How To Fail With Elizabeth Day - S10, Ep6 How to Fail: Jim Down

Episode Date: March 10, 2021

Today's episode is an important one. Jim Down is an ICU doctor on the frontline of the Covid crisis. He is a consultant in critical care and anaesthesia at University College London Hospital, running the intensive care unit at one of London’s busiest hospitals, where life and death decisions are an everyday occurrence.Despite having spent all his adult life working in these conditions, nothing could have prepared Jim Down for Covid-19. As the pandemic descended in spring 2020, Down found himself under almost unimaginable pressure. He and his colleagues dealt with an unprecedented surge in patients, critically ill from a terrible new disease with no known cure. Down is still working at the frontline, still donning PPE every day, still under extreme pressure as the NHS continues to battle through the pandemic and keep us safe.He joins me to talk about this, as well as how he manages his own anxiety, why lockdown works (it's worth it, everyone!) and what he's learned from this unprecedented time. He tells me about his awkwardness at being described as a 'hero' and how he deals with the emotional challenge of informing relatives their loved ones have died. Plus, we discuss his failures in adolescence, professional failures and - rather unexpectedly - a failure in stand-up comedy.Listen to be both moved and informed. Thank you, Jim.*You can watch Jim Down being interviewed on BBC News at the height of the pandemic here.*Jim Down's book, Life Support: Diary of an ICU Doctor on the Frontline of the Covid Crisis is available to order here.*How To Fail With Elizabeth Day is hosted by Elizabeth Day, produced by Naomi Mantin and Chris Sharp. We love hearing from you! To contact us, email [e-mail]*Social Media:Elizabeth Day @elizabdayHow To Fail @howtofailpod         Learn more about your ad choices. Visit podcastchoices.com/adchoices

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Again, that's betterhelp.com forward slash howtofail. Thank you very much to BetterHelp. Hello and welcome to How to Fail with Elizabeth Day, the podcast that celebrates the things that haven't gone right. This is a podcast about learning from our mistakes and understanding that why we fail ultimately makes us stronger. Because learning how to fail in life actually means learning how to succeed better. I'm your host, author and journalist Elizabeth Day, and every week I'll be asking a new interviewee what they've learned from failure. Jim Downs' father was a doctor. Both his grandfathers were doctors. He met his actress wife on the set of Holby City

when he was employed as a medical advisor. You could say then that medicine has always been in his blood. He is now a consultant in critical care and anaesthesia at University College London Hospitals. What this effectively means is that he runs the intensive care unit at one of London's busiest hospitals, where life and death decisions are an everyday occurrence. Despite having spent all his adult life working in these conditions, nothing could have prepared Jim Down for COVID-19. As the pandemic descended in spring 2020, Down found himself under almost unimaginable pressure as he and his colleagues dealt with an unprecedented surge in patients critically ill from a terrible new disease. Down is still working at the front line, still donning full PPE to treat patients in crisis, still leaving his wife and 11-year-old twins every day without knowing what lies ahead. Although he disdains the word, many would call him a hero. His debut book,

Life Support, tells the month-by-month story of how he and his colleagues tackled the biggest challenge faced by the NHS. It is gripping, moving and an unparalleled insight into the astonishing work done by doctors, nurses and other frontline workers during the pandemic. People who saved lives but who also stood witness to death and tragedy on an awful scale. I have never got used to breaking bad news to relatives, Dan writes in Life Support. I used to work hard to contain my emotions and stay professional. I thought that was what was required, but I don't anymore. I can't. What has become clear to me is that even at the lowest point, people are capable of the most incredible humanity and dignity. Dr. Jim Down,

welcome to How to Fail. Thank you very much indeed for having me. It's a privilege and an honour to be on. It is a privilege and an honour to have you on. And I chose that particular quote because it resonates with me so deeply as someone who fundamentally believes in the power of connection through vulnerability and how difficult that must be for a consultant who is put in a position of power then to have to share his own emotions when breaking bad news tell me a little bit more about that moment of vulnerability for you and how important you've come to believe it is. It's strange, I think through my career, the older I've got, the more emotional I've become in those moments. It's a combination of

things really. It's I think a combination of being more similar age to a lot of patients and feeling like we all do as we get older, our mortality. And so when you're 25 and you sort of feel immortal and they feel like a different, it's unusual that you're talking about a 25 year old, whereas when you're 50, they're much more your generation. Also having children is maybe more vulnerable, it feels more vulnerable. And then in my particular world, those conversations are often with the families of patients who may have never met the family before because they've got critically ill in the last day or two. And you meet them and the first thing you say to them is, you know, the worst news they'll ever get. And as I think I said in the book, it's just awful to see the impact that you're having.

