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Life Support: Diary of an ICU Doctor on the Frontline of the Covid Crisis
'Deeply affecting - a personal memoir that grips, harrows, inspires and, ultimately, uplifts with its vein of deep humanity' Philippe Sands'An extraordinarily frank book laced with humour and self-deprecation' The TimesAs a doctor on the intensive care unit at one of London's top hospitals, Jim Down has spent his life working as healthcare's last resort, where each day reveals a new challenge. But nothing could prepare Jim and his colleagues for the events of spring 2020, when the Covid-19 pandemic put them on the frontline of a global health crisis.In Life Support, Jim tells the extraordinary month-by-month story of how, as the world came to a standstill, he and his co-workers faced down the biggest challenge in the history of the NHS. Full of warmth, honesty and humour, this book is a gripping and moving testament to the everyday heroism of the NHS staff in a global emergency, and an unforgettable insight into what was really happening on the wards as we clapped on our doorsteps.
217 pages, Kindle Edition
First published March 4, 2021
21 people are currently reading
265 people want to read
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Displaying 1 - 30 of 34 reviews
February 28, 2022
(3.5) I think I’ve read about 20 Covid-themed books by now. Of the medical ones, this is in the second tier: it’s not quite as reflective, comprehensive and compelling as Intensive Care by Gavin Francis, or as literary, provocative and personal as Everything Is True by Roopa Farooki, but it’s a great read with solid case studies and good recreated scenes and natural dialogue. The focus is on the first few months of the pandemic and colleagues plus some key patients who he follows up on later through a September 2020 epilogue.
Down is an ICU doctor specializing in anaesthesia. His London hospital was soon overwhelmed with Covid patients. When I saw him speak at the 2021 online Hay Festival, he mentioned that the question of who would benefit most from the use of ventilation was creeping in as there was a risk that there would be more patients than there was equipment to treat them with. With decisions needing to be made very quickly, his hospital adopted the “three wise people” collaborative method. Tracheostomies and proning were two other frequently used treatment methods. He goes back and forth on his opinions of them based on their limited experience at the time.
Down is an ICU doctor specializing in anaesthesia. His London hospital was soon overwhelmed with Covid patients. When I saw him speak at the 2021 online Hay Festival, he mentioned that the question of who would benefit most from the use of ventilation was creeping in as there was a risk that there would be more patients than there was equipment to treat them with. With decisions needing to be made very quickly, his hospital adopted the “three wise people” collaborative method. Tracheostomies and proning were two other frequently used treatment methods. He goes back and forth on his opinions of them based on their limited experience at the time.
March 8, 2021
Excellent. Poignant, relatable and beautifully-written account of Covid from the eyes of an expert.
February 7, 2022
4.5 stars.
Not a book I would necessarily have picked up but I'm glad it was chosen for our reading group. I was really affected while reading it. It was sad, it was inspiring, it was poignant, it was thought-provoking, it was important. A very readable, candid, compassionate account of the beginning of the COVID-19 pandemic written by an ICU doctor in London and a timely reminder of the importance of the NHS and its amazing staff.
I didn't know anything about how ICUs are set up and run and I was glad to learn more about that. Reading about how doctors had to increase ICU capacity and react to and treat a disease no one knew anything about, from how it was transmitted to how it affected people, was so powerful and impressive. For a lot of people the early days of the pandemic were just about lockdown and uncertainty. What NHS staff did then (and have continued to do) is incredible. They put themselves at risk every day and went above and beyond to help people, including having to treat their own colleagues and friends. Reading about how people from other areas of medicine (dentists, medical students, surgeons and nurses from other specialities etc.) volunteered to work with ICU staff to treat COVID patients was inspiring and humbling.
Some parts that really stood out to me included learning about how staff worked to set up new ways for family members to communicate with patients, buying iPads and setting up video calls. Holding on to humanity and compassion in the midst of everything that was happening. The toll it took on staff, on their mental health, dealing with so much death every day, especially the ICU nurses. The fact that in April, some private hospitals signed a contract with the NHS to perform major cancer surgeries (which NHS hospitals treating COVID patients were no longer able to do). But most of all, the stories of Adam, Tricia and Jonathan. They were heart-breaking. So much of the reporting of COVID focused on the overall numbers and not the individual lives lost. Their stories were incredibly sad. I'm glad that stories of survivors were included as well, especially Tess and Carla, two ICU nurses.
