Sometimes in hospital people die – but not all of them should. A moving, addictive debut novel for readers of Going Under and Emotional Female.
Dedicated and ambitious, Emma Swann is about to start a gruelling year as a surgical registrar at the prestigious Mount teaching hospital. She’s excited to join her adored older brother Andy in pursuing the same career as their father, an eminent surgeon who made his name at The Mount.
But the pressure of living up to his distinguished reputation is nothing compared with the escalating stress Emma experiences as a registrar. It’s an arduous, unremitting slog of twenty-hour days, punishing schedules, life and death decisions – and very little assistance, instruction or support from her superiors, who waste no time pointing out just how superior they are. Amidst a background culture of humiliation and bullying, being a woman just makes things worse: misogyny is rife and Emma is subjected to other, more insidious, kinds of male attention.
As Emma battles overwork, exhaustion and increasing disillusion, she has less and less ability and time to care for her patients’ welfare, and that of herself and those she loves. Is it possible for her to be the doctor, wife, sister and friend she aspires to be in such a broken hospital system? Can she salvage her own life while she’s trying to save others? And how can she and her colleagues endure such impossible conditions without making fatal mistakes?
With the frenetic pace of a psychological thriller, The Registrar offers a rare insight into the world of a surgeon-in-the-making from one who has survived it. Told with compassion, skill and emotional heart, this gripping and moving novel goes behind the headlines to reveal the human experience of being both doctor and patient in a medical system at breaking point.
Read some great reviews from our Preview readers here:
Wow, what a story! A true insight into the secret lives of doctors and the hell they have to endure on a daily basis due to failed system. The writing was simple yet beautiful. The characters are clever yet felt like friends/family. From the very start I was drawn in by the main character, Emma, and I loved following the ups and downs of her surgical training. Highly recommend this book. Ammie, NSW, 5 Stars
The Registrar is one of those books that will haunt you long after you finish it, knowing that stories like this are playing out in hospitals all over. It’s gritty and realistic without feeling hopeless. For someone with detailed knowledge of the area they’re writing in, Janakiramanan has the rare knack of being able to provide enough medical information to keep the reader informed, but not so much that the story gets bogged down in it. It moves along at a good pace, balancing the focus on Emma’s professional and personal lives in about the same way Emma does throughout the book. Janakiramanan believes in ‘show, don’t tell’ in her storytelling; for example, we’re given glimpses into Emma’s troubled relationship with her father but, unusually in this sort of book, we’re not subjected to detailed memories of all the ways he’s failed her through the years. The Registrar was a quality read, with realistic (if not always likeable) characters and a narrator whose storytelling becomes increasingly vague and decision-making increasingly poor with her increasing fatigue levels. We may not always agree with what she does, but we can understand why it’s happening. Amanda, WA, 5 Stars
I loved this book. The main character, Emma, is struggling in her first year as a registrar surgeon, thrown in the deep end, she becomes exhausted and disillusioned while juggling the expectations of her family and trying to keep her marriage afloat. As we came to know the other characters we learn the culture of the industry and the stress and overload they are put under. I love Emma’s compassion, dedication and the strength she finds, with the support of other friends, like Daphne and her husband, Shamsi. It’s very sad and confronting in some parts, but also eye opening knowing this has a very real truth to it and the realisation that so many are hiding their struggles, not just Emma. I would highly recommend this book. Tracey, NSW, 5 Stars
THE REGISTRAR hits hard from the first page when you learn the author wrote the book because of the suicide of an ex medical colleague. As a healthcare professional, sister of a surgeon-in-training and big fan of anything medical, this was a book I didn’t want to miss. Emma Swann starts her first year as a surgical registrar in orthopaedics at a prestigious hospital her brother Andy also works as a registrar and their surgeon father has retired. As the year progresses, we get a terrifying insight into the life of a surgeon-in-the-making. Although this is fiction it felt incredibly real and I’m sure elements of it are. I loved how the pace of the story amplified Emma’s feelings making the tension palpable. I couldn’t stop reading this gripping story and it had me bawling my eyes out towards the end. THE REGISTRAR puts a powerful spotlight on the mental health of those that care for us and a system that needs to change. Julia, NSW, 5 Stars
Wow what an incredible read. This book took you for a ride through the real life hospital system. Written with a realistic and descriptive narrative this book had you well and truly hooked from the first page. I had to keep reminding myself that this was a work of fiction it was so realistic. It was an eye opener to how much a register is pushed but how much compassion a person can show. Highly recommended this book. Christine, QLD, 5 Stars
