Life in the Balance

A moving, frank and unflinching-yet-witty account of the realities of intensive care medicine from Dr Jim Down, ICU consultant at one of London's top hospitals

In these stories, Dr Jim Down brings us to the very heart of the intensive care unit - the hospital section where the sickest patients are brought for emergency care. 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, who was admitted to Down's ward after his poisoning by Russian agents, to the appalling aftermath of a train crash, and the daily struggle to simply find enough beds, Jim Down provides a unique insight into life on The Unit, and the critical medicine doctors and nurses perform there.

Life in the Balance offers the first real glimpse of intensive care medicine; its immense challenges, its deleterious effects on doctors' mental health and also its enormous rewards. This profound work reframes the fragility of life and shows what it really means to care.

About the Author

Dr Jim Down is a consultant in critical care and anaesthesia based in London. He chairs the ICU consultants' group, the department of anaesthesia weekly scientific meetings and the UCLH Trust guideline committee. During the Covid-19 pandemic he worked on UCLH's busy ICU ward, and was interviewed by the BBC for a groundbreaking report depicting medics on the frontline. His account of that period, Life Support, was published in 2021 and his second book, Life in the Balance, was published in 2023.