A Story of Home Interview with Dr Jim Down

Dr Jim Down from UCLH’s Intensive Care Unit talks to Story of Home about Fitzrovia

During the pandemic and lockdown senior critical care consultant, Dr Jim Down, was part of the team responding to the biggest challenge to ever face the Intensive Care Unit at UCLH (University College London Hospital) in the heart of Fitzrovia.

In 2021, Penguin Random House published the extraordinary book Jim wrote about his experience. He met with us to talk about ICU, the book and about Fitzrovia as a place of work and solace.

At The Heart of Everything

Dr Jim Down describes Fitzrovia, as “a place of surprises that has grown on me as I have come to realise that it is buzzing with creative activity and stuffed with gorgeous pubs, restaurants and Bakery’s, (my favourite being Miel’s on Warren Street).”

For a man occupying one of the most pressurised jobs in the capital, Fitzrovia has come to be a place not just of work but of solace from the stress and strain of saving lives.

“This is a very special part of town. I love the black Iron gates that mark the entrance to Regent’s Park. They remind of being taken to Osbourne House first thing in the morning for a swim by my grandfather in the 1970s.”

With the Park to the north, and bordered on the east by St Pancras and Bloomsbury, on the south by Soho and on the west by Marylebone, Fitzrovia is the most central and well-placed residential area in London. Beautiful streets of 18th, 19th and early 20th century apartments, townhouses, mansion blocks and warehouse conversions dissect the throughfares packed with commercial art galleries, restaurants, boutique hotels, bistros, cafes and pubs.

Media, advertising and architectural businesses hunker around Charlotte Street in the shadow of the iconic BT Tower. Fitzroy Place, on the site of the old Middlesex Hospital, is a polished labyrinth of homes with interiors designed by Johnson Naylor, office space, and shops, restaurants, and community spaces. The publicly accessible central square is the first new garden square to be constructed in W1 for 100 years.

Fitzroy Square

Despite all this, Fitzrovia has preserved a calmer, more laid-back feel than its surrounding neighbourhoods. But like those areas, a tangible connection to the past resides here. The area was designed and built for the aristocracy. When they moved on to Belgravia and Mayfair, many of the grand houses were subdivided into workshops and studios. European artisans established the district as a centre for the furniture trade by the end of the 18th century, with Thomas Chippendale among those based here.

The architectural jewel in the area’s crown, Fitzroy Square, is a short walk from Jim Down’s workplace, the UCLH campus, which dominates the northern corner of Fitzrovia. It is one of London’s finest garden squares, designed in the late-18th century by architect Robert Adam and named after Charles Fitzroy, 4th Duke of Grafton. “I like to wander around Fitzroy Square which always puts me in mind of Oliver Twist. I love the yellow grit of the pedestrianised streets and the grand Terraces. I sit on the benches and imagine what is going on behind the huge windows.”

The other thing Jim does on his walks around Fitzrovia is listen to a lot of comedy podcasts. He performed as a stand-up comic for a few months during what he describes as an early mid-life crisis and does not speak highly of the results. This and his stint as a consultant on the long-running TV series Holby City (where he met and fell in love with his wife) is an interesting off-set to a career that could not be more serious and which had inauspicious beginnings when his father, a hospital physician, arranged work experience for him in a hospital and a 17-year-old Jim Down kept fainting, to his father’s mortification. That all seems hard to associate now with the man who was a key part of the leadership team at UCLH during Covid, who announced Litvinenko’s death to the press on November 23rd 2006, and was working in the emergency department of the Royal London Hospital on 7/7. He spent the morning of that dark day in London’s history assessing and stabilising victims before they were taken to theatre and then on to ICU.

“I had never looked after a bomb victim before, and nothing can prepare you for it. After a morning of preparing 9 casualties for theatre I went up to the ICU to prepare for their arrival. My job then was to transfer one particular ICU patient to another hospital and I remember emerging with my patient into the sunshine and a bank of press and realising that this was a day that would go down in history. In the end, 7 of the 9 survived, one died on day one and one died 5 days later. I won’t forget him because tragically his girlfriend also died in the tunnel and his parents were extraordinary and donated his organs. There were incredible stories though, one woman I saw in the Emergency Department ended up losing both her legs above the knee but went on to compete in the 2012 Paralympics.”