Fiction regarding mental health issues often draws a very fine line in the sand to being too confronting or not confronting the issue enough. The Registrar, although not just about mental health issues that health professionals suffer with, also reminds us that everyone is important, whatever they do and whatever they feel. Immediately after reading this book, I read another with the phrase “be patient to yourself”. I really felt the pain of staff dealing with unsympathetic hierarchies when everybody should be hoping to achieve the same outcome. Family and peer pressures seem to be at their most stressful levels for high achievers and this was apparent in this book. There will always be bullies in every profession but with so much attention on the fact that bullying is not ok, it troubles me that it is still made light of by those in authority. I thought this book was great and read it in one sitting. My heart just goes out to those people reading it and nodding and thinking to themselves that is what is like in their workplace and we still don’t make it easy for change. Denise, NSW, 5 Stars
This book, a novel , was a very insightful look into the background of how hard it is for our registrars in their training. Emma Swann, the daughter of an eminent surgeon felt she had a lot to live up to. Her brother was also pursuing the same career as her but was a few years older. The hours expected of them to work and yet care for patients and study were horrendous. We discover just what a hard background there is of humiliation and bullying for woman trainees by the male surgeons. There seems no allowances for the trainees as they battle on. This is a story of survival, of love and relationships, of family and the demands. But it is thoughtfully written, a great story by one who knows and survived it. Janet, QLD, 5 Stars
With her background as a reconstructive plastic surgeon, Neela Janakiramanan’s fictional debut, The Registrar, prises open the closed walls of our hospital system and gives us a very privileged look inside as to what it is like for a young surgeon-in-the-making: attaining both status as a surgeon, and, hopefully, as a person with their morality and compassion intact. Emma Swann is engaging in her first year as a surgical registrar at the prestigious Mount teaching hospital where her father taught, and her brother trains also. The difficult challenges facing a woman in a traditionally male environment are revealed with an ever-increasing acuity: bullying, misogyny, the lack of compassionate patient care, and, on top of it all, the gruelling and relentless overwork. The ripples radiate and impact upon other relationships. The Registrar reads like an autobiography – fast-paced, immediate, and incredibly vivid. The further Emma gets through the year, the more exhaustion literally permeates the pages, until the intensity builds to an emotional incident that has every red light signaling as to what is so very wrong with our medical training system. The Registrar is both timely and relevant, and a riveting must-read to better understand what our medical staff face. Cecilia, VIC, 5 Stars
Could not put this book down!!!! Such a great read detailing the life of a specialist surgeon. Very revealing and interesting, but also so very sad. Written by a lady who understands the life of a surgeon (as she is one herself), from all the training and work involved, also covering the personal side of life, and then getting to the ultimate stage of being a surgeon. Their father was a specialist surgeon and a leader in his field of surgery, and his two children followed him into the field of surgery. While being pleased with their choices, he places such great burdens on them to excel as he did. Not always giving them encouragement and praise, he looks at the negatives and puts great pressure on them. So sad some of the things he said to his son and daughter. Details of all the study involved, l-o-n-g hours involved in being a registrar in a hospital gives the reader a great insight into the work and life of a surgeon. Rather distressing at times to hear what they have to go through and put up with from their senior surgeons. Highly recommend a read of this great book. Glenice, VIC, 5 Stars
From start to finish, this story engaged. The first person narrator skilfully brings you into her world and keeps you with her as she pursues a dream that has its confidence boosting highs, its relentless demands and terrible lows. It invites you to ask yourself what you would do in her place, how you would respond in the face of challenges. Are power and being the best dressed up as success all they’re cracked up to be? Does success equate to being a good human? Reflect on these questions as you share the protagonist’s journey. Well worth the read. Margaret, QLD, 5 Stars
Wow, just wow. This book is incredible! It felt so real reading this book and that alone is crazy. I love all the characters and all their quirky personalities. Highly recommend! Zhyesha, WA, 5 Stars
Wow oh wow, this book may be a novel, but it is totally realistic. All the scenarios are totally familiar, having worked in this environment myself. The pain described is real and heartfelt and very sincere. I could not put the novel down, and I think the author has a real skill in relaying the truth of what goes on in our public health system. The compassion that is inherent in most clinicians so soon burns out due to the ridiculous treatment and environment as described in this amazing book. Thank you Neela for your passion in sharing what truly happens. A highly recommended read. Toni, QLD, 5 Stars