And you being a stranger, having that impact is it sort of double hit, if if you like so it's someone they don't know telling them the worst thing possible they then often say oh gosh this must be awful for you and you just think well that's crazy but it just sort of shows how amazing people can be even in the worst moments and during covid as well you write about this so movingly in the book. I mean, you did make me cry at several junctures. But I know that there was an added difficulty because of course, loved ones couldn't come into the hospital to say their goodbyes. And there's this one couple that you talk about, Jonathan and Megan, and the nursing staff got an iPad to him. But could you tell us about Jonathan and Megan and how they said their goodbyes and how that affected you? Yeah so Jonathan was a young man of

40 who'd already been through two or three years of terrible time with leukaemia and bone marrow transplant and he'd just come through that I think he might have even been the last one we did in the run-up to Covid and then he had complications and he caught COVID and he came down to ITU and he was on the CPAP so he was awake for a few days then he and we realized that he needed to be put off to sleep for us to take over the ventilation and we'd come to the point at that time of allowing families in at that moment to sort of talk to their loved ones face to face because unfortunately we knew that about, you know, somewhere around 50% of people put on a ventilator, don't get off it. But his wife, Megan has asthma and was shielding at home, and they've got two kids. So we did it through an

iPad. They had the conversation, and it was clear they knew what it meant. And he was able to talk, but it's hard for him, you know, his breathing was hard, and he had a tight mask on his face. And he was able to talk, but it's hard for him. You know, his breathing was hard and he had a tight mask on his face. And she was just amazing because she was completely calm and supportive of him, but knew exactly what it meant, but knew that she had to be calm and strong for him so that he had confidence going off to sleep. And the other thing was that I could totally imagine picking my kids up from school and them being one of the parents at the school gate.

And I know their kids are just a bit younger than mine. And that combination of strength and love and I just recognized them so clearly that that was sort of overwhelming. And because of the book, with a few of them, I've been in touch with them since. And that's a new thing for me you know normally we don't see people months and months after so that's another aspect of it. We're talking on the 3rd of February 2021 and Covid-19 is still very much happening all around us it's still a frightening time to be living through and I suppose I just wanted to know how you are and how the hospital is. I mean, I'm so grateful that you've given us this time,

because I can imagine you're still under extraordinary pressure. So yeah, the hospital's still busier than it was in the first surge. We've got about 110 ICU patients at UCH, which is three times normal. It's flattening. I mean, I think a bit, or we're hoping it is, but they're still coming in through the door. And it's still a horrible disease. If you get this sick, it's still incredibly complicated and unpredictable and severe. And obviously still lots of people are dying. I think we're at the bad point at the moment in that we're sort of the equivalent of the, I hope, of the sort of late April where there's lots of people who are lots of sick, and I'm hoping that that'll start to turn soon. But it's, yeah, it's busy. I think the big change

this time is we've done it before, so we're a bit more used to it and we're a bit better organized. And so working is actually better from that point of view you know we're better set up but the disease is it's just horrible one of the things that i really value about your writing is that you openly admit to being pretty anxious yourself and um and you say there's this great line where you say that you know people people of medical profession generally fall into one of two categories. They're either stoics or hypochondriacs. And you put yourself firmly in the hypochondriac category. How are you managing your own anxiety right now?

So I'm a terrible hypochondriac. I mean, if you ask anyone in my family. And in fact, I've had to develop a few techniques. One is to run too much. I've had to develop a few techniques. One is to run too much. And the other is to, someone said, you're going to have to develop a four day rule where any symptom you've got, you're not allowed to tell anyone until it's been there for more than four days. And that's been very useful to me because most things have gone away in four days as GPs will tell you, but you know, it doesn't stop me being a hypochondriac. It's a funny time for everyone, isn't it? I mean, when it started,

