Fifteen minutes long, because you're in a hurry, and we're not that smart.

19.01: Interview with Abraham Verghese

In our first episode of 2024, we interviewed author and physician Abraham Verghese, who most recently published “The Covenant of Water.” We talked with Verghese about how to convey technical information in fiction.

Verghese explains how he shares medical and world-building details in the most engaging way. We also asked Verghese how to make things feel real without overwhelming your reader, and how he has mastered conveying the passing of time. We also discussed verisimilitude, translation, point of view, and revision (we love revision!).


From Abraham Verghese: Write a landscape in three different moods. Imagine that someone dear to you has died and you are now gazing at the landscape. Describe it without any reference to this event in your life. The second time you write it as if you were experiencing a moment of great joy, and you’re looking at that landscape. The third time, imagine you are in a terrible rage and you are describing this landscape. This allows you to explore how descriptions of the physical world can reflect the various moods of characters.

Thing of the Week: 

“How To Draw A Novel” by Martín Solares (recommended by Abraham Verghese)

Credits: Your hosts for this episode were Mary Robinette Kowal, Erin Roberts, and Howard Tayler. Our guest was Abraham Verghese. It was produced by Emma Reynolds, recorded by Marshall Carr, Jr., and mastered by Alex Jackson.

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As transcribed by Mike Barker

Key Points: Verisimilitude, feeling of reality, and conveying medical information. Readers have seen it all, but you can tell them what’s important. Revision, it’s easier to take words out then add missing details. Beware circuitous information, make sure it serves a purpose. How did you organize time passing and generations? Well, really I didn’t know before I started. I did use a spreadsheet, characters, etc. New chapters allow you to sail through time. Gardening, finding your way through a novel. We all know, “I’m just muddling through…” 

[Season 19, Episode 01]

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[Mary Robinette] This episode of Writing Excuses has been brought to you by our listeners, patrons, and friends. If you would like to learn how to support this podcast, visit

[Season 19, Episode 01]

[Mary Robinette] This is Writing Excuses, Interview with Abraham Verghese.

[Erin] 15 minutes long, because you’re in a hurry.

[Howard] And we’re not that smart.

[Mary Robinette] I’m Mary Robinette.

[Erin] I’m Erin.

[Howard] I’m Howard

[Mary Robinette] We are joined today for our first episode of the new year with our special guest, Abraham Verghese. Thank you so much for joining us.

[Abraham] Pleasure to be here. Thank you.

[Mary Robinette] I have been reading your novel, The Covenant of Water, and, of course, have read your bio. But I was wondering if you could just quickly introduce yourself to our listeners.

[Abraham] Sure. First of all, I should say that I wish you guys had been around when I was starting out writing. It would have been very helpful. I’m Abraham Verghese. I live in California. I’m the author of The Covenant of Water and 3 other books. One other novel, which was called Cutting for Stone. 2 works of nonfiction, My Own Country, and The Tennis Partner. My day job is I work as a physician at Stanford University. Yeah, that’s me.

[Mary Robinette] That’s amazing. I just want to say how much I really have been enjoying The Covenant of Water. There’s such a richness to the language and verisimilitude. So what we’re going to be talking about with you, which is something I’m very excited about, is how to kind of create that verisimilitude and also how to convey technical information like medical information in a way that is engaging to the reader. So, we often talk about this idea of verisimilitude, the feeling that something is real. When writing about medicine in particular, what have you found makes it feel real for the reader? Since you write both fiction and nonfiction, do you find that changes between the 2?