This hit me hard, from the afterword: "Having seen such remarkable recoveries towards the end of the first wave, I thought that if we were just determined and persistent then this time around we'd be able to save more people. Patients came back from the brink first time round, from past the brink, from places I'd thought were beyond hope. Never give up, I reasoned, and eventually they'd pull through - not all of them perhaps, but the vast majority. I was wrong. The outcomes were better than in the first surge, but not dramatically so. More people caught Covid this time, so more came to ICU and more died. They didn't die in the first surge because we gave up on them, they died because Covid is brutal and relentless, and while some patients claw their way back against the odds, many do not - whatever support and care they receive."
I think sometimes the reality of COVID gets lost. This book is an important reminder.
Not a book I would necessarily have picked up but I'm glad it was chosen for our reading group. I was really affected while reading it. It was sad, it was inspiring, it was poignant, it was thought-provoking, it was important. A very readable, candid, compassionate account of the beginning of the COVID-19 pandemic written by an ICU doctor in London and a timely reminder of the importance of the NHS and its amazing staff.
I didn't know anything about how ICUs are set up and run and I was glad to learn more about that. Reading about how doctors had to increase ICU capacity and react to and treat a disease no one knew anything about, from how it was transmitted to how it affected people, was so powerful and impressive. For a lot of people the early days of the pandemic were just about lockdown and uncertainty. What NHS staff did then (and have continued to do) is incredible. They put themselves at risk every day and went above and beyond to help people, including having to treat their own colleagues and friends. Reading about how people from other areas of medicine (dentists, medical students, surgeons and nurses from other specialities etc.) volunteered to work with ICU staff to treat COVID patients was inspiring and humbling.
Some parts that really stood out to me included learning about how staff worked to set up new ways for family members to communicate with patients, buying iPads and setting up video calls. Holding on to humanity and compassion in the midst of everything that was happening. The toll it took on staff, on their mental health, dealing with so much death every day, especially the ICU nurses. The fact that in April, some private hospitals signed a contract with the NHS to perform major cancer surgeries (which NHS hospitals treating COVID patients were no longer able to do). But most of all, the stories of Adam, Tricia and Jonathan. They were heart-breaking. So much of the reporting of COVID focused on the overall numbers and not the individual lives lost. Their stories were incredibly sad. I'm glad that stories of survivors were included as well, especially Tess and Carla, two ICU nurses.
This hit me hard, from the afterword: "Having seen such remarkable recoveries towards the end of the first wave, I thought that if we were just determined and persistent then this time around we'd be able to save more people. Patients came back from the brink first time round, from past the brink, from places I'd thought were beyond hope. Never give up, I reasoned, and eventually they'd pull through - not all of them perhaps, but the vast majority. I was wrong. The outcomes were better than in the first surge, but not dramatically so. More people caught Covid this time, so more came to ICU and more died. They didn't die in the first surge because we gave up on them, they died because Covid is brutal and relentless, and while some patients claw their way back against the odds, many do not - whatever support and care they receive."
I think sometimes the reality of COVID gets lost. This book is an important reminder.
This entire review has been hidden because of spoilers.
March 21, 2021
Incredibly moving book from an ICU consultant at University College Hospital, London describing his work through the first wave of Covid in 2020. Humane and compassionate and fascinating to read as he sets it out against the dates and political interventions. Nothing but admiration for all those on the frontline - truly humbling.
March 17, 2021
This book is simply stunning. The writing is so powerful, so honest, simply stunning. Thank you Jim for writing it and thank you to you and all of your NHS colleagues for everything you have done and continue to do.
July 30, 2025
Having read "Life in the Balance", I knew what to expect from Dr Down's writing and I wasn't disappointed - his account of the first wave of Covid was both factual and moving. I learnt an awful lot about what the doctors were facing i.e., the trial and error in terms of treatment methods and how there was very little overall guidance provided.
The only downside for me is that I wish it had covered future waves of the pandemic. Although the treatments would likely have been standardised and the doctors would have known what to expect, I think it would have been insightful to understand how the virus and the doctor's attitudes changed beyond June 2020
The only downside for me is that I wish it had covered future waves of the pandemic. Although the treatments would likely have been standardised and the doctors would have known what to expect, I think it would have been insightful to understand how the virus and the doctor's attitudes changed beyond June 2020
January 31, 2025
It's such a great snapshot of the realities of front line ICU care during covid. It goes through a lot of the issues that were identified and the solutions.