I was frightened with COVID like everyone, there was a buildup, but then once you're, it doesn't stop me being a hypochondriac. It's a funny time for everyone, isn't it? I mean, when it started, I was frightened with COVID like everyone, there was a build up. But then once you're doing it, once I've come to terms with what the risks were gone through them on my head, put on the PPE, seen everyone else was putting on the PPE, it was sort of a relief. And in fact, as long as I'm being careful, it's actually fine on the whole. And most of the staff members, I think very few of us have caught COVID off patients. I think we're lucky in that way, in that we've got good protection. I think some of us caught it from each other and, you know, on the tube and all that kind of thing. But I think once we're in the room, in the bays with the patients, we're pretty safe. The other bit of anxiety that I've had is treating a disease that we've never

seen before and I found that very hard because all bets are off. I mean this time it's a bit better but we didn't know what was coming next. It is such a horrible disease so unpredictable that constantly going off down a treatment which seems all sensible and then a day later it does something completely throws it all back in your face but you know I'm lucky I work with a group of very clever people who drag me along and we collaborate so there's always a mate you can ring and talk to about it there's always someone to discuss it with you won't be aware that you're doing it but I just want to point out to listeners that whenever I ask you a personal question you start answering as you and then you completely broaden it out to include everyone else including

your colleagues and you do that in your book as well as I mentioned in the introduction you don't like the idea of being called a hero there was a fantastic profile of you in the new statesman in which you didn't want to be quoted and And actually, it's an amazing read in spite of that. But I wonder how then it sits with you, that we members of the public have such extraordinary admiration and gratitude towards you. And there was all that kind of clapping for the NHS at the beginning of the first lockdown and being called heroes. How does that sit with you? If I'm really honest, I've got elements of show-offness I've stand up on a stage you know I like presenting to people and that kind of thing so I can't claim to be a total retiring wallflower whatever whatever shy and retiring person on the

other hand with this I'm not a hero in this I'm just one of millions of people doing their job. And I happen to be the person who they filmed on the BBC. But, you know, I'm not doing anything different to anything special. That's definitely true. So I do feel very sort of self-conscious about it, if you like. The work that nurses are doing, quite a lot of doctors, consultants from other specialties are doing nursing shifts. For instance, yesterday I was on and there was a consultant gynecologist working as an ITU nursing assistant. And he said he does this two 12-hour shifts a week around his other work because he said no one's going to die of the stuff I do.

This is what's needed. And I said, how are you finding it and he said I cannot believe the amount of care that the nurses deliver to these patients every day and that's really what it comes down to the detail and intensity of the nursing care to IT patients is the key to this and the fact that they've had to expand up to three times their capacity with no more trained ITU nurses. They've got lots of helpers, but in terms of trained ones, they're all employed. There aren't hundreds of unemployed ITU nurses.

So, you know, I'm a bit biased, but I think they're certainly some of the heroes along with lots of other people. But they're the ones that sort of strike me every day. We've got a whole floor of UCH that is now an ITU that was just a normal ward before. And you walk around, it seems completely calm and in control and all the machines are not alarming. And then if you dig a bit deeper, you find that the IT nurses are right on the edge of being able to do it because they're stretched between three patients instead of one. But you'd never know that unless you sort of really push them and ask them because they're totally professional and they just sort of get on with it and cope.

To me, they're pretty humbling. This obviously is the podcast about failure and we're going to get on to your three personal failures in a minute. But I wanted to ask you a bit about a kind of global failure. a kind of global failure. We are talking in this context. And I wonder if you have felt any anger at a failure to respond and to manage this crisis in the right kind of way, whether that be directed at government or members of the public who aren't social distancing or people who insist on wearing their masks around their chins. Is there a sense of anger at that? I mean, I'm very cautious. I've had the vaccine, but I'm very cautious about, you know, infection transmission and masks and public places. But I'm also aware that I'm very influenced by what I see

day to day. And so to me, it's this awful disease that kills everyone or makes everyone crissly ill who's got it, which is obviously not what everyone else sees. You know, I'd love everyone to obey the lockdown. You know, I've got 11-year-olds. I can't imagine what it's like to be a student. I believe these lockdowns work. We definitely see in the hospital they have a huge impact

and we can't cope with more patients. That is great to hear. Yeah. You mentioned your 11 year old twins there and I wanted to ask you about them actually because I'm assuming they will have started secondary school around now but online. In September so they're still in their last year but they're both at home I think every parent around the country knows what that's like but they're doing well I mean in fact one of them's just changed schools and has gone to a school where he's not actually been yet it's quite weird so he's in a class but he's never seen any of the people apart from through a zoom call but he's doing really well and he's sort of