Neela Janakiramanan’s ‘The Registrar’ is an eye-opening read. Written by someone who has apparently gone through the exhausting and brutal process of training to be a surgeon, it makes the reader wonder how anyone survives the ordeal and emerges as an undamaged soul. Perhaps they don’t. Emma’s successful surgeon father is one of the main sources of unrelenting pressure, until something happens that rocks his whole family. Emma is stretched in every direction, trying to give her patients the best possible care while also being a wife, daughter, sister, friend and supportive colleague. Sexism is rampant as entitled males behave appallingly. Humiliation and bullying are entrenched, making the hospital environment seem incredibly unsafe for staff and patients. This engaging book presents, in an extremely relatable way, a system that is massively flawed – and that makes it a horrifying read. Penny, VIC, 5 Stars
Neela Janakiramanan’s The Registrar is an eye-opening, riveting, heart wrenching and sobering plunge into the world of medicine, and more specifically surgery, with all its dark secrets, misogyny, and stuffy rigid patriarchal thinking when it comes to training the next generation. We can only hope to learn from these experiences and change the system so they become distant history. Jason, VIC, 5 Stars
The Registrar is an incredibly eye opening read that makes you appreciate our health care workers and the limits they are pushed to in our hospital systems. While this is a work of fiction, Janakiramanan has extensive experience working in our hospitals and health care systems and this is shown through her writing as throughout the novel, I often felt I was reading a work of non-fiction such as Yumiko Kadota’s Emotional Female. In the age of Covid I feel we all look at those involved in looking after our health in a new light and hopefully appreciate them all the more, but this book hammers home the fact that Doctors and Nurses have long gone above and beyond for their patients we just fail to see the workings of their system they are going through, we are only viewing the patient or loved ones side of the system. Janakiramanan has written a novel that will stand the test of time, I feel it could be set in any country, city or town around the world in any time in the last twenty to thirty years and would still be the same unfortunately. She has given us a lot to think about. Mel, NSW, 5 Stars
The Registrar read like a non-fiction account into the life of a surgical registrar. I found it a harrowing ride but enlightening. These are our brightest people with a passion to ease suffering. But what I read showed a lack of empathy from the senior staff, who had endured and conquered this journey. I would have expected more understanding. But my personal experience has a patient saw it this way too. A battle of unrelenting tiredness and those who love them not really understanding. The final exam is a torture which sometimes breaks, rather than making them stronger! I was fascinated by this story and applaud those who have conquered this system. I am left questioning how valid this system is now and do we need to break doctors to make them surgeons? Thank you for this insiders glimpse into another world. Lisa, QLD, 5 Stars
Fantastic! Superbly written and easy to engage with. I couldn’t put it down and finished it within three days. The characters were well developed and I couldn’t help feeling invested in them. Despite it being medically focused, it was easy to understand and digest. I really felt for Emma, her brother and medical colleagues. There was a lot of emotion and empathy here. It shone a much-needed spotlight on burnout, short-staffing and the absurdity of hospital politics – relevant more than ever since the pandemic! A phenomenal book that I will be recommending to my friends, especially those in the medical field. Ellen, TAS, 5 Stars
From the first page to the last, The Registrar makes for completely addictive reading. Neela Janakiramanan’s lived experience as a surgeon and natural writing ability takes the reader on a ride through the incredibly demanding, stressful and exhausting work of a hospital registrar. Emma Swann and her brother Andy are growing into fast-paced surgical careers like their father had, but over the course of their story, we see the unending burdens of their roles grow and witness the impacts on their personal lives. The Registrar is a pressure cooker – the first half of the book sets the scene for an inevitable tragedy as the surgeons crack under the immense weight of their roles. It’s easy to get hooked on Emma’s story and the parallel story of a patient, Jacqui, who is the same age as Emma but suffering through surgery, rather than performing it. The Registrar is both an enthralling work of fiction and a critique of the grossly unrealistic expectations placed upon up-and-coming surgeons – particularly women, who additionally have to battle sexism and the dilemma of whether to take time out of their careers to have children. Five stars. Here’s hoping Janakiramanan ventures into fiction again in future! Lara, VIC, 5 Stars
Australia has one of the best healthcare systems in the world, and yet the healthcare system is starting to buckle under the pressure. Medical staff are pushed to their limits, and the culture of hospitals can often leave a lot to be desired. Emma’s story reflects the experiences of many, and leaves you wondering why we can’t treat each other gently. A good read, with insights into the challenges and struggles of our clinical staff as they are learning, and trying to make a difference. Next time you see a frontline health worker not being treated well – tell them they are doing a good job and thank them. Leticia, QLD, 4 Stars
An insight into the world of doctor training and the rigorous hours they work and what they have to go through in order to be ready to help us at our worst. It portrayed the best and worst of the people within. Emma’s journey to become a surgeon isn’t easy – long days, exhaustion and less and less time to care for her patients the way she wants and they deserve. Is this what we want from our top doctors? Is the system working or in need of an overhaul? Nicole, VIC, 4 Stars