It is quite work-focussed though, which may be off-putting for people who are not in healthcare and don't understand why so many meetings are necessary.
It is quite work-focussed though, which may be off-putting for people who are not in healthcare and don't understand why so many meetings are necessary.
December 29, 2022
I loved the way this was written. A really good insight into an ICU and how one was run during the first wave of the pandemic.
November 13, 2021
As it says in the title, first hand account of in icu doctor at the forefront and within the cycle of the first vivid wave through London in 2020.
Clarity, honesty, emotion, easily understood scientific explanations and at times stoic humor. Am I sight into what those in the public NHS health system went through at one of the major London hospitals at a time no one had experience, understanding or an accurate vision of what Covid brought, was and would/could be.
Emotional, touching, inspiring.
4.5
Clarity, honesty, emotion, easily understood scientific explanations and at times stoic humor. Am I sight into what those in the public NHS health system went through at one of the major London hospitals at a time no one had experience, understanding or an accurate vision of what Covid brought, was and would/could be.
Emotional, touching, inspiring.
4.5
June 22, 2021
A fascinating behind the scenes look at life for clinicians in ICUs during the pandemic. Written by a very senior anaesthetist/intensivist who is not afraid to highlight the deficiencies and wrong decisions, but who is also a realist. He took responsibility for the ethical dimensions and that was the most fascinating aspect of the book for me. How DO you balance everything when resources are finite, so much about the disease unknown, and death is all around you?
September 12, 2021
This book is the story of an ICU doctors experience during COVID's 1st wave, as an NHS worker I am more than aware of the struggles and expansions made to ICU to help cope with the severity of ill people needing ventilation. But to hear it from a consultant doctor who works in London, and the sheer stress of working with an unknown virus just makes it hit home all over again!!
Definitely recommend
Definitely recommend
June 6, 2021
A humbling read. An important book. A reminder that Covid is an incredibly dangerous virus that attacks the whole body and oh how fortunate we are to have the wonderful NHS (stop clapping nurses, pay them properly).
April 19, 2021
O.M.G.
October 6, 2021
This book made Covid very real for me - it gives good insight as to who the heroes of today really are.
January 18, 2024
I’ve read many many books on Covid and this matches up very well. Honest, direct and compassionate - what the staff went through in ICU is horrific.
March 1, 2022
Thanks to the Reading Agency and Warwickshire Libraries who sent me a copy of this book, which otherwise I would never have read. And I am so glad I did.
Jim Down is a doctor on the Intensive Care Unit at University College Hospital in London and the book is the story of his experiences during the first wave of the COVID-19 pandemic March – May 2020. It builds from those first stories coming out of China that something extraordinary was happening through the first lockdown as the pandemic hit the UK and millions of people had to change their lifestyles and daily habits.
Doctors, of course, had to change those habits for very different reasons and Jim Down describes his personal feelings as they had to start “donning and doffing” the full PPE for the first time and then change the nature of the hospital from one mainly dealing with the usual planned treatments and operations to dealing with the rising input of patients suffering from COVID-19 infection.
What really struck me was how the situation was dealt with. As Jim describes in the book, when they needed to take over the operating theatres to change them into “pods” with all the necessary equipment, drugs and staff to treat COVID patients, they JUST DID. There were no budget meetings, no looking at whether this could or should be done, it was just done. Teams changed the space into working areas, others ordered ventilation equipment whilst still others recruited nurses, doctors and ancillaries and drew up the necessary rotas to ensure that the ratios of staff to patients were kept up.
Jim Down uses real patients’ stories to illustrate what was going on as they discovered more about the disease and treatments, the tragedy of losing some and the joy of saving others and how that affected the hospital staff and the patients’ families. This is a must read and if you wondered why you were on your doorsteps clapping on a Thursday evening during this time, then your answers lie within.
Jim Down is a doctor on the Intensive Care Unit at University College Hospital in London and the book is the story of his experiences during the first wave of the COVID-19 pandemic March – May 2020. It builds from those first stories coming out of China that something extraordinary was happening through the first lockdown as the pandemic hit the UK and millions of people had to change their lifestyles and daily habits.
Doctors, of course, had to change those habits for very different reasons and Jim Down describes his personal feelings as they had to start “donning and doffing” the full PPE for the first time and then change the nature of the hospital from one mainly dealing with the usual planned treatments and operations to dealing with the rising input of patients suffering from COVID-19 infection.
