The Registrar by Neela Janakiramanan

Reviewed by Antonella Townsend

The Registrar reads like a report from the trenches of an unremitting war. Thinly disguised as a novel, Dr. Neela Janakiramanan has written about her experiences as a trainee surgeon. Dr Neela Janakiramanan is a reconstructive plastic surgeon with expertise in hand and wrist surgery.  She has worked extensively in both the public and private health sector and is an advocate for health equity, gender equity and diversity.  The Registrar is a riveting read.  Nevertheless, this will be a short review because if I stay too long on the page it could get ugly.  It is hard not to be infuriated by how Australian hospitals are so under-funded. Equally so, how young doctors in training are required to endure toxic nineteenth-century autocratic teaching practices.  This could not possibly produce the best result for anyone involved, particularly patients.  Why are we so bonkers?  But I digress …

The protagonist, Emma, has begun training as a surgical registrar specializing in orthopaedics at The Mount, a prestigious hospital where her famous surgeon father, Professor Swann, once taught.  Her brother Andy, four years into his training at the same hospital, is about to take The Exam, the final step in qualifying as a surgeon. Andy and his wife Laura have twins and it is clear that a private life is hard when both parents are at the beginning of professional careers.  But Emma’s marriage to Shamsi, a lawyer, is also under tremendous strain as she sets out on her five years of training before taking The Exam.  Readers feel so involved as she battles the hospital system that seems to be designed to create as much hardship as possible.  Emma and Andy also have the added personal tension of their father’s expectations and constant goading predicting their failure. Stress springs from every page.  The doctors in charge of training the Registrars are portrayed as either caring professionals where medicine is a vocation, or those more concerned with procuring a Maserati, bullies, and a few straddling each position.  And yet, amazingly, Janakiramanan manages to provide readers with some relief via a few humorous scenes, such as The Workforce Transformation Committee introducing measures to relieve stress.  Shorter working hours, where medical staff could actually get to sleep, one might think.  Turns out whales are the answer.

There is little down time is this ‘novel’, energy bars and strong coffee required during reading, because readers will not be inclined to stop reading.   The pace is fast.  The shocking climax sneaks up without warning, and I do hope that it is the ‘fiction’ in this not so fictional novel.   But I fear the worst, and it is unsurprising given the context.

The central thesis is played out earlier in the novel when Emma has a conversation with an ex-pilot sitting beside her as she flies to a conference and who now works in safety systems.   During their conversation, he makes the point that pilots would never be allowed to fly as tired as surgeons must be when on call for days.  What follows is a staggering statistic: the pilot informs Emma that sixty billion dollars was spent retrieving the black box of a plane that disappeared over the Southern Ocean causing the death of three hundred and sixty-seven people.  This stretched my ability to suspend disbelief.  I feel sure this was supposed to be ‘million’; an internet search came up with fifty-three million for attempts to retrieve MH370 for instance.  Nevertheless, it’s a good point of comparison.


The Registrar

By Neela Janakiramanan


Allen & Unwin


ISBN: 978 176106 651 1

$32.99; 368pp

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