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Life in the Balance: A Doctor’s Stories of Intensive Care
'A remarkably honest memoir of a life spent pulling people back from death' - Adam Kay
In these stories, Dr Jim Down brings us to the very heart of the intensive care unit - the section of the hospital where the sickest patients are brought to be cared for until their condition improves. With honesty, humility and a streak of dark humour, Dr Down describes the quietly heroic work of doctors and nurses on the ICU, a place which sits at the cutting edge of medical technology and where a split-second decision can make the difference between life and death.
From headline-grabbing cases like that of Alexander Litvinenko, poisoned by Russian agents and admitted to Down's ward, to the appalling aftermath of a train crash, Life in the Balance offers an inside glimpse of intensive care medicine, its immense challenges, deleterious effects on doctors' mental health and enormous rewards. Its profundity will make you reconsider the fragility of life and reframe your understanding of what it means to care.
In these stories, Dr Jim Down brings us to the very heart of the intensive care unit - the section of the hospital where the sickest patients are brought to be cared for until their condition improves. With honesty, humility and a streak of dark humour, Dr Down describes the quietly heroic work of doctors and nurses on the ICU, a place which sits at the cutting edge of medical technology and where a split-second decision can make the difference between life and death.
From headline-grabbing cases like that of Alexander Litvinenko, poisoned by Russian agents and admitted to Down's ward, to the appalling aftermath of a train crash, Life in the Balance offers an inside glimpse of intensive care medicine, its immense challenges, deleterious effects on doctors' mental health and enormous rewards. Its profundity will make you reconsider the fragility of life and reframe your understanding of what it means to care.
245 pages, Kindle Edition
Published February 23, 2023
28 people are currently reading
545 people want to read
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Displaying 1 - 23 of 23 reviews
June 2, 2024
Better than Life Support, Down’s record of being an ICU anaesthetist during Covid. He has some great stories to tell of momentous occasions for his London hospital’s staff: a train crash, the 7 July 2005 terrorist bombings, and Alexander Litvinenko’s fatal polonium poisoning by Russia. There are also more personal accounts of having two of his friends as patients at his hospital: Sean with necrotic pancreatitis and Laura with Guillain–Barré syndrome. I was reminded of Henry Marsh’s memoirs (and, to a lesser extent, Stephen Westaby’s) for their combination of confession and self-deprecating humour. “My relationships with patients are usually short term,” Down quips. “If they’re not unconscious when I meet them, I often render them so within minutes.” One chapter describes ICU bed allocation as a complicated chess-like game of strategy. But he also chronicles ethical dilemmas and difficult decisions, including one case that wouldn’t stop haunting him and prompted him to get mental health support – under a counsellor’s care, he tried antidepressants, EMDR, and cold-water swimming.
April 28, 2024
(4.5*) - Exhilarating, gripping and terrifying.
A very well written insight into life as a top consultant at UCH on Euston Square. Down takes us through some terrifying tales as he treated victims of the 7/7 terrorist attack and then led the medical investigation into ex Russian FSB agent Alexander Litvinenko.
What’s most noticeable is how vital strong decision-making is in the ICU and the ability to recall all the decisions you have to make. Everything from the decision not to double up on gloves when inserting a needle into a patient that potentially has HIV and risk infecting yourself to the decisions around DNR orders and ventilation.
But also the significant mental toll from working as an ICU consultant takes on you. Rather than bringing his work home physically, it weighs on Down mentally as he goes through endless iterations of possible solutions, problems and re-diagnoses again and again to try and be that difference that could save a life.
Jim Down is a hero as are all of the NHS staff that look after the health of this country 24/7! Definitely recommend!
A very well written insight into life as a top consultant at UCH on Euston Square. Down takes us through some terrifying tales as he treated victims of the 7/7 terrorist attack and then led the medical investigation into ex Russian FSB agent Alexander Litvinenko.
What’s most noticeable is how vital strong decision-making is in the ICU and the ability to recall all the decisions you have to make. Everything from the decision not to double up on gloves when inserting a needle into a patient that potentially has HIV and risk infecting yourself to the decisions around DNR orders and ventilation.
But also the significant mental toll from working as an ICU consultant takes on you. Rather than bringing his work home physically, it weighs on Down mentally as he goes through endless iterations of possible solutions, problems and re-diagnoses again and again to try and be that difference that could save a life.