made virtual friends which is quite an odd thing I think for an 11 year old probably less odd I suppose for him than would be for someone like me it's hard to judge isn't it I think they're doing okay they're still talking to us I mean I'm desperate for it to be over like everyone else but I think they're hanging in there I have to say I really enjoyed the glimpses of your family life that you gave us in the book your wife sounds terrific there's this brilliant anecdote about I think it's the first few times that people were doing clap for carers and your wife was sort of hissing under her breath yes but they need to fund the NHS probably they can't just clap and get away with it and I loved it I'd got a real sense of of the love that's there but also the fact that it kind

of keeps you grounded yes I mean that sarcastic clapping of my children was hilarious but they've been great on that I mean the quote I think that my daughter said you only had her so you could look good on tv I think that's a real quote and it was brilliant because at any day coming home from whatever the covid was he got back to normal which was probably, I think, what kept us all sane. So they were wonderful in their own way. That quote you mentioned, you only had us so you could look good on TV, refers to the fact that you were interviewed for the BBC News by Fergus Walsh in a piece that was, for many of us, the first

time that we had seen the reality of a COVID ward in a busy London hospital and I think it was a massive turning point for many people in the first lockdown it was an incredibly memorable piece and you welled up even though you hadn't expected to when you were talking about your children and what they were going through so I actually re-watched that report in preparation for this interview. And I highly recommend anyone to go and Google it because it really does bring it home to you. But talking about your 11-year-old children brings us onto your first failure. And we've never had this failure before. And I'm so pleased that you've chosen it because it's going to affect so many people and your first failure is puberty so tell us why you chose that so I wrestled with whether to choose this or not for two reasons one

is that I've passed puberty now uh so it's yeah I know exactly and the second is it's a sort of failure of the body rather than the mind but I put it in because it's two years that feel much more than two years over the span of my life because basically I went to one of these very ancient traditional boarding school where essentially I mean that seems bizarre now thinking about it but rugby was sort of the main currency and I arrived there as a 13 year old and was quite sporty and quite into it and my stock was reasonable and then everyone else went through puberty and I didn't and it went on and on for a while and I vaguely I remember vaguely ever hearing my dad sort of talking to someone else about it not quite as a problem but

I think you know he's medical and he was sort of clearly slightly on his mind and at the same time I was bullied at the school and that was the sort of route I had a high-pitched voice and it was in a town our school used to hear this squeak that was the kind of bullying call and it just did it had a sort of physical effect on me at the time I was unhappy and sort of also worried that it might never happen. But also it made me re-evaluate everything because I suddenly realised, you know, before that I'd not really understood being an outsider or readjusting. And anyway, then when I was about 16, I think things changed and it was all sort of fine. So I'd become a more empathetic person who wasn't just trying to be in this sort of cool gang and was a bit more aware of other people. And it sort of always stayed with me for lots of different reasons. That's a funny time for people's lives.

And that was my particular reason. I think you think that there's something wrong with you at that age. And it's so interesting talking about this because I like you was a late developer even that phrase I hate using but I still feel I still feel at the age of 42 well past puberty a sort of sense of shame and slight embarrassment that it took me longer than my peers to hit puberty and it's not something I would ever have spoken openly about. And I wonder how alone you felt at the time. I felt very alone. I mean, obviously it highlighted that I wasn't tough, you know,

and I don't think anyone would describe me as tough. And I think the thing about it is such a physically obvious thing, you know, I suppose for boys and girls but it's my experience for boys and there's such a dramatic change and I'm living with my contemporaries there's no going home at night to forget about it it seemed that all that mattered was playing rugby as far as I could see I think it was mandatory to go and watch the first 15 play rugby on a Saturday afternoon and bizarre looking back when I was too small to and watch the first 15 play rugby on a Saturday afternoon. It was bizarre looking back. When I was too small to be in the rugby team,