[Abraham] Well, I think when I’m describing something medical, there probably isn’t a lot of difference between the way I might do it in fiction or nonfiction, other than the fact that I’m making things up in terms of outcomes and so on. But I think that, in a way, I think it’s a challenge because in this day and age, most readers are also television viewers. So there’s no part of the medical operation that’s not familiar to them. This is not like writing in the days of Somerset Maughan when he wrote about traveling to far islands, it was exciting, because there was no other way readers could visualize those places. So you write about surgery and most viewers have seen surgery on YouTube or… So your challenge is to write about it in a way that’s somehow fresh and different from what they think they know about it from having seen the operation or seen the procedure or seen whatever it is you’re writing about. Part of that is, even though they may have seen something, they may not have realized what the crucial thing is in that inner scene or what the insider’s view is on what really matters in all the different things that we’re doing. So, I think… I’m hard-pressed to say more than that. I very often worry that I’m giving too much detail. Clearly, for some readers, it may well be too much detail. For that, I really rely on my editor who often will tell me it’s not enough or rarely it’s too much. So I think I have a… I’m very conscious of not taxing the reader with more than they need. I’m trying to keep it informative and entertaining. It’s a fine balance.

[Howard] I find that when the time comes to rewrite, it is a lot easier to take words out than to put words back in. So, erring on the side of too much information means, oh, all I need to do is remove the wrong ones and I will be left with exactly what I need. Rather than needing to sit down and add a bunch of details that I didn’t realize was missing.

[Erin] Yeah. I also love what you said about figuring out what matters, and that using that as a way to focus in. I’m curious, like, how do you decide in a certain scene, what is it that matters, like, to you, to the characters, to the readers, in order to focus in like that?

[Abraham] Well, I’m not sure that I have a blanket rule about that. But, for example, when I was describing a particularly hazardous labor scene in The Covenant of Water, I’m thinking a lot about the layperson involved in that, delivering that child, and what this must seem like to them. They obviously don’t have the medical terms, so they’re looking at it through a different lens than say I might look at the scene. Also, I’m trying to really understand what the patient might be going through. So, for example, in terms of the feeling of a woman giving birth, obviously, that’s something that I can only imagine. I don’t have personal experience of that. But I was able to talk to the women around me, but also to a gynecologist friend who was also a mother. There were something she talked about that I would never have found myself or by imagining the scene. She talked about the tremendous isolation, the moment that labor starts. Despite the fact that there’s all these people around you, suddenly it’s you against the world. Everybody else sort of disappears, your focus is so intense on yourself. So I’m not sure how to give you more specifics than that. But I think it’s recognizing… I mean, it’s rare that I’m describing something from the point of view of purely of a physician, but when I am, even then, if it’s routine for the physician, I need to convey in that routine this, what are the things that this person is looking for, what is essential to this whole complicated act. That’s often true in my medical practice, for example. People come with a lot of complex complaints. But there are also keywords they say, there are key things they say that are much more important than the things they don’t say. Or other things they say. Sometimes it’s what they don’t say that matters. So certain words, certain acts are terribly important. I try to make sure I underline that for the reader.

[Mary Robinette] Yeah, I think that…

[Abraham] For example, chest pain is pretty common. But chest pain with any tinge of anxiety and sweating, say, that comes with the chest pain, just makes little alarm bells go off. Because this is probably a different kind of chest pain. So, just small… That may be not the best example that I… Just to give you a sense…

[Howard] Oh, no. That’s a good example. I had chest pain, and then I had a dull ache spreading down my left arm. I decided this was… 99, this was, 25 years ago. Decided to go into the hospital and they said, “Well, good news. Yes, a lot of what you’re experiencing is indigestion. Bad news. Your heart is doing a thing and we’re not going to let you leave for 3 days.” I learned all kinds of new words.


[Howard] My point of view from the beginning was, yeah, my chest hurts and my arm aches. At the end, I had all kinds of medical terminology and things that if I were being described in a book, that would be my character arc.

[Abraham] I think the other… That’s well said. It’s I think the other thing that I have to keep in mind is not to belabor the reader with medical information that’s circuitous. It has to serve a purpose. I think readers are interested in technical details of the world that they don’t know very well. So, whether it’s Tom Clancy on submarines or, I don’t know, Arthur Hailey on the working of an airport, I think we as readers have an inherent interest in the working of a locale and a profession that we don’t have a great deal of familiarity with. So you want to provide them enough details to create verisimilitude that you mentioned, but not so many to sort of flash your knowledge. You don’t want to just…

[Mary Robinette] Yeah

[Abraham] Pour out words to impress them. It’s a fine line, and I think, as you said, the real art is in the revision, it’s not really in the writing of the scene. It’s in the many, many attempts at revision that hone it down.

