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B e e r h e LP join over one million people who have taken charge of their mental health. Again, that's better help dot com forward slash how to fail. Thank you very much. To better help. 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 adviser.

You could say then that medicine has always been in his blood. He is now a consultant in critical care and anesthesia 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 him down for covid-19. As the pandemic descended in spring, 20-20 down find 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 Dan, welcome to How to Fail.

Thank you very much indeed for having me. It's a privilege and an honor to be on.

It is a privilege and an honor 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 of similar age to a lot of patients and feeling like we all do as you get older, our mortality. And so when you're 25 and you know, you sort of feel immortal. And I 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 who may be more vulnerable 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 a double hit, if you like, said someone I don't know, telling them the worst thing possible and 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 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. 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 is a young man of 40 who'd already been through two or three years of terrible time with leukemia and bone marrow transplant. And he'd just come through that. I think he might even be the last one we did in the run up to covid. And then he had complications and he called covid and he came down to ITV News on the perhaps Pepsis away 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 of 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 percent of people put on a ventilator don't get off it. But his wife, Megan, has asthma and was shielding 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 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 I meant, but knew that she had to be calm and strong for him so that he has confidence going off to sleep. And the other thing was that I could totally imagine picking my kids up from school and then 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 was sort of overwhelming. And because of the book with a few of them, I have 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 that. And that's another aspect.

We're talking on the 3rd of February 20, 21, 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 is still busier than it was in the first surge. We've got about 110 ICU patients. That usage, which is three times normal, it's flattening. I mean, I think a bit 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 point at the moment in that we're sort of the equivalent of the hope of the sort of late April where there's lots of people, 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 bit better organized. And so working is actually better from that point of view. We're better set up, but the disease is just horrible.

One of the things that I really value about your writing is that you openly admit to being pretty anxious, yourself and Sam.

And you say there's this great line where you say that, you know, people of the medical profession generally fall into one of two categories that 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 and the other is to someone says 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 you've been there for more than four days. And that has been very useful to me because most things have gone away in four days, as doctors will tell you.

But 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 that was a build up. But then once you're doing it, once I've come to terms with what the risks were gone through, my head put on the PPE, since everyone else is putting on the PPE as 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 called covid of patients. I think we're lucky in that way and that we've got good protection. I think some of us of the 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've found that very hard because all bets are off. I mean, this time is a bit better, but we didn't know what was coming next. It is such a. It's 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 is 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 actually, it is an amazing read in spite of that. But I wonder how then it sits with you.

The wee members of the public have such extraordinary admiration and gratitude towards you and their wars or that kind of clapping for the NHS at the beginning of the first lockdown and and being called heroes.

How does that sit with you, if I'm really honest?

I've got elements of show often as I stand up on a stage, and I like presenting to people in that kind of thing. So I can't claim to be a total retiring or 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 the nurses are doing, quite a lot of doctors, consultants from other specialties are doing nursing shifts. For instance, yesterday I was on and I was a consultant gynecologist working as an ICU nursing assistant, and he said he does two 12 hour shifts a week around his other work because he said no one's going to die of the stuff I'm doing.

This is what's needed. And I said, how are you? Fine. 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 80 patients is the key to this and the fact that they've had to expand up to three times that capacity with no more trained nurses. They've got lots of helpers. But in terms of trained ones, they're all employed.

There aren't hundreds of unemployed nurses. So, you know, I'm biased, but I think there are certainly some areas, along with lots of other people, because they're the ones that sort of strike me every day. We've got a whole floor of you that is now an idea that was just a normal walk before. And you walk around, it seems completely calm and in control and all the machines are not alarming. And and then if you dig a bit deeper, you find that the nurses are right on the edge of being able to do it because they're stretched between three patients at 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, that's pretty humbling. This obviously is the podcast about failure.

And we're going to get onto your three personal failures in a minute.

But I wanted to ask you a bit about 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 on their chins.

Is there a sense of anger at that? I mean, I am very cautious. I've had the vaccine, but I'm very cautious about infection transmission and masks and public places. But I'm also aware that I'm very influenced by what I see day to day. So to me, it's this awful disease that kills everyone or makes everyone who's got it, which is obviously not what everyone else sees. You know, I love everyone to buy 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 in the hospital, they have a huge impact and we can't cope with more patients. I.

Yeah, you mentioned your 11 year old twins there. And I wanted to ask you about them, actually, because I'm assuming they would 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, if I want to just change schools and has gone to school was not actually being it's quite we're taking a class, but he's never seen any of people in the.