I sort of met all the other people in the school who are now the ambassador to China or something and director of Opera North and amazing people. But at the time, because they didn't play rugby, they were nothing to me. But there was this sort of broader group of people who maybe didn't sort of march through the town quite so proudly, but were very interesting. I suppose the other thing is I worry for my kids

whether they'll have the same thing. So that's probably why it's slightly on my mind at the moment. You're so compassionate and insightful about that that it's probably made you into a better parent. I'm very impatient. That's my problem as a parent. My son particularly is very sort of destructible, is that the word? And I'm terrible with that. His mind wanders off and he'll find he hasn't eaten and he's been sitting in front of his food for about an hour

thinking about something completely different. So I'm not going to claim to be a paragon of parenthood. I mean, my parents were very loving. I don't want to diss them. They did they thought was right and there's lots of things you know I'm very grateful for it served me very well in many ways the school I went to or not but I wouldn't send my kids away to school I hope they'll always come and talk to me or my wife well probably my wife more but I'd hope they'd come and talk to us both if they were ever unhappy in fact I think they would yeah it struck me and perhaps it's because I also have a medical father that you said that your father you overheard him talking to someone about the fact that your late puberty might be an issue and I always remember my father seeing me with a spot on my chin when I was a teenager saying, you know, I could just remove that for you.

I could just slice it off. And again, like, yes, that's not meant as a diss towards my parents at all. That was an act of love where he was coming from. It was like a surgical intervention. And I wonder if, yes, did you have that with your dad on other occasions? He always had this thing that he was quite strict. You know, if we were ill, we weren't allowed to eat or do anything like that.

You know, you had to be ill and get better. And then I remember the shutters opening when I noticed him getting a huge meal when he was ill in bed, thinking, hang on a minute, there's a double standard here. My wife was sort of very similar, but the one way he's very different is that he's the stoic and plays down any symptoms or illness he's caught I don't know if he does internally but

externally he's very different on that front I mean he was a different kind of doctor he was a physician he was a gastroenterologist I think he was great he was very loved by his patients as far as I can see he was a real sort of clinical doctor down in the country. Let's talk about something else that I heard a lot about through my own father, which is the amount of management that one has to do as a doctor in the NHS, which is your second failure, which is that you, in your own words, you got on the ambition conveyor belt and you realised through having to do so much managing that you were drifting away from being a doctor. Tell us about that. When I arrived in UCH as a consultant, within about two years, all my colleagues were basically too important to be head of department. And they were all professors

or they were a medical director of the hospital or they were running another, you know. And so sort of by default, I became the clinical lead of the department and the clinical director. And suddenly I was going to the board and dealing with the spreadsheets about the finances and dealing with complaints and all the other stuff. And I was doing less clinical medicine. And because it's a big teaching hospital, you know, a big academic hospital, there's a sort of a slight mantra that

the clinical bit is given everyone does the clinical bit but your ambition isn't something else it's to be a researcher or a manager or something else and they're all great clinicians but that was slightly looked on as not the the ambition bit if you like and I looked around thought gosh what's my ambition do I want to be a manager? Do I want to do research? You know, and I definitely didn't want to do research. I spent a year doing research where basically I stared out the window for a year and then left. And I realized the other thing was that I was slightly losing my clinical confidence because I think if you do less of it, you get a bit more nervous about it because your muscle memory goes and your decision-making skills go. So I so I thought well actually I want to go and be a you know a clinician again and I think that was

the right decision I mean there were bits of it that I enjoyed and that I was quite good at while chairing a meeting it's one of my I know you're that's what you say that's what you say in life support you'd rather have the tennis skills of Roger Federer but you'll settle for being an excellent chair of meetings well I went on a course where they you know like when you go to career advice at school you do sort of a questionnaire and they always came out with hospitality for me for some reason which i'd be terrible at but i went on a course and they said well you're not very good at a lot of this but you're very good at chairing meetings i've chair a lot of meetings long short was i went back to being a clinician and more and gradually my confidence came back and

there's a funny thing at medical school someone said to me always work for the patients not for your boss and I thought well that obviously you know we know any I was young and of course I'll always do that you don't tell me that but like job, if you're on a career ladder, the boss always is in the back of your mind. And that sort of slightly happened with the management stuff and things. And going back and spending more time at the bedside was a really good thing. I'm not saying I'm particularly good at it, but I'm much better than I was. And is the reason that you've chosen it as a failure because you felt that your ambition was getting too big for itself? because you felt that your ambition was getting too big for itself.