[Mary Robinette] One of the things that I’m struck by as were talking is about the difference between insider knowledge and translating it for an audience. I find that often some of the things that are the most difficult for me to write are the things that I have a deep intimate knowledge of because I can’t tell what I have to unpack for the reader. You’re dealing with a couple of different knowledge bases in this book, both your medical knowledge but also the knowledge of this particular community. I can see the… My writer brain can see the places that you are translating for outsiders. Where you will use a word, and then you will say, and this is what this word means. But it’s all very much, for me, seated in point of view, in the tactile details, the way the character is moving through the world. I think one of the questions that I have is, like, do you… I’m certain that the answer is going to be it depends, but I’m going to ask it anyway. Do you find that you just write it, and then rely on your editor to say, “Oh, you’re going to need to unpack that for people,” or do you have a sense of, oh, I should probably pause here to explain this before I carry on?

[Abraham] I think I have a pretty good sense. So I don’t really rely on the editor to do the hard work for me. I really have to catch myself if I feel I’ve used the term that’s very familiar to me, and may not be for the reader. On the other hand, you don’t want to keep stopping to say, oh, that word means this. I will often use a big word or an unfamiliar word, and as a reader, I enjoy when I don’t know the word, but the next sentence or the context makes it clear what this might be. For example, I love reading Horatio Hornblower’s series on sailing, or the whole Audrey Martin… Help me out. The other big sailing series? Patrick O’Brien? Is that…

[Mary Robinette] Patrick O’Brien. Yeah.

[Abraham] So, I mean, I still don’t know a lee shore from a not lee shore…


[Abraham] But it doesn’t really matter. I certainly get the gist of it. I think that’s what you’re after, you’re not for a complete explication, but enough so that the reader’s not lost. By the way, I meet readers from time to time who tell me, “I have to skip over all the medical parts.” I just have to bite my tongue when I hear that because…


[Abraham] I don’t want them to skip anything, but some people do for whatever reason.

[Mary Robinette] Well, speaking of things we don’t want to skip, we’re going to pause right now. We’re going to take a quick break, and then when we come back, we’re going to talk more about how to make things feel real without overwhelming the reader.

[Abraham] Yeah, I’ve been drawn to this book that I read about, I don’t know where, and I ordered. It’s called How to Draw a Novel. The title alone is intriguing. It’s by Martin Solares. He’s a fairly well-known foreign writer. I don’t think his work is as well known to us. But it literally has… It’s a very erudite meditation on novels. But he uses graphics to sort of illustrate the course of particular novels. So you have a little figure comparing Moby Dick to Wuthering Heights. It’s really quite entertaining. The figures are sparse, there’s a lot of text in between. But the whole thing is a delight. So that’s what I’m recommending and reading right now.

[Mary Robinette] That’s How to Draw a Novel by Martin Solares.

[Abraham] Yes. Exactly.

[Mary Robinette] Sounds amazing.

[Mary Robinette] Well, let’s dive back in. One of the other things that you do when you’re… You’re not only dealing with the technical information, but The Covenant of Water takes place over multiple generations of a family. One of the things that I find fascinating is how to convey time passing and how to show the connections between generations. When you were diving into this, did you have touch points in your head about, “Oh, if I mentioned this,” or “I want to draw this piece of history out?”

[Abraham] No, not really. I mean, I knew… There are very few things I do about this novel before I started.


