The novel tells the story of an Australian doctor haunted by memories of a love affair with his uncle's wife and of his subsequent experiences as a Far East prisoner of war during the construction of the Burma Railway.

Dorrigo Evans has found fame and public recognition as a war veteran in old age, but inwardly he is plagued by his own shortcomings and considers his numerous accolades to be a “failure of perception on the part of others”.

He knows that his colleagues consider him a reckless and dangerous surgeon, and he has habitually cheated on his faithful and adoring wife, though his public reputation has been undented by the air of scandal that trails him in his private life.

His regiment is captured during the Battle of Java and is sent to labour on the notorious Burma Death Railway, intended to provide the necessary supplies for an invasion of India.

[5] During the construction of the railroad, he is reluctantly bestowed the leadership over his fellow prisoners and fights a losing battle to protect his charges against disease, malnutrition and the violence of their captors.

Dorrigo sadly observes as the bodies of his fellow POWs break down and disintegrate with "eyes that already seemed to be little more than black-shadowed sockets waiting for worms".

[5] Other POWs include the artistic Rabbit Hendricks who secretly makes drawings of camp life (which could lead to his execution if the drawings are discovered), the white supremacist Rooster MacNeice who has trouble accepting that he is now a prisoner of the Japanese, and the defiant Darky Gardiner who is repeatedly beaten by the guards and finally drowns himself in a latrine full of excrement rather than endure another beating.

After a conversation with a Japanese doctor who served with Unit 731 in Manchukuo reveals to him the country’s human experimentation program during the war, he gradually absolves himself of any sense of guilt for his actions.

The magazine's critical summary reads: "The Narrow Road to the Deep North goes well beyond "an enlivened historical documentary or a corrective to Pierre Boulle's The Bridge over the River Kwai" and may just become a "classic work of war fiction" (Washington Post)".

"[3] Writing in Literary Review, A. S. H. Smyth praised Flanagan for his "poet's appreciation of unsentimental detail", which serves less to embellish memory than to clarify it, bestowing "the quiet blessing of veracity on episodes perhaps otherwise too outlandish or too harrowing to be thought real.

"[13] in November 2023, it was announced that Jacob Elordi would play the male lead of a miniseries adaptation of the novel by Prime Video Australia, along with Ciarán Hinds, Odessa Young, Thomas Weatherall, Olivia DeJonge, and Simon Baker.