Dr. Abraham Verghese, the Stanford physician and bestselling novelist, says he felt a twinge of reluctance at first about setting his long-awaited second novel, “The Covenant of Water,” in Kerala, India.

“I didn’t grow up there, so I wasn’t steeped in it the way I was in Ethiopia,” where Verghese spent his childhood. But, as he recently shared over a video call from his campus office, “it was the land of my parents’ birth, and our lineage there goes back to the moment when St. Thomas supposedly converted us,” he said, referring to the apostle’s first century arrival on the Malabar Coast.

The lush strip of land along India’s southern tip, where a lattice of rivers and streams wind toward the sea, turned out to be the perfect setting, both geographically and metaphorically, for Verghese’s epic story about a family afflicted by a condition known as familial drowning, in which someone from every generation has drowned, reflecting a genetic abnormality that puts them in jeopardy when in water.

“Covenant,” out Tuesday, May 2, is a heartfelt, capacious work of fiction — 736 pages, spanning 70-plus years — about characters whose lives, loves and inevitable traumas become their own immersive narrative web connecting them to their pasts.

Just as he did in his blockbuster debut, “Cutting for Stone” (2009), Verghese writes about the lure of medicine as a calling and about surgical procedures with vivid attention to detail. One of the book’s third-generation characters, Mariamma, becomes a neurosurgeon to try to determine if her family’s mysterious affliction resides in the brain, rather than simply in fate.

In a wide-ranging conversation with The Chronicle, Verghese discussed how congruent his acute powers of observation as a doctor are with the craft of writing, and why he believes, he said, “to paraphrase Camus, that fiction is the great lie that tells the truth.”

The following conversation has been edited for clarity and length.

Q: Kerala, where towns are surrounded by waterways, is an extraordinary location for a family that lives with a fear of drowning. How did this idea come to you?

A:Over a long career, I’ve always been intrigued by a couple of rare conditions and this was one of them: familial drowning. It’s not very well known at all.

Q: So it’s a real medical condition?

A:Yes. I actually reference the medical papers in the acknowledgements, a kindred in Pennsylvania. I basically took that idea and ran with it, especially because the idea of people drowning in shallow water just seemed incredible.

Q: Was it helpful that since it’s such a bizarre and rare condition, it lends itself to neurological, psychological, even metaphysical explanations?

A:Yes. I have always been intrigued that so much of what we think we understand now is going to look silly in 100 years. Things we shove under the rug as being trivial or psychosomatic could turn out to have a biological basis. That’s the lovely thing about choosing the time period 1900 to 1977. You not only watch your family evolve, you watch medicine evolve.

Q: How much was your own family history an inspiration?

A:When my niece was 5 years old, she asked my mother, “What was it like when you were a little girl?” My mother was 70-something at the time, and she was intrigued by this question from an American-born child trying to imagine such a foreign world. So she began to write out this longhand manuscript describing what it was like, illustrated with her lovely sketches. When I saw that manuscript, it cemented for me the notion that I wanted to try to set a novel in her Kerala.

Q: The novel begins with Ammachi as a child bride, and we follow her until she’s an old woman. Did you know when you began writing how epic in sweep the novel would be?

A:I knew that it would be many generations, partly because one of the illustrations in my mother’s manuscript was a family tree. But I’m not one of those writers who knows the whole story. God, I wish I did. But I did do my best with this one to map it out, on a giant whiteboard in my living room.

Q: You write so vividly about medical procedures and surgeries, whether hand surgery or a complicated birth. Is there something about the practice of medicine that you want to convey through fiction?

A:As a reader myself, I’m fascinated by procedural stuff, whether it’s in a police station or it’s Tom Clancy writing about submarines. I think we’re all inherently intrigued by the technicalities of a profession, whichever it happens to be.

但由于YouTube,现在并不是那么难someone to look over a surgeon’s shoulder. So the challenge is, how do you take what is accessible and add another layer to make it interesting to the reader? I was trying to do that, and you need a good editor to tell you how much is too much.

Q:Do you feel like your writing has affected your work as a doctor, or vice versa?

A:They very much inform each other. I think I’ve taken my passion for astute observation and brought it to medicine, and vice versa.

My role in the hospital is never so mercenary as to be looking for material, but I’m always absorbing, and I don’t often have the time to analyze what I’m actually feeling. It’s only later, in the act of writing, that it comes out, and sometimes I didn’t even know something was there.

I had an interesting experience recording this audiobook. I began to see eerie connections and themes in the book that I swear I never planned. Where are they coming from? The subconscious? The muse? God knows.

Q: You completed “The Covenant of Water” during the first couple years of the COVID pandemic. Do you feel like it informed the book in some way?

A:In the sense that I was struck by how, in the midst of this acute tragedy and grave threat to life, there are certain commonalities from 1900 or 1952, across the century. The search for meaning, for sustenance, family love, support was very challenging in COVID because we couldn’t let family in. We couldn’t even reveal our faces to them. It really stirred me emotionally, and I think some of that made its way into the book.

As I was writing about drowning or a child’s death, I would literally weep as I wrote some of the scenes. That wasn’t just weeping for that character; I was weeping for the misery I was witnessing.

Q: Despite those incredibly painful scenes, I found the book hopeful. I took away a sense that people can restore one another, and that being a healer, as well as making art, can help with that process.

A:I think so, and I’m glad to hear that. I’m often worried that people think I’ve got this morbid fascination with death, but it’s not like that at all. It’s more that as physicians, we are much more aware of the fact that life is a terminal condition. This isn’t a dress rehearsal. We have one shot, and in the hospital I’m surrounded by people whose one shot has been taken away prematurely. If I write a lot about death, it’s because we need that acute reminder to live fully our days, to make sure that we did our best, because it’s so easily slashed away.

Jessica Zack is a freelance writer.