[Abraham] I’m embarrassed to say. I knew the geography. I think that’s terribly important because setting this in the South India, in this community of Christians who believe their religion came when St. Thomas the apostle landed on the shores of Kerala, India, in 52 A.D. That was an important decision. Because the same story anywhere else, in Hoboken or somewhere, would be a very, very different story. I also knew that I wanted it to be multi generational. Mostly because, as someone who’s practiced medicine for almost 40 years now, I really liked being able to see, in my early years, some entity for which we just have a label but no understanding, and then watch it evolve over decades to where the molecular basis was better understood, and then eventually completely understood, and then we have a diagnostic test, and then we have treatment. That sort of unfolding requires generations. So I knew that much. But I didn’t really know much else. So I was sort of… As I was writing, I actually had a spreadsheet with the characters, when they were born, when they died. I had a parallel column with milestones from my grandparents and parents lives, just because they were sort of helpful touchstones in terms of helping me imagine that moment in time. Rather than saying, “Okay, World War I,” you can say, “Well, the year my grandparents got married,” or something like that. So then I had 1/3 column with milestones and world history that pertained to that region. For example, seminal events in the long, long journey towards emancipation from the British in India [garbled] about independence in Independence Day, August 15, there were many, many milestones, hundreds of years of them leading up to that. Of course, world events. And, yet another column for medical milestones. I had to keep in mind that my current medical knowledge is not the knowledge I should be using describing something. I had to stay true to the knowledge of that time. So, I suppose in that sense, I was very conscious of time and history. But I didn’t really know until I was well into the writing how to weave all these elements together and when to switch scenes. One very useful thing that an editor told me many years ago was the great magical thing about a blank page or a white page or a new chapter is that you can skip over years, just by doing that.


[Abraham] You don’t really need explanations. Which was a huge revelation to me at the time. I think it was with Cutting for Stone. So, make use of that. The white space allows you to just sail through time.

[Howard] As an aside, I think I deserve an award for not shouting, “Yes!” When you said spreadsheet. Because I have preached spreadsheets…


[Howard] A lot. I use them in exactly the same way. Columns for events, columns for character lives. I even have a column sometimes that describes what I’ll call story beats. I want this story beat, needs to be dark night of the soul. Or, this needs to be a moment where I tell the reader that this is a character they can trust. For this is a character they can’t trust. Very explicit notes to be, so that when I sit down to write, I can write words that are better than that.

[Mary Robinette] I think it’s going to be really comforting for our listeners… A couple of us, like, I’m an outliner, usually. It’s I know that a lot of listeners are people who garden, who find their way through the novel. I think it will be very comforting for them to hear, “Oh, yeah, I didn’t… I sat down and I kind of found my way through the novel.” Especially if they pick up the novel and read it, which, it feels so cohesive after it’s all done.

[Erin] I was going to say, I wonder a little bit, like, how do you… If you are gardening, if you are finding your way through, but also you have this structure, these columns that like sort of form a trellis, let’s say, in the garden, sort of, how do you ensure that you garden to it? How do you make sure that, like, your spreadsheet says X, but you’re really feeling Y as you’re writing. How do you reconcile between those differences to make sure that you’re telling something that both works, and also works for you?

[Abraham] Yeah. I mean, first of all, I should say, the spreadsheet came much, much later. I’m almost embarrassed to confess this, but my books have taken a long time. The last novel I wrote, Carving for Stone, was 14 years before this one. I spent 8 years writing that novel. So with this novel, I really wanted to not spend 8 years, or 14 years. I wanted it to be a few years. So I really wish I could have plotted out the whole novel. In fact, on my right side is this whiteboard with a fairly extensive drawing of the entire novel. Which I know your listeners can’t see, but you guys can. So I would plot out the entire novel, and I love to think visually. I draw things out, kind of cartoon fashion. Then I would start writing, only to find that the novel is wandering off in a completely different direction. So then I would photograph the whiteboard, and start all over again. So, to be quite honest, I started with a mood, I started with one character. That was a young bride on her wedding day in 1900. It’s I vaguely knew that I wanted 3 generations. I knew where this was situated. But I really didn’t know the central conflict of this novel. I didn’t know very much of anything. I wish I wasn’t that kind of a writer. I wish I knew everything that was going to happen. There are writers like that. I’m a friend of John Irving, who’s been a mentor and a correspondent for many, many years. I’m amazed. He knows the first and last line of the novel before he starts, he knows the first and last line of every chapter. So when he begins, it’s not that new things don’t come up, but he really knows the entire story. He has said… He will say, “If you don’t know what you’re showing to the reader and what you’re hiding and when you’re going to reveal it, you’re just making it up as you go along, Abraham. You’re not a writer, you’re just an ordinary liar.”


