the famous writing workshop at the University of Iowa while you were studying medicine?
No no. When I was studying I had no intention of being a writer. It was later, in my thirties. I was a specialist in infectious diseases and that was when we started to see the first cases of AIDS. I moved from Boston to a small town in Tennessee. The gene told me: you won't have AIDS patients there, this is an urban disease. But it was the opposite. I was seeing a minimum of a hundred patients a year in this city of 50,000 people. What happened is that many young gay men had left for the big cities because they didn't want to live under the scrutiny of their families. But when the virus found them, many returned home. I wrote a scientific paper describing this virus migration phenomenon and it received a lot of attention because it was happening everywhere. But I found that the language of science did not even begin to capture the tragic nature of this journey. I felt very close to them, they were my friends. And I decided to write the story. I applied to the Iowa writing program and got in. I left my secure position at the University, collected my pension money, which was very little, and dragged my wife and two young children to Iowa for two semesters. To earn some money, I worked on emergency duty. But I went there to write, that became a story that The New Yorker published and then my first book.
Accidental deaths run through 'The Water Pact'. Do you think that your practice as a doctor has made you understand death differently?
I have to say that every time I went back to those scenes I started crying, as if they were real people. I am not introducing death for entertainment. It is also true that if I write about that broad period of time, from 1900 to 1970, there was a higher mortality. Both of my grandmothers were an inspiration for the character of Ammachi. One of them lost a son at the age of 12 to typhoid fever, her only child. My father remembers his older brother, who was attacked by a dog with rabies, and there was nothing to do. Those people knew tragedy. As a doctor, I see that many people are now in denial about the suffering and mortality around us and only become aware of it when a shock hits them. But if you work in a hospital you see death up close every day, you are in contact with it.
Did you receive that revelation when you started working as a doctor?
In the time of AIDS, yes. All those men I saw dying were my age. And some of them had done so many things in life already, in terms of traveling, experimenting, learning about art, music. And that also pushed me to discard the job security that I had then, with my permanent place at the University, to dedicate myself to writing. I got the message that what makes life good is that it is short. Not short, but not infinite. What makes a rose beautiful is that it blooms and then withers.
Does the current opioid crisis in the United States remind you of those early years of HIV?
My second book, The Tennis Partner, was about drug addiction among doctors and it's funny how many people are coming back to it now because it's happening with fentanyl too, which is reaching the suburbs. And that's why the opioid crisis is getting so much media attention now, because it's reaching privileged targets, but it's a long-standing problem. But I don't see much of a relationship with HIV because it is not an exogenous virus, it is a drug control problem.
Returning to the book, the story begins with the wedding of Ammachi, a 12-year-old girl who is married to a 40-year-old man. In the eyes of many of its readers that is an aberration but surely someone like her mother did not see it that way. Did you have to do an exercise in cultural relativization to write that character?
Exact. Both of my grandmothers got married when they were ten or eleven years old, but other ten-year-olds got married. Essentially, they were alliances of families, like those of royalty in Europe. They got married and became girls of the other house. The most common thing is that they established a closer relationship with their mothers-in-law than with their own mothers. That's why at Indian weddings there is a moment of sadness when the bride goes home. I have been to many of my cousins' weddings and it always happens like this. It's like leaving your country when you leave your home. What happened in this type of union is that the mother-in-law supervised everything and they were not consummated until they were about 16 years old. My great-grandmother's story was similar to Ammachi's. She married a widower who had a couple of children. On the surface you can't imagine that it would turn out well, but apparently it was a very productive and humorous marriage. She had many more children and they all got along well. What is perhaps not so obvious is that they were not coerced. People accepted the judgment of her parents.
The Indian culture of 'matchmaking', of arranged marriages, is still being done.
Sure, absolutely. I know many highly qualified professionals who reach a point in their life where their dating is going nowhere and they know that their parents are going to find them someone who will be compatible and they will be able to form a suitable marriage. Many of these marriages work very well, because what goes along with it is commitment. They commit to them. At its core, Tinder is the modern version of arranged marriages.
In the sense that there are a series of objective criteria that people take into account: tastes, location, age group...?
Now, you could meet a girl on the app, go to a barbecue and watch a movie, and after three dates you have to say whether this is going ahead or not. In my parents' time it was also like that. It was a limited time so as not to ruin the girl's reputation. It was rare for you to marry someone you had either never met or someone your family didn't know. You went to have tea and the parents decided, it was a sacred thing. I don't know, it's a mystery to me. It's hard for me to conceive, but I've also been married and divorced, so I don't know if I did better by choosing my own wife. I should have left it to my parents anyway.
You who have lived between three continents, and with dozens of moves, often say that you are somewhat envious of people who are clear about where they mean when they say “home”, who belong to the same place as their ancestors.
There is some envy, yes. It must be nice to return to your town and know that several generations of your family have lived there. But I have also begun to appreciate that those circumstances in my life have given me the permanent perspective of the outsider looking from the outside, which is pretty good for a writer. One of my fiction books is set in Tennessee, another in El Paso, Texas. I have written a novel set in Ethiopia and now finally in India and the most gratifying thing I have heard in all of those cases is: “You know? “I lived there all my life and I had never seen it like that.” It gives you the power to appreciate things that locals don't see.