Those are the days when medics and emergency workers are hailed as heroes, but it is not a description Down accepts for himself. In writing about his work, he talks of any achievements in terms of the team he is a part of, whilst putting the humiliations down to himself.

Fitzroy Square has been home to a line of eminent writers, including Virginia Woolf, George Bernard Shaw, Ian McEwan and the French Poet, Rimbaud. Too modest to admit it, but when he steps out of the hospital for the respite offered by the square, Jim is himself joining the established relationship between Fitzrovia and literary excellence. His first book, Life Support: diary of an ICU doctor on the frontline of the Covid crisis, was published in 2021 to huge acclaim.

Life Support

The book is a powerful and deeply moving account of an intensive care doctor’s life on the frontline of the Covid-19 pandemic. Jim tells the extraordinary month-by-month story of how

as the nation came to a standstill, he and his colleagues received an unprecedented influx of patients, transformed their hospital and took on the biggest challenge in the history of the NHS.

Described by Philippe Sands as ‘a personal memoir that grips, harrows, inspires and, ultimately, uplifts with its vein of deep humanity,’ one of the most striking things about reading Life Support is the realisation that a doctor running the ICU at one of London’s top hospitals is simultaneously capable of such extraordinary high-calibre prose writing.

“One of the reasons why I wanted to write this book was to give an insight into what intensive care is and how it changed in the pandemic. Most people do not get to see ICU unless they are a patient or a relative.”

The book is rightly described by the publisher as a testament to the everyday heroism of the NHS staff in a global crisis, and an unforgettable insight into what was really happening in the wards as we clapped on our doorsteps. But Jim is at pains to take the spotlight off himself and remind us that the book is about the team he is a part of.

One of his roles as part of the team was head of ethics through the pandemic for the University College London Hospitals trust. He implemented a “three wise people” system, so that no ICU doctor would be required to make life-or-death decisions without support and input from two colleagues. The pandemic also raised difficult questions for him personally, especially how do you go home at night to your wife and young children when you’ve spent all day around highly infectious patients?

“I certainly found the contrast between the ICU and the outside world a challenging one at times,” he says. “I think my relationship to the beautiful backstreets of Fitzrovia, to the square and to Regents Park, went from being one of appreciating an area as a backdrop to my working life to gaining great strength from it. We have amazing views over the whole of London from the upper floors of UCH. Usually, I work on the third floor so rarely get to enjoy them but during covid we opened an ICU on the seventh floor, and I witnessed some beautiful and dramatic sunrises over Fitzrovia and the wider city on those never to be forgotten night shifts.”

Puzzled, Frightened and Inspired

Whilst his professional home is Fitzrovia, home is North London and Jim’s great love is Hampstead Heath, where he runs.

“My current obsession is the Lido there. I started going a year ago in response to a period of poor mental health and never stopped. Now every morning I join the same group of 15 people in the queue waiting for it to open at five to seven in the morning. When the temperature dropped below 10 degrees I put on neoprene gloves and socks and against all my expectations I made it through the winter. I know the whole wild swimming thing is a cliché, but I love it and the community that surrounds it.”

Jim has an ambition to write fiction but before he fulfils that he is putting the finishing touches to his second non-fiction book for Penguin, to be called Life in the Balance – Stories from Intensive Care.

“The second book is probably best described as ‘all the things that bother me about working in ICU.’ Illustrated by real cases that I have dealt with over the years, it explores all the aspects that puzzle, frighten, move, depress and inspire me about the job. It is personal and honest and as well as trying to give an insight it gently challenges the received wisdom, to make the point that much is unknown or up for debate and that the world of ICU is an evolving one, both clinically and ethically. It will be out March 1st, 2023, and will include some personal moments of humiliation for light relief.”

 ‘Life Support’ by Jim Down is published by Penguin Random House and available from your bookseller of choice. Click here to follow the link.