Jim Down is a hero as are all of the NHS staff that look after the health of this country 24/7! Definitely recommend!
This entire review has been hidden because of spoilers.
January 3, 2024
Audible. Alistair Campbell recommended. Working in ICU. Bit indulgent in the end , but quite good. Read well.
March 28, 2024
Some amazing anecdotes from a busy London hospital. A valuable perspective on the NHS, such that I perhaps would have appreciated some more commentary on the current struggles, particularly how they compare to previous decades. Liked the writing style! Definitely the kind of doctor I want to be.
June 22, 2025
As Jim Down states towards the end of his book, many of the general public aren't aware that anaesthetists responsible for putting us to sleep aren't aware that they are in fact medically trained to do so. His memoirs give all the reasons why they are. The incredible responsibilities these individuals hold in an Intensive Care Unit where patients hover between life and death, and the powerful choice they have in deciding who will benefit from their care and who won't. Jim talks us through his choice to move into anaesthetics/intensive care; from his first days feeling overwhelmed at the reality of being a newly qualified Doctor, through to the confidence rising as he qualifies to a Consultant, and right back to the psychological torment of his role after the Covid pandemic. Intermingled with fascinating real life cases that drip feed the medical knowledge required to do his role and the personal sacrifices he has made through his career, Jim's memoirs are powerful in both a life affirming and saddening way of the encounters he has faced. Laced with his patient centred focus but also thought provoking conversation on patient care, end of life care, advanced directive care and the state of the NHS in England, Jim has written a short read worthy of reading even for those with minimal interest in medicine.
January 23, 2024
I first heard about this book when Alastair Campbell recommended it as his book of 2023, so promptly sought it out.
For much of this book, I thought to myself that others might find it strange, listening to a book by a doctor about their job, and that it might be too close to what I do. Actually, on the contrary, I find accounts of other specialties quite fascinating, particularly when interspersed with stories from major incidents and the like. This was a fascinating look at intensive care and the ethical decisions as well as the clinical ones.
Towards the end, as Jim describes his anxiety and diagnosis of depression following a challenging case, some of it felt more personal and more applicable to all of us working across medicine. It has given me much to reflect on, and his honesty and detailed description of his mindset and recovery has prompted me to think further about how I would cope with similar stresses, and if there are proactive steps I could take to shore up my own resilience.
The chapter about the pandemic, as always with these things, provoked emotional flashbacks and were a difficult listen.
Overall a strong recommend - I imagine medical or non medical, you will get something valuable from this book.
(Listened to the audiobook)
For much of this book, I thought to myself that others might find it strange, listening to a book by a doctor about their job, and that it might be too close to what I do. Actually, on the contrary, I find accounts of other specialties quite fascinating, particularly when interspersed with stories from major incidents and the like. This was a fascinating look at intensive care and the ethical decisions as well as the clinical ones.
Towards the end, as Jim describes his anxiety and diagnosis of depression following a challenging case, some of it felt more personal and more applicable to all of us working across medicine. It has given me much to reflect on, and his honesty and detailed description of his mindset and recovery has prompted me to think further about how I would cope with similar stresses, and if there are proactive steps I could take to shore up my own resilience.
The chapter about the pandemic, as always with these things, provoked emotional flashbacks and were a difficult listen.
Overall a strong recommend - I imagine medical or non medical, you will get something valuable from this book.
(Listened to the audiobook)
March 27, 2023
A marvellous book written with evident warmth and care for his patients by Dr.Down.
A mixture of professional autobiography and tutorial into the workings of the intensive care unit this book engaged from the first page owing to the approach of the author and his focus on the patients and the limitations of what medical theory can do even as we move through the 21st century.
The toll of being both an intensivist and an anaesthetist over a career of some 25years is clearly shown here and the author has bared his vulnerabilities for all to see on the page, this cannot have been an easy decision to make , it would have been so easy to focus on the purely medical and veer away from the personal.
The challenges of an NHS under increasing strain is not shied away from.
An engrossing read from a very thoughtful and admirable author
A mixture of professional autobiography and tutorial into the workings of the intensive care unit this book engaged from the first page owing to the approach of the author and his focus on the patients and the limitations of what medical theory can do even as we move through the 21st century.
