Neela Janakiramanan – The Registrar

Allen & Unwin, Australia, 2022
Cover design by Christabella Designs
Cover photograph: Getty Images

Neela Janakiramanan’s debut is a fiction, but based on her experience as a surgical registrar. The work illuminates publicly reported issues about the deleterious effects of excessive workload on junior doctors and specialist trainees.

Barbie spoke to Neela Janakiramanan about The Registrar

The book also reflects upon the effects on patient welfare and care of a system groaning under the weight of this overwork and worryingly high levels of health worker burnout.

It is a compassionate piece, eloquently but accessibly written.

The story follows Emma, a surgical registrar whose father was a renowned surgeon at The Mount hospital where she is training. Like many before her, she feels compelled to follow in the family tradition, as indeed does her older brother, Andy. Both labour under the weight of their father’s ever critical eye, never feeling adequate to his expectations.

Emma is thrown into the thick of a busy public hospital with little to no orientation – even the most minor administrative things like the issuing of an access pass seems beyond the capability of the system. Added to this is the hierarchical and systemic bullying of young doctors (both male and female) and the equally entrenched misogyny of an entitled upper echelon of often uncommunicative, supercilious surgeons.

The pace of work and its weight – life and death decisions the daily fare – are bound to take their toll, and family life and relationships, as well as mental and physical health, suffer.

Emma though, once there, is determined to be a good doctor, one who cares about her patients’ welfare, knows their names not just their medical conditions and takes time to talk with them and explain what their options and likely outcomes are. She is often beaten by the system, but persists to the end, despite the greatest personal challenges and tragedies that befall her.

This is a detailed day to day glimpse into the lives of surgical registrars and other health workers, intimate and troubling in its verisimilitude. The reader could very well despair about the state of our public hospitals and the medical system, training and practice in general.

However, there is light here and it is found in the character of our heroine. She is bowed but never broken by the machine; she learns valuable life lessons from her mistakes and missteps, which she candidly shares with us. In the end Emma Swann finds a way to honour her principles, to recognise the reality of her situation and to pragmatically accept it as imperfect.

She finds a way to survive the harshness and egocentricity of her superiors’ behaviour, because she must if she wants to fulfil her goals and qualify as a surgeon. As Emma also comes to understand the need for release, for allowing herself some slack and for doing the best within a flawed system, so does the reader cheer for all those who altruistically follow such professions, lose a little gloss along the way but make it to the other side.

This novel will have wide appeal; it is not merely for those with a fascination for all things medical. It is a sensitive human story which raises, but happily does not always answer, high moral questions to which we should all be giving our attention.

At the same time, it is written with a light hand, never flippant but nevertheless with optimism. The writing is deft, fluid and able to  carry the heft of this tale.

There’s grit here, an acknowledgement that doing great things can be in the smallest, sometimes banal details – but they are no less great for that. I hope we see more from this author, if there is space between her surgical and personal lives.

Thank you to Allen & Unwin for my review copy and to Neela for such an interesting and forthright conversation about modern medicine and this book.