An emotional rollercoaster providing commentary on the world modern, female professionals have to navigate. Jacquelyn, NSW, 4 Stars
Having only a patient’s view of an experience in a hospital, it was quite an eye-opener to read things from a training doctor’s perspective. It’s evident that the wait times and errors and what we see as “lack of polish” are all part of a “broken” system where the health professionals are severely over-worked and just trying their best, it’s quite heart-breaking. Although a work of fiction, it reads as a memoir, a very enjoyable read. Amanda, VIC, 4 Stars
I have to admit, this is not the type of book I would normally read. It took me a bit to get used to the style, it read very much like a non-fiction book, but I started really enjoying it. The story is of a registrar and all the general day to day happenings, some minor, others more dramatic. I really enjoyed this book and will recommend it to my bookclub friends. Sue, WA, 4 Stars
The Registrar is a great novel giving the reader an insight to the work life balance of being a new Registrar. Some Registrars make it and some break. Some patients make it and some don’t. I loved reading about Emma and her work family life balance. Lizzie, SA, 4 Stars
Now I know this is a work of fiction but it gave me many, many feelings. I know there are amazing Doctors and Surgeons out there, (I have had many) but I know there are some that are just plain rude! 🏨Wow, this book made me very angry in places. The utter disrespect, disregard and uncaring attitude that some surgeons have for their fellow care givers is astonishing. And this book paints this picture perfectly. I raged, sympathised, empathised, cried and did it all over again. 👨⚕️ Is it the person that is so uncaring, or the system that trains them to be that way? A very unputdownable (not a word?) book. Ali, TAS, 4 Stars
A devastating story about the passion and sacrifice of a woman trying to fulfil her career dreams that really gets to the heart of why we need to be kind to people because you never know what someone is really going through. Chiara, WA, 4 Stars
The Registrar by Neela Janakiramanan gives an account of 1 womans first year as a surgical registrar in an Australian hospital. It is very easy to read and the language swept me along at a quick pace. The story was gripping and held my attention throughout. It felt a little like I was reading an episode of the TV show ER. I would absolutely recommend this book to anyone who enjoys medical dramas. Aidan, NSW, 4 Stars
A real insight into the inner workings of a hospital and the struggles of trying to make your way in the working world as a woman. Set in England, it made me hope that things aren’t so bad in our Australian hospitals and cemented my respect for emergency workers. Well written and enjoyable. Rachel, QLD, 4 Stars
This one was stressful and intense but in a good way. Living through the stress and trauma of a surgical registrar at a large city hospital was kind of the opposite of vicarious fun. Emma’s struggles under the unrealistic expectations of her superiors are a constant battle throughout this story and watching her life slowly begin to fall apart under the strain makes up the bulk of this book. It’s an easy read, the language straightforward and a lot of dialogue and I finished it in a day. Emma is an appealing person to share brainspace with and I never felt annoyed or upset by her, even when she does some things are definitely wrong. The only negative I had with this story is that everything proceeds about as expected and all the bad things that happen can be seen coming from waaaay off. But maybe that’s part of the tragedy? Very enjoyable although also very stressful. Richard, VIC, 4 Stars
The mental health of those who work in the health sector is in crisis. Anyone who reads the news can attest to this. This is a fictional account of the crisis but grounded in truth. The author has a wide experience working in the public health sector and her writing is convincing. We are carried on the whirlwind of Emma’s journey training to be a surgeon as a registrar. The hours are relentless and unforgiving but Emma is all you would want in a trainee surgeon, brilliant but empathic. Her baptism into the gruelling work is made bearable by the support of her older brother. He becomes her guide and chief counsel in times of unbearable stress. I was barracking for Emma all the way and incredulous at such a flawed system designed to trip up rather than support those in it. The ludicrous attempts of the human resources department to fix the problem are lampooned. But they of course are not to blame. The blame lies fairly and squarely in the hands of the surgeons themselves. An outdated apprenticeship system, like a stack of cards, is doomed to collapse. But will the system or its participants collapse first? Alex, QLD, 4 Stars
The book gives an insight into the harsh realities of surgical training at a traditional academic centre. Although fictional, it felt true to life. The downside of this is that sometimes the many characters making up the cast of the hospital felt like stereotypes of their role or specialty, rather than complex characters in their own right. Georgina, NT, 3 Stars
This is not the usual type of book that I would pick up but I found it very interesting. It’s like an autobiography or a diarised version of the author’s time as a hospital registrar. It was like looking through a window on the trials of working within the Australian hospital system. It was well written and described. The story held my interest and I was intrigued to see how the story finally concluded. Astrid, VIC, 3 Stars
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