The toll of being both an intensivist and an anaesthetist over a career of some 25years is clearly shown here and the author has bared his vulnerabilities for all to see on the page, this cannot have been an easy decision to make , it would have been so easy to focus on the purely medical and veer away from the personal.
The challenges of an NHS under increasing strain is not shied away from.
An engrossing read from a very thoughtful and admirable author
September 21, 2024
Life in the Balance is very well structured and written. It begins quite factually, providing an overview of why Dr Down chose ICU as his specialty, how an ICU is structured, then discussing his more high-profile days at work
The book then turns to the ethical side of his specialty, and the dilemmas faced everyday. For me, the chapter on capacity hit the hardest... I definitely got emotional
I also liked Dr Down's take on the pandemic. Yes there was a bit about how difficult and busy it was to work in ICU at that time, but I thought he offered a unique and candid perspective of the aftermath as he tackled getting to grips with his "ordinary" job again and struggles with his mental health
I'll definitely be seeking out his earlier book Life Support, which discusses the pandemic in more detail
The book then turns to the ethical side of his specialty, and the dilemmas faced everyday. For me, the chapter on capacity hit the hardest... I definitely got emotional
I also liked Dr Down's take on the pandemic. Yes there was a bit about how difficult and busy it was to work in ICU at that time, but I thought he offered a unique and candid perspective of the aftermath as he tackled getting to grips with his "ordinary" job again and struggles with his mental health
I'll definitely be seeking out his earlier book Life Support, which discusses the pandemic in more detail
April 7, 2023
A fascinating insight into how decisions are (and should/could be) made for ICU patients and the pressure intensive care doctors and anaesthetists come under every day.
Jim Down speaks of the philosophy around a life worth living and poses several thought provoking questions such as “Is a patient really alive if they are fully supported by machines?”, “Should CPR/DNR decisions be made by doctors, patients or their families?”, “Can we justify the enormous cost of ICU beds for patients who have little-to-no hope of living a ‘valuable’ life?/Who gets to choose what defines a valuable life?”, “How should doctors prioritise patients for ICU admission and is it fair to prioritise beds for emergency patients over those scheduled for elective surgery?”
Jim Down speaks of the philosophy around a life worth living and poses several thought provoking questions such as “Is a patient really alive if they are fully supported by machines?”, “Should CPR/DNR decisions be made by doctors, patients or their families?”, “Can we justify the enormous cost of ICU beds for patients who have little-to-no hope of living a ‘valuable’ life?/Who gets to choose what defines a valuable life?”, “How should doctors prioritise patients for ICU admission and is it fair to prioritise beds for emergency patients over those scheduled for elective surgery?”
This entire review has been hidden because of spoilers.
April 8, 2024
This was a fascinating read! I've read hundreds and hundreds of medical biographies from nurses/doctors/surgeons working in hospitals but I've never read any which goes into detail about working on Intensive Care.
Unless you are unlucky enough that someone close to you has spent time on an intensive care unit, we don't really find out what is behind those doors, this book gives us a real insight into the level of care, the protocols and the day to day running on the unit. It was extremely interesting and I couldn't put this down. It was very well written, with stories of past patients and their illnesses, and I thought this was a riveting book.
Well worth a read if you enjoy biographies or anything medical related. I've still got one of his books based around Covid which I haven't read yet, I will be making it a priority now as I'm sure that's just as good.
Unless you are unlucky enough that someone close to you has spent time on an intensive care unit, we don't really find out what is behind those doors, this book gives us a real insight into the level of care, the protocols and the day to day running on the unit. It was extremely interesting and I couldn't put this down. It was very well written, with stories of past patients and their illnesses, and I thought this was a riveting book.
Well worth a read if you enjoy biographies or anything medical related. I've still got one of his books based around Covid which I haven't read yet, I will be making it a priority now as I'm sure that's just as good.
July 10, 2024
Can one say that they actually enjoy this book? It's informative, very personal and an insight into the work of a doctor who spends his days making life and death decisions on critically ill patients. I think I can say I enjoyed this book!
Apert from the fact it is well written, the anecdotes about the dilemma patients, their close relatives and their doctors make on a daily basis, is astounding.
Don't let anyone tell you the NHS is not fit for purpose.
Well done to Jim Down. May he continue to serve his patients.
