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A rather good bit of fiction, Verghese is a good writer who borders on brilliant at times. The book is off to a slow roll and even seems rambling at first. But perhaps like something from Fyodor Dostoyevsky, it gets itself going to the point of being hard to put down before it's over. The acknowledgements help untangle the question the reader must be asking by the end: "How much of this is fiction, and how much autobiography?"
Given Verghese's background in medicine, the reader should be forewarned that the medical scenes throughout the book are portrayed in graphic details; the book will be difficult to read for the squeamish of stomach. The characters may as well be real people, and the scenes and settings vivid enough that not only does the reader know Verghese is personally familiar with them, but the reader feels almost as familiar with them by the book's end. Much of it is set in a mission hospital in Addis Ababa misnamed "Missing," but in fact the misnomer is an important plot device, as the cast of characters that work there or come and go are themselves all castaways of sorts, all finding their ways in this little island of misfit toys.
The story carries its share of ups and downs, but is probably not the choice for the person looking for a feel-good beach read. The story is both heavy and deep in parts, and there is no shortage of tragedy and sadness, even if it's not all bad news throughout. The sex, though, tends to only be spiteful, dysfunctional, or otherwise anything but romantic, so don't expect the latter if picking this up.
Verghese carries the reader through India, Yemen, Ethiopia, and the United States, spanning decades of time and providing a lifelike cast of characters. He certainly doesn't lack for ambition, but he largely lives up to it and delivers what he promises. In fact, this is probably a book better enjoyed the second reading through (though I haven't attempted to confirm that yet).
If you are looking for a slightly heftier version of fiction, one with some real meaning and insight into life and living, this may well be a good choice for you. But if vivid scenes of physical trauma conjured up in the theater of your mind sounds like too much, maybe pass along to something else.