Yes, I think it was because I felt I should be ambitious in an area of work next to the clinical. And that was the one that I could do, if you like. And then I realised, you know, if you go right up in it, you end up doing it all the time and you stop being a clinical doctor at all. And then some ways that's looked on as the ultimate achievement because you're you know running the NHS or whatever you're doing although I have to say Chris Whitty still does clinical shifts as does our boss so you don't have to give up clinical and I thought well actually what I'm trained to do

is to be a doctor we need clinical managers but it's not my love and I should be a doctor and that's when I started to it's not my love. And I should be a doctor. And that's when I started to do other things. I thought actually, what I want to do apart from medicine is stuff outside of medicine completely. So it's a bit of a turning point from that point of view. And why did you become a clinician in the first place? I mean, I mentioned that there's a family history of being a doctor. But what is it? What's the purpose for you? Why do you love doing it? So when I was about 17, I was going to do anything apart from be a doctor.

I was surrounded by doctors. And my brother, in fact, went to medical school and he changed professions immediately. He finished. And I thought, well, I better go and do a week's work experience with my dad dad just to be sure and looking back it's the most bizarre week because one day I kept passing out I was pathetic around anything vaguely sort of painful but on the other hand I came out thinking yep I want to do

that and I can't quite remember why I think it was the personal interaction with a purpose, I guess. I'm not going to claim it's because I wanted to, you know, help people or it was an element of interacting with people. But it wasn't just interacting people for no reason. There was something, a reason to do it. And then you move on to another one. And I quite like that combination of something to do and a personal interaction, I think. like that combination of something to do and a personal interaction I think. Do you think that there's a high rate of idealism or a high sense that medicine is a vocation amongst practicing staff or is that something that we civilians sort of project onto you? So I'm going to be shot down by everyone at work for this but I think there's nice doctors and horrid doctors

that's not fair probably I don't think there's there's not many malevolent doctors but they're a spread of society like everyone else aren't they I would have thought where I work there's an awful lot of very clever ones who are doing amazing stuff in whatever area so we have lots of academics who are amazing and then there are the ones that we'd all like to look after us as well who you know who are also amazing and then there's a lot of people in the middle who are muddling along like me I think you know a lot of people say I would never tell their children to do it because it's underfunded and it's just not what it used to be I think the job is still what it's always been and it's just not what it used to be. I think the job is still what it's always been, and it's a good job.

The breadth of things you can do in medicine is huge. I think it's a good job. I've had periods where it's made me very anxious. In anaesthetics particularly, there's this strange thing where you don't make people better, but you can make them a lot worse. And that's an odd psychological combination, I think. I've known people who've gradually got the fear of that and then had to stop I've not stopped but I've had times when I've had to really think about it and readdress it and there's definitely stresses to it

but I'm pleased I've done it I was actually going to ask you about what you touched on there where you know failure in any normal context can generally be got through with a measure of mental resilience failure as a clinician can end in someone's death and you mentioned there that that sense of responsibility weighs heavily and you have to have periods of time going away and thinking about it what does that look like that period of time going away thinking about it but how do you do it how do you cope with that weight I don't know is the honest answer and I think the main thing for me is to be aware of it I think it all sounds very dramatic and things doesn't it and I think it all sounds very dramatic and things, doesn't it? And I suppose it is dramatic. On the other hand, it is the job that we're trained to do. So in some ways, you know, I get very stressed about tiny things outside of medicine. So it's not like there's a linear scale of you get more

stressed. And you know, I mean, I think we all get stressed about, I don't know, waiting in a traffic jam. So it's hard to categorise in a way, but if it does go wrong, as you say, it's awful. There was a short period when my kids were young, when I used to go on a scooter to work on a moped. And I suddenly realised that for about two months, I'd been getting onto my scooter and then saying to myself outside, out loud, don't crash your scooter and make that the last time you talk to the children and don't kill anyone and then I thought god this isn't healthy for me I just need to be aware of sort of where I am I suppose and the other thing is I'm really lucky because I work in a department where there's never a time day or night you know three in the morning when I couldn't call a friend

for help and that's the case all the time and in fact it's about the only piece of advice I give to new consultants starting is ring one of us anytime whatever the problem and I think that is the key thing that you've always got to make. And how do you relax when you get the chance I mean do you please tell me you have a ponch on for just terrible television or just something. Oh, yeah. Dreadful. Dreadful. Yeah, yeah, yeah, yeah. In fact, well, obviously, lockdown, that's been exaggerated. Have you been watching Bridgerton? No, is this terrible? I couldn't quite cope with Bridgerton.