What really struck me was how the situation was dealt with. As Jim describes in the book, when they needed to take over the operating theatres to change them into “pods” with all the necessary equipment, drugs and staff to treat COVID patients, they JUST DID. There were no budget meetings, no looking at whether this could or should be done, it was just done. Teams changed the space into working areas, others ordered ventilation equipment whilst still others recruited nurses, doctors and ancillaries and drew up the necessary rotas to ensure that the ratios of staff to patients were kept up.
Jim Down uses real patients’ stories to illustrate what was going on as they discovered more about the disease and treatments, the tragedy of losing some and the joy of saving others and how that affected the hospital staff and the patients’ families. This is a must read and if you wondered why you were on your doorsteps clapping on a Thursday evening during this time, then your answers lie within.
October 4, 2021
Jim Down is a consultant in critical care and anesthesia at University College London Hospitals. This book is an account of his experience treating covid-19 patients inside the UCH Intensive Care Unit as the pandemic took hold.
While I do agree that this book is a powerful, moving account of a doctor's life on the frontline of the Covid-19 pandemic, I was expecting more in-depth information about not just Covid's reactions in patients, but how he and his colleagues dealt with an unprecedented influx of patients (he gives details here and there, but moves quickly to other matters).
What I enjoyed the most of this book was how Dr. Down really delivers a moving testament to the everyday heroism of the medical staff in a global crisis and a powerful insight into what really happened behind the wards- all with honesty and warmth. I seriously felt I was with Dr. Down right inside the ICU. There were some very raw anecdotes of patients that died, and Dr. Down explained in simple medical terms how the Covid affected them, and ultimately shut down their bodies. Moreover, he detailed (also using simple medical terms) how Drs and medical staff use everything in their hands to save lives.
Overall, Im giving 3 stars because:
* Even though its a personal recollection of events during the pandemic, I would've liked a bit more context and his personal view perhaps of covid's origins and future (he mentions vaccines very briefly)
* I wanted Dr. Down to include more anecdotes of Covid patients (particularly how covid developed and affected the body, and what measures Drs. were taking to save lives)
* I felt the end was a bit rushed, quickly thanking everyone in one page. I would've liked perhaps some food for thought about how hospitals and medical staff should adapt and design measures to be more effective shall a new virus/pandemic arise.
While I do agree that this book is a powerful, moving account of a doctor's life on the frontline of the Covid-19 pandemic, I was expecting more in-depth information about not just Covid's reactions in patients, but how he and his colleagues dealt with an unprecedented influx of patients (he gives details here and there, but moves quickly to other matters).
What I enjoyed the most of this book was how Dr. Down really delivers a moving testament to the everyday heroism of the medical staff in a global crisis and a powerful insight into what really happened behind the wards- all with honesty and warmth. I seriously felt I was with Dr. Down right inside the ICU. There were some very raw anecdotes of patients that died, and Dr. Down explained in simple medical terms how the Covid affected them, and ultimately shut down their bodies. Moreover, he detailed (also using simple medical terms) how Drs and medical staff use everything in their hands to save lives.
Overall, Im giving 3 stars because:
* Even though its a personal recollection of events during the pandemic, I would've liked a bit more context and his personal view perhaps of covid's origins and future (he mentions vaccines very briefly)
* I wanted Dr. Down to include more anecdotes of Covid patients (particularly how covid developed and affected the body, and what measures Drs. were taking to save lives)
* I felt the end was a bit rushed, quickly thanking everyone in one page. I would've liked perhaps some food for thought about how hospitals and medical staff should adapt and design measures to be more effective shall a new virus/pandemic arise.
May 21, 2023
An important book because it traces the experience of front line medical staff and patients through the pandemic year of 2020. Reading about the way that the hospitals managed the demands placed on them was almost incredible.
I particularly appreciated page 126 where the doctor is so open about his attempt to see things from the patient’s perspective, when he reads about his conversation with her in the book she later wrote. I am pleased to see empathy taking a bigger part of doctors’ training. I appreciate that doctors can’t have total empathy - how would they ever sleep at night - but the doctor patient relationship does contain a huge power imbalance and it’s good to see this acknowledged.
