A twelve year girl grieving the death of father and a forty year old widower with a young son, both Malayali Christians, marry as the novel opens in 1900. This marriage establishes the family that we follow throughout the next 77 years. The girl, eventually known as Big Ammachi, lives a life filled with sorrow and tragedy (the family she's married into appears cursed, at least one member dying by drowning in each generation) but also one of expansive love. In parallel to the story of Big Ammachi and her family, is the story of a Scottish doctor named Digby Kilgour who comes to British India to work for the Indian Medical Service. How the two seemingly disparate plot lines come together is quite intricate and well done.
Because of the long time frame of the novel, Verghese has the chance to see his characters through enormous changes politically and socially, from the British Raj to an India that stands on its own. Some of these historical events have larger impacts on Big Ammachi's family than others do but all are woven seamlessly into the domestic story at the heart of the novel. The scope of the story is both broad and narrow, resulting in a colorful and diverse tapestry of a novel. There are some side plots that are more interesting than others (likely fully dependent on the reader) and some are more well developed than others but each has certainly earned its place in this wide-ranging, personal novel. Readers looking for an immersive experience filled with love and grief, tradition and novelty, colonialism and self-determination, and all of the history and variety that has forever characterized India will thrill to this impressive reading experience.