I could either. No, what have I? I did The Queen's Gambit. I loved The Queen's Gambit. We've got a sort of family thing going over modern family at the moment, is about 15 years too late on and my kids have become obsessed with friends my daughter completely obsessed and relates characteristics to that so monica and thinking this isn't your you know this is 25 years ago it's totally bizarre well talking about sharply written comedy brings us onto your third failure which was very unexpected when I got to it Jim it's your third failure is stand-up comedy when you were 40 did you become a stand-up comedian what happened well I didn't in the sense of being paid to be a stand-up comedian when I was a teenager everyone was really into music and I just didn't

I was like apparently Hugh Grant has two records and that was hearing that was absolute music to my ears because I don't think I have any records but what the thing I was obsessed with was comedy and it was kind of my music Peter Cook and Monty Python and the Young Ones all this lot I mean that really aged me doesn't it they were a bit before me, some of those, by the way. They were my kind of David Bowie, I suppose. And so I'd always just been really interested in it. And then about this time, my medical management career was hitting the buffers. I thought, what do I want to do?

And I wanted to do something creative. So I thought, well, the obvious thing to do is become a stand-up comedian which was a massive mistake but I went and did evening classes I mean it's hilarious how did you find the time yes it was a little bit unpopular with young children I have to admit I'd like to say was your wife like this is a midlife crisis Jim it was but I argued that it was better than a Porsche you know or an affair I suppose it's not a great argument is it but I but I am it was at nine o'clock at night in Camden you know it was all quite the kids were in bed I think anyway I had six months I did the course and I got five

minutes together as you do after those things and the terrible thing was that the first gig I did went quite well which in retrospect was not the first gig I did went quite well, which in retrospect was not helpful because it meant I went on and did more, which went very badly. Because although saying it for the first time was okay, repeating these things that you've sort of just thought of ostensibly I found just unbearable. But I did.

I did about 50, 60 gigs, I think. Wow. Totally bizarre. wearable but I did I did about 50 60 gigs I think wow totally bizarre I was as a middle-aged man surrounded by 20 year olds it was not fun but it was interesting and it gave me another insight into what being a comedian is and that sort of magic fairy dust they seem to spray over the first 15 rows which I just never understood I've got so many questions, Jim. My first is, did you make Be A Doctor part of your shtick or did you have a totally invented character? No, I thought about doing that

and that probably would have been better, but I didn't. I did this sort of very poor man's Miles Jupp. In fact, about halfway through it, I saw his set on YouTube or something and thought oh yeah that's what I was trying to do and he does it brilliantly obviously but the reason I put it in here was because what I really enjoyed about it was writing it it was just getting up and saying that I liked less and less the longer it went on and so then I sort of that's

what sort of sparked my interest in trying to write and eventually write the book. I want to come back onto the writing but can I ask whether doing stand-up comedy because it's such a brutal arena where if you fail there is no hiding it's so conspicuous did it help you with your bedside manner in any way was there any knowledge that you took from it that you applied to your medical life it made me learn stuff about myself I mean I've realized that well I don't know stand-ups may well tell me this is nonsense but one thing it seemed to me is that they have to go on thinking that everyone loves them and believe that because otherwise it just doesn't work even if you're

playing a low status person you've got to believe in your charm or whatever it is and the more I did it I mean by after about five gigs I used to go on thinking they hated me immediately and then of course when you think that then they do and so it made me think about how I come across and examine myself and that was I think that is quite helpful and made me yourself aware of what people's perception I think being a doctor and I'm slightly making this up but well completely making up but I think it's sort of naturally it's a slightly high status position and people rely on you and so people may not tell you that if you're pissing them off you know they might feel a little bit inhibited to say actually easy mate that's not very nice and say whatever it is and so it made me quite aware of reactions and in fact in through

my career the odd time when I've got proper feedback it's a bit painful but it's really instructive because it's not as common as it should be I think I spoken to someone in the past with a background in improvisation who taught me that improv was absolutely about going out there and being prepared to suck at it and through that process of a crowd either responding to you or not responding to you, you acquired necessary data to make your next attempt funnier or more entertaining. And it basically taught me the idea of failure as data acquisition, which I think is a very interesting one. And it removes the sting of failure. And in a way, I think you're saying the same thing about honest feedback, that all the data you require can be very helpful. Oh, yeah, completely. I think you're saying the same thing about honest feedback, that all the data you require can be very helpful. Oh, yeah, completely. I think particularly if there's a paucity of it,