He also considers the fairness/benefit ethical arguments, which I also found fascinating because of the pressure that could have been placed on doctors during the pandemic. It would be good (but idealistic) to hope that we never have to move to a benefit based model of care, but surely it must be edging closer.
Overall this is a humane, affecting and important book about pandemic medicine and a straightforward read for a reader with no medical background.
I particularly appreciated page 126 where the doctor is so open about his attempt to see things from the patient’s perspective, when he reads about his conversation with her in the book she later wrote. I am pleased to see empathy taking a bigger part of doctors’ training. I appreciate that doctors can’t have total empathy - how would they ever sleep at night - but the doctor patient relationship does contain a huge power imbalance and it’s good to see this acknowledged.
He also considers the fairness/benefit ethical arguments, which I also found fascinating because of the pressure that could have been placed on doctors during the pandemic. It would be good (but idealistic) to hope that we never have to move to a benefit based model of care, but surely it must be edging closer.
Overall this is a humane, affecting and important book about pandemic medicine and a straightforward read for a reader with no medical background.
January 30, 2022
Jim Down is an intensivist at UCH in London who was working at the frontline of the Covid pandemic from the very first day. This book details the panic and professionalism of facing an unknown virus that filled ICUs with some of the sickest patients ever seen. And so many of them. Down details the urgent planning and reorganisation needed to increase capacity with pop up ICUs, re-purposing of equipment and pulling in staff from dentists to medical students to help deliver care. He also shares the agony of caring for NHS staff and his sorrow and despair for all the patients who died. No part of the NHS remains untouched by Covid 19, but those working in intensive care were the vanguard. Throughout the pandemic they risked their own lives to help others. They deserve books like this that honour them.
March 18, 2022
This was a very interesting and scary read at the same time. It was honest and if we hadn't have lived through the past 2 years I would say it was unbelievable - who knew. It is definitely a book for future generations to read to understand the pandemic and what I wonderful Doctors and Nurses went through. I really enjoyed the book and recommend this read to everyone.
March 1, 2023
Great insight into life as a doctor especially life as a doctor or medical worker during the Covid-19 pandemic. A lot of this will stick with me. Serious at times, scary, heartbreaking, educational, but also lighthearted at times and very funny. Thanasis sounds so cool and best wishes to everyone involved in the book.
October 9, 2023
Picked this up after listening to Jim Down on the How to Fail pod and I'm glad I did. Even after a few years it still felt incredibly raw to go back to pandemic times and relive the experience, albeit from a slightly different perspective. It was factual but easily understandable, moving, humane, empathetic and enjoyable to read and get a real glimps into the NHS world at the time.
March 17, 2022
I really recommend this book as it has made me see the hard work that the ICU staff do. Such an inspirational book, very informative of the dedication of the staff to their work. It is a gripping and compelling read. It is interesting to see how the pandemic has affected the everyone.
December 25, 2022
An insightful and captivating book about the author’s experience in preparing the hospital and ICU for Covid and in treating Covid patients. The author handled the backstory of the healthcare workers and patients well and managed to get us to empathize with them.
April 25, 2023
another emotional book
regarding covid and ICU; i always find ICU books hard-hitting yet so informative of the touch and to scenarios faced everyday. Down describes his experience in such a moving manner whilst conveying solid facts of the pandemic. highly recommend.
regarding covid and ICU; i always find ICU books hard-hitting yet so informative of the touch and to scenarios faced everyday. Down describes his experience in such a moving manner whilst conveying solid facts of the pandemic. highly recommend.
June 2, 2024
This book covers the lead up to the end of the first “wave” of the pandemic, from the perspective of the author, who was working as an intensive care consultant in the NHS. It's really well-written, which makes it engaging and easy to read, and the content is unsurprisingly fascinating.
August 30, 2024
Excellent writing by a very warm, clever, human and self deprecating Dr. An interesting portrait of the first Covid wave. It would be good to have a more detailed account of the waves that came afterwards, vaccines etc and also what things are like now.
February 22, 2022
Is good. Didn't shy away from racial issues but also didn't say anything glaringly racist.
A personal account from the frontlines.
Definitely made me cry but also celebrate the wins.
A personal account from the frontlines.
Definitely made me cry but also celebrate the wins.
March 17, 2022
Loved it. For someone with no medical experience it gave me an insight into what an ICU Doctor’s day to day work life is like, as well as how busy it got during this unfortunate period in our lives.
Displaying 1 - 30 of 34 reviews