The following version of this book was used to create the guide: Verghese, Abraham. The Covenant of Water. Grove Atlantic, 2023.

Abraham Verghese's novel The Covenant of Water spans over 70 years and is set in Kerala, on India's Malabar Coast. Written from the third person omniscient point of view and in the present tense, this epic and sweeping narrative traces the lives and stories of three generations. For the sake of clarity, the following summary abides by a linear and streamlined mode of explanation.

When Big Ammachi is 12 years old, her uncle arranges her marriage to a wealthy man decades her senior. She leaves her home and her mother, marries him, and moves into her new home at the Parambil estate. Because this world is unfamiliar and her husband is distant, Big Ammachi comes to rely upon her stepson JoJo and her sister-in-law Thankamma for company. She often misses her home and worries about her mother, but knows she must adapt.

When Big Ammachi is 19, she gets pregnant and gives birth to a baby girl she names Baby Mol. Shortly thereafter, JoJo falls from a tree and drowns in an irrigation ditch. Afterwards, her husband reveals that his family has been cursed by the Condition. This is the name they have given to their family's history of drowning. When she sees the genealogy, Big Ammachi realizes that at least one person in each generation has died in this manner. Terrified that what happened to JoJo will happen to Baby Mol, she begins praying.

When Big Ammachi gives birth to her son Philipose, her husband is ill. Shortly before his death, he makes her promise that she will not imprison Philipose. He does not want him to live with the same fears and anxieties that he lived with as a boy. Although she is afraid for her son, Big Ammachi does her best to keep this promise. She makes her son swear never to go near water without the company of another.

Philipose tries to fulfill his promise to his mother. However, one day, he fears that he must disobey her. He is sitting by the water when he notices a boatman screaming frantically. Philipose boards the boat, discovering that the boatman's child is not breathing. The boatman begs for Philipose's help. Unsure what to do, Philipose rows him to the opposite shore, hoping to find medical attention there.

Philipose, the boatman, and the baby arrive at Saint Bridget's Leprosarium. A Scottish surgeon named Digby rushes to their aid. However, he informs Philipose that he will have to assist in the surgery. Digby was recently in a fire and suffered severe burns on his hands. He has had a surgery but is still recovering and thus cannot operate on the dying baby without help. Therefore, with Digby's guidance, Philipose performs the procedure and saves the child.

The next morning, Digby has a nearby landowner and friend named Chandy drive Philipose back to Parambil. Chandy's daughter Elsie, with whom Digby is also close, accompanies them. Philipose is immediately enamored with Elsie.

Years later, Philipose leaves home for college in Madras. Shortly after arriving, he realizes city and college life are too much for him. On the train ride home, he is thrilled to reunite with Elsie. When he gets back to Parambil thereafter, he tells Big Ammachi that he wants to marry Elsie.

With Chandy's blessing, Philipose and Elsie marry. Philipose is in love with Elsie. Elsie hopes Philipose will respect her artistic practice and give her the freedom to create. Although Philipose promises to do so, he soon proves selfish and controlling. When the couple's first child Ninan dies when he is just a toddler, Elsie blames Philipose and flees Parambil.

Six months later, Elsie returns to Parambil. Philipose is hopeful she wants to start again. He particularly begins to believe in their future after Elsie has sex with him. Shortly thereafter, everyone learns that Elsie is pregnant. Hoping the baby will be a boy and thus a reincarnation of Ninan, Philipose is disappointed and angry when Elsie gives birth to a girl. She names the baby Mariamma after Big Ammachi.

Three weeks after Mariamma's birth, Elsie disappears. The family is convinced she drowned herself in the river. Although devastated, Big Ammachi quickly assumes Elsie's role in Mariamma's life.

Mariamma is close with Philipose and Big Ammachi throughout her childhood. She remains in touch with Philipose after leaving home to attend medical school in Madras. Although Big Ammachi dies not long after, Mariamma feels her presence with her constantly.

When Philipose sees the image of a statue on a magazine cover in a hotel lobby, he becomes convinced that Elsie is still alive. He boards a train to Madras to discover the truth. The train crashes and he is killed. Mariamma is shocked to hear this news, as she cannot understand her father's reasons for leaving Parambil.

Philipose's autopsy and brain scans reveal that the Condition is caused by tumors in the brain. Although this information is clarifying, Mariamma wants more answers. She therefore turns to Philipose's journals. While reading, she is shocked to discover that Philipose is not her biological father. She rushes to Saint Bridget's, where she previously met Digby, and begins demanding answers. Digby reveals that he is her biological father and that her mother is alive. Elsie has been living with leprosy at the leprosarium ever since abandoning Mariamma. Although overwhelmed by this information, Mariamma decides to pursue relationships with her parents.