In the 1980s, through the devastation of AIDS, Abraham Verghese was working as a doctor in rural Tennessee. Burned-out, he cashed everything in to take a sabbatical and attend the Iowa Writers’ Workshop. He left in 1991 with an MFA and an agent.

Verghese would go on to publish his first book in 1994, My Own Country: A Doctor’s Story, an account of those years in Tennessee. Today he lives in California, where he’s a professor and practicing physician at Stanford with a fourth book and second novel, The Covenant of Water, publishing with Grove Press in May.

Covenant covers the same themes—history, medicine, culture, family—as Verghese’s bestselling 2009 debut novel, Cutting for Stone, which followed twin brothers born in Ethiopia. But Covenant is the story of India’s modernization from 1900 to the 1970s, told through the experiences of three generations of a family from the insular Christian community of Kerala.

Kerala, on India’s Malabar Coast, is where, according to legend, St. Thomas arrived in 52 CE. When Portuguese explorer Vasco da Gama landed on that same coast 1,400 years later—“to bring Christ’s love to the heathens,” Verghese writes—the Christian community there was well established, committed to its faith and customs.

Verghese tells me he was looking for a topic when his niece asked his mother, then in her 70s, about her life as a young girl. “My mother was a great storyteller to me and my brothers, and her response to my niece’s request was to write, in her elegant longhand, the story of her life, with anecdotes and illustrations,” he says. “This was the genesis. I spent holidays in Kerala as a young boy but didn’t much think about it.”

In Covenant, Verghese tells the story of a family in personal and historical detail, describing the strange family condition where at least one person in each generation dies by drowning. This, in a place where water is everywhere.

Born in Ethiopia to Indian parents who came from Kerala and were recruited by Ethiopian emperor Haile Selassie as teachers, Verghese was studying medicine when Selassie was deposed in 1974. Amid civil unrest, Verghese left the country and later completed his studies in Madras, India. “My medical life is a plus plus,” Verghese tells me. “I love medicine and identify as a physician. My writing emanates from this stance, to be with people in the difficult times of their lives. When I assume the doctor gaze, ideally I walk in another’s shoes. Similarly, it’s a privilege to be a writer. Doctoring and writing are parallel; they are both about the truth in people’s lives.”

His agent, Mary Evans of Mary Evans Inc., has been there from the beginning. “I’ve been in this business 50 years,” Evans says, “and I’ve read several versions of The Covenant. In the middle, there’s a character who dies, and every time that character dies, I cry—and I am not a crier. Abraham’s writing makes me feel there’s hope, that there’s still humanity in spite of poverty and propaganda. This book is so nutritious; it’s such an escape.”

Evans tells me the story of how she came to represent Verghese: the boyfriend of a friend was at Iowa, and when Evans was asked to read his work, she agreed, but not without trepidation. The boyfriend was Charles D’Ambrosio, and Evans wound up signing him on the basis of one story. It was, she says, “the first time I’d done that in my career.” D’Ambrosio then told her about Verghese. She read one of Verghese’s stories and immediately wanted to represent him as well. “Another first—I took on two writers based on one short story from each of them. And I sold both stories to the New Yorker!”

Verghese’s story “Lilacs,” about, Evans says, “a pissed-off biker who finds out he has AIDS,” appeared in the Oct. 6, 1991, issue of the New Yorker. “AIDS was new subject matter then,” she adds.

“Mary has just always been there,” Verghese says. He was moonlighting as a doctor while he was at Iowa, when “Mary picked up some workshopped stories, asked if she could send them to the New Yorker, and asked if she could represent me. There was no contract. I never even saw her for another two years.”

The Covenant was initially under contract with Scribner, but when it became evident, according to Evans, that the editorial vision didn’t match, she found herself “two weeks before Christmas 2021 with this book.” She asked her trusted scouts about editors, and Peter Blackstock’s name came up. “I had never submitted to Peter before,” she says. “It also went out to the usual suspects, and there were offers and options. It speaks to Abraham’s power that so many editors were ready to read an 800-page manuscript during the holidays.”

Ultimately, Evans worked out a deal with Blackstock that she calls “fair to everyone,” complimenting Grove as “this feisty independent publisher.”

Blackstock, Grove Atlantic’s deputy publisher, read The Covenant over a week. “Last year was quieter than this year, so I had the time to get into it—into this world,” he says. “It was extraordinary, so evocative of time and place and then the turns of plot.”

When Blackstock was reading, he made editorial notes, thinking that if he bought it, he’d have a head start, he says. “I was thankful that I did. We had a great Zoom, and I made the deal with Mary for North American rights.” Grove UK has U.K. and Commonwealth rights. To date, Evans has sold the book in 12 territories.

Cutting for Stone resonated with booksellers and readers. “It was a word-of-mouth success,” Blackstock says. “This is a similar book. And we have high hopes for a whole new generation of booksellers and readers. It’s a family story, a story of medicine, a story of the development of India. Publishers can be wary of long books, but when they are immersive, readers love them.” (Even so, the final draft was 50,000 words shorter than earlier iterations.)

Verghese is pleased with the book. “I wrote the bulk of the novel during Covid, and what we faced in the hospital made me think of the simplicity and faith of my grandmother’s life,” he says. “I remember her vividly. She had never been anywhere, but her life had meaning. I hope this book allows readers to see that even with much less we can have rich lives. Novels deliver instructions for living. They tell the great lie that tells the truth.”

Correction: An earlier version of this article mistakenly said that Verghese's daughter asked him about his mother; it was his niece who asked.