Apert from the fact it is well written, the anecdotes about the dilemma patients, their close relatives and their doctors make on a daily basis, is astounding.
Don't let anyone tell you the NHS is not fit for purpose.
Well done to Jim Down. May he continue to serve his patients.
August 29, 2023
A beautifully written, fascinating look at the world of intensive care. Dr. Down has been not only in the midst of care of critically ill patients, but in the midst of multiple world events. His insights and compassion for the patients, his team, and ultimately himself and his colleagues, make for a wonderful, moving book that should be read by all.
April 12, 2024
How is it that medics can be such good writers as well? Henry Marsh and Rachel Clark come to mind. Such an interesting and thoughtful book which explored various ethical themes but in easy to understand writing. The author is not afraid to share his own struggles and experiences too. I look forward to reading his next book about his work during Covid.
November 13, 2024
This is a thought provoking and beautifully written book. As an anaesthetist I can relate to so much of this yet it still made me stop and reflect in a way I haven’t done before. Relevant and valuable to everyone…health care professional or not!
March 1, 2023
Really well written - made me appreciate just how amazing ICU staff are
March 12, 2023
A book filled with the stories of n intensivist in the UK NHS. A story of ethics, philosophy,life, love and loss and the choices we make.
March 15, 2023
A thought provoking and enjoyable read.
January 13, 2024
I felt incredibly tense reading this account (I can’t imagine living it!) and am glad it’s finished but it was fascinating, thoughtful and honest.
March 29, 2024
Fascinating account of the work and dilemmas of an ICU consultant. I read it over 24hours and probably didn’t fully digest the decisions he had to make but I couldn’t put it down.
April 9, 2024
Amazing book written by a wonderful person. I loved hearing all of Jim Down's thoughts and stories from his experience. A delightful read.
April 13, 2024
The inner workings of an ICU laid bare. It sounds terrifying, I hope I never need to be in one!
February 10, 2025
Fascinating read. So interesting to read the author’s perspective on death, terminal care, the impact of covid and NHS resources.
April 9, 2023
Life in the Balance
I read this book as a result of listening to the podcast The Rest is Politics. Alastair Campbell mentioned the book and as I’m very interested in his work on mental health I wanted to read it. It is a superb book about the life and work of an intensive care doctor. It’s a very honest account of the author’s career, and I’m now going to get hold of Jim Down’s first book, Life Support, about the Covid 19 pandemic.
The chapters that particularly interested me were the ones about patient care and the doctor’s demeanour. From a patient’s point of view, it surprises me that doctors aren’t trained in ‘bedside manner’, and that some of them find it a bit tricky to empathise with the patient. In the chapter Friends, Down is very honest about how talking to two friends about their ICU experience taught him more about what the beginning of each shift feels like for the patient, as the patient wonders nervously which staff will be on that shift.
The chapter Crash covers the author’s experience of anxiety and depression and is so refreshingly frank about his own reaction to a death on the ICU that I think it was some of the most insightful and revealing writing about the medical profession that I’ve ever read. Doctors and patients both have things to learn about how it feels on the other side of the bed.
Overall this was one of the most moving and revealing books about hospitals that I’ve ever read.
I read this book as a result of listening to the podcast The Rest is Politics. Alastair Campbell mentioned the book and as I’m very interested in his work on mental health I wanted to read it. It is a superb book about the life and work of an intensive care doctor. It’s a very honest account of the author’s career, and I’m now going to get hold of Jim Down’s first book, Life Support, about the Covid 19 pandemic.
The chapters that particularly interested me were the ones about patient care and the doctor’s demeanour. From a patient’s point of view, it surprises me that doctors aren’t trained in ‘bedside manner’, and that some of them find it a bit tricky to empathise with the patient. In the chapter Friends, Down is very honest about how talking to two friends about their ICU experience taught him more about what the beginning of each shift feels like for the patient, as the patient wonders nervously which staff will be on that shift.
The chapter Crash covers the author’s experience of anxiety and depression and is so refreshingly frank about his own reaction to a death on the ICU that I think it was some of the most insightful and revealing writing about the medical profession that I’ve ever read. Doctors and patients both have things to learn about how it feels on the other side of the bed.
Overall this was one of the most moving and revealing books about hospitals that I’ve ever read.
Displaying 1 - 23 of 23 reviews