I waited for more than a year to get this book via the library. It stayed on the best seller lists for months and months and has been translated into more than twenty languages. It is the saga of one family from 1900 to 1977. The setting is the Kerala area of India (I have been to India but not this area). It is unique compared to much of India in that Christians, Muslims, and Hindus live in relative peace with each other. Unlike the more arid parts of India, this is a place dominated by water which is a major theme in the book. Several of the main characters in the book suffer from an inherited Condition, as they refer to it. In every generation, at least one person dies from drowning.

The book begins with a 12 year old girl being married off to a 40 some year old widower. She has to travel far from her family via water. He is kind and patient but unlike her, who loves the water, he will travel many extra miles to avoid even traveling by water. He is terrified of water because he has the Condition. Eventually, she becomes the family matriarch, Big Ammachi. This is her story and the story of her descendants, the Christian community in Kerala, and the fate of one British man who remained in India after independence. It is also the story of the progress of medicine (Big Ammachi’s granddaughter is determined to become a doctor and find what causes the Condition) and how one family experiences many hardships to further future generations.

The author, Vice Chair of the Department of Medicine at Stanford, details this fictional family’s history for several generations in 715 pages. It sounds daunting but I kept reading because I wanted to know what happens to all the people. At the same time, I found this to be one of the saddest books I have ever read. Due to the Condition and leprosy, for which there was no cure at the time, many people’s lives are horrendously affected. I did learn a lot about medicine and medical advances, how leprosy destroyed lives, Kerala and, much to my amazement, that many Christians in Kerala continued to follow the Hindu caste system.