[Abraham] I think he’s right.

[Mary Robinette] I hate to disagree with John Irving, but…

[Abraham] I was going to say that, at the end of my stumbling process of pushing this feeling long and many dead ends and many hundreds of pages in months and months in the wrong direction… Realizing that that’s not the novel. There is a point where you finally arrive where… For me, it was almost halfway, two thirds into the novel where I could suddenly see everything. See exactly how it ended. Immediately, many extraneous but important characters and scenes fall away. You realize that they’re not critical to this outcome. So I think we eventually all arrive at the same place as John does, but he spends many months in the planning before he embarks on it. So you could say that my writing for all those years was an inefficient way to come to that same point.

[Howard] It may be inefficient, but I would… I’ll put a stake in the ground and say, “You’re not just a writer, you’re an extraordinary writer, and you’re a really good liar.”


[Abraham] I’m happy to take that from you. I feel very blessed actually… When you write without any sense of how it’s going to be received. So hearing things like this now our wonderful, but at the time, you’re not sure. You just do your best.

[Mary Robinette] I think we all feel that sense of, “Oh, I’m just muddling through, and hopefully no one catches me.” But since you are a man of science, I’m just going to remind you and our listeners that there’s… In science, there’s no such thing as a failed experiment. In writing, there’s no such thing as a wasted word. You find the story often by discovering what the story is not.

[Abraham] Especially mysteries.

[Mary Robinette] Yeah. Nancy Kress, who is one of my favorite writers, said that her process is that she writes a draft of the story. She doesn’t outline. She blunders her way through it. Then when she finishes, she knows what the story is about, and she tosses her first draft completely, and starts over from scratch, and this time she knows what the story is. So she doesn’t extremely long, detailed outline.


[Abraham] I think, very much like you, I’m fascinated by process. In my library, such as it is, in my study, I have bookshelves very well organized, fiction, nonfiction, poetry, one whole shelf of marriage self-help, which didn’t help, by the way. Then, I have a whole section on writing. Because I keep thinking there will be some book there that’s going to give me the key to make the process more efficient. I finally gave up when I bought a book recently and they were quoting me. Here I was trying to find the key, and there quoting something I said. I think we just all have to muddle our way through it, and some of this is organic to the individual. You just can’t adopt someone else’s method and have it work for you. It doesn’t always happen that way.

[Mary Robinette] That is so true. I think that’s actually a great note focus to move to our homework. I think you’ve got some homework for us?

[Abraham] Yeah. I think, I was going to suggest something that I found useful is to either take something you’ve written that describes something, sort of passive, a landscape or a… Ideally, a landscape. But then write it in 3 different moods. Pretend that someone very precious to you has just died, and you’re now gazing at this, and you describe the landscape without any reference to this event in your life. The 2nd time you write it, at a moment of great joy, whatever that is, the birth of your first child, and you’re looking at the landscape. Again, no reference to what just happened to you. The 3rd time, imagine you’re in a terrible rage, and you’re describing this landscape. You can actually see this happening in the best of Dostoyevsky and some of the other writers, where the very landscape is affected by the mood of… That the narrator’s carrying into that scene. It’s quite beautiful. It’s a good exercise to show us how even the most unrelated things to the emotion and the characters can still take on the hue of the prevailing emotion.

[Mary Robinette] Yeah. That’s wonderful homework. Thank you so much for that. Thank you for joining us.

[Abraham] My pleasure. Thank you.

[Mary Robinette] This has been Writing Excuses. You’re out of excuses. Now go write.

[Howard] We love hearing about your successes. Have you sold a short story or finished your first novel? Tell us about it. Tell us about how you’ve applied the stuff that we’ve been talking about. Use the hashtag WXsuccess on social media or drop us a line at [email protected].