the mantra that we don't learn from our successors, do we? You know, and I think that's completely true. But it's quite hard to get honest feedback in life, isn't it? Without getting upset by it. There's about sort of four or five things over my career that have really stayed with me and they're all about not thinking about the person in front of me just thinking about my day as it were and just quietly not being as attentive to the person who's having a much worse time than I am but for me I sort of slightly feel I need them regularly because they have an impact and then it drifts away again after a couple of years and then they have another you know it's almost like you need a sort of refresher in a fail to get you back on the straight and narrow as it were now you mentioned there that the thing that you liked

about silent comedy was the writing and you have now written your first book which is a wonderful read in many ways and it's also a bit harrowing. What was the experience like for you of writing it? Did you enjoy it? Did you find it cathartic? All of those questions. It's been every emotion that I've ever had. When I started writing it just at the end of the first pandemic, it was quite cathartic in that it was something I wanted to do anyway, writing, and it was an experience that was very vivid in my mind and it was helpful to get it out there because all the things that have been bothering me and playing on my mind and the patience and you know what had been done all that kind of thing I could just

write it all down and that was really helpful but then I finished it then I started had to ring around the people in it and see if they'd be all right with being in it and that was harrowing I mean it was amazing in that the people were amazing but ridiculously it made me realize that normally people die quite a lot I don't see them again in fact we have one day a year where we invite relatives back to a big meeting where people can talk about the person who's died on on the ic which is an amazing day we do that every year but this one was just me talking to the relatives of people who died three months later six months later in

fact i'm still in touch with one family particularly with tricia's family i spoke to her daughter yesterday because she's applying to med school, which is amazing. And Tricia was a nurse, wasn't she? She's a nurse. Yeah, she was a nurse at Great Wall Street. That was really tough because then I questioned whether it was OK to write the book. You know, was it too raw and too much for these people? And I had a big sort of discussion with colleagues and family and various people therapists and I sort of ended up thinking well the people who didn't want to be in it are not in it and the people who did

do you want to be in it and because they I think they want their loved ones to be remembered I guess and then there's the people who got better are just amazing in that what they've been through and how they are now it was great to hear but also sort of very humbling to hear what they've been through and how they are now. It was great to hear, but also sort of very humbling to hear what they've been through. So it's been very mixed emotions. And in sort of November, I didn't know whether I should be doing a tour, but I think it's okay to publish it now, I think. Oh, I think it's necessary as well as okay. But how did the book come about? Was it someone who saw you on the BBC and then got in touch? Or was it an idea you'd already had? Last year, I'd been to another evening class of playwriting, and that had slightly ground to a halt. But we had one project left to do, which was a one act,

a radio play. And so I wrote very quickly, almost sort of verbatim, wrote one of our consultant meetings as a play. And I didn't change anything. And it was, I mean, you couldn't repeat that because I'd been caught libel and slander or whatever it is. And then a friend of mine who's a book literary agent and knew I'd been interested in writing before just sent me a text saying,

are you keeping a diary? You know, you should keep a diary of this. And I think she'd seen me on the BBC thing. So I said, oh, well, it's funny that I've just written this thing. And I sent it to her and said, why don't you try and write this into a book? And she's been amazing. She's Georgia Garrett. She's kind of been like a mentor and just sort of took me through it really. So I did. Well, you've done us all a tremendous service and life support is a must read for anyone who wants an insight into what life on a COVID ward was like. And you write with such sincerity, such insight and such humour. And thank you for doing it because I know it

can't have been easy from everything you've just said. And I know that you're a big fan of feedback. So I would also like to say that you have been a wonderful, wonderful podcast guest, and I'm so truly honored that you've come on How to Fail. And I just want to thank you so, so much on my behalf, but on behalf of everyone you've ever helped and everyone who will listen to this podcast and be moved and informed. So thank you very, very much, Dr. Jim Down. Oh, thank you so much for having me. It's my first ever podcast. You've been very kind and I've really enjoyed it. Thank you. If you enjoyed this episode of How to Fail with Elizabeth Day, I would so appreciate it if you could rate, review and subscribe.

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