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 or less than it would be for someone like me. It's hard to judge, isn't it? I think they're doing OK. They're still talking to us. I mean, I desperately over like everyone else, but I think they're hanging.

I have to say, I really enjoyed the glimpses of your family life that you gave us in the book. Your wife sounds terrific. That's a brilliant anecdote about, I think is the first few times that people were doing clapped for carers and your wife was sort of hissing under her breath. Yes, but they need to fund the NHS properly. They can't just clap and get away with it. And I loved it. I got a real sense of the love that was there, but also the fact that it kind of keeps you grounded.

Yes. I mean, that sarcastic claffey of my children was hilarious, but they've been great on that. I mean, the quote I think my daughter said you only had it 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 it was, you got back to normal, which was probably, I think, outsourcing. So they were wonderful in their own way.

That quote you mention, you only had I think you 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 covered ward in a busy London hospital. And I think it was a massive turning point for many people in the first lockdown. And 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 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 on to 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 Choose this or not for two reasons. One is that I've passed puberty now, so. Yeah, I know exactly. And the second is it's a sort of failure of the body rather than the mind. But for him, 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, it seems bizarre and I'm 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 got 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 remember vaguely and my dad sort of talking to someone else about it, not quite as a problem, but I think, you know, his medical needs sort of claims on his mind. And at the same time, I was bullied at the school and that was the sort of a high pitched voice.

And it was an attack on our school. Used to hear the squeak. That was the kind of bullying call. And it just 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 before that I not really understood being an outsider or readjusting in any way. Then when I was about 16, I think things changed and it was all sort of fine.

But I think I hope I've become a more empathetic person who wasn't just trying to be in this sort of cool gang and and was a bit more aware of other people. And it's sort of always stayed with me for lots of different reasons as 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, I sort of sense of shame and 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 it as tough. And I think the thing about it is such a physically obvious thing, you know, I suppose with boys and girls. But my experience for boys and there's such a dramatic change and I'm living with my concern because there's no going home at night to forget about it. It seemed that all that. I was playing rugby as far as I could see.

I think it was mandatory to go and watch the first team play rugby on a Saturday afternoon. 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 Northend. Amazing people. But at the time they because they didn't play rugby, they were nothing to me. But there was this sort of broader group of people that you 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 are of the same thing. So that's probably one sign in 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 is mind wanders off and he'll be fine. He hasn't eaten in front of his food for 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 do this. They did what they thought was right.

And there's lots of things I'm very grateful for. It served me very well in many ways, the school I went on, but I wouldn't send my kids away to school. I hope they always come and talk to me or my wife or probably my wife more, but I hope they come and talk to us both if they were ever unhappy. And in fact, I think they would. Yeah, it struck me. And perhaps it's because I also have a magical 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 say so. And I said, yes, that's not meant as a death towards my parents. I thought that was an act of love. Where he was coming from was like a surgical intervention. I want to. 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 we weren't allowed to eat or anything like that. You had to be ill and get better. And then I remember the shutters opening when I noticed in 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 got.

I don't know if he does internally, but externally, he's very different on that front. I mean, he was different. He was a physician. He was a guy. Sometimes 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've got all the ambition, conveyor belts, 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 usage as a consultant within about two years, all my colleagues were basically too important to be had the department and the rule professors or they were the medical director of the hospital they were running. And, you know, and so sort of by default, I became the clinical leader of the department, the clinical director, and suddenly I was going to the board and dealing with this about the finances and dealing with complaints and all the other stuff.

And I was doing less clinical medicine. And because it was a big teaching hospital, big academic hospital, there's a sort of a sly mantra that the clinical betters give, given everyone does the clinical bit. But your ambition isn't something else. It's to be a research manager or something else. And there are great clinicians. But that was slightly looked on as not the the ambition bit, if you like. And I a around, of course, was my ambition.

Do I want to be a manager or I want to do research 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 realised 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 in your decision making skills. 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 are bits of it that I enjoyed and that I was quite good at my 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 of the questionnaire. And it always came out with hospitality for me for reason my. Which I did terrible that I went to cause, and I said, well, you're not very good at a lot of this, that you're very good at meetings. I've general meetings, Longshoreman's. 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, obviously, you know, we know when I was young and of course, I always do them, you have to tell me that. But like any job, if you 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 example of that. 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?

Yes, I think it was because I felt I should be ambitious in a area of work next to the clinical. And that was the one that I could do, if you like. And then I realized if you go right up and you end up doing it all the time and you stop being a clinical doctor at all and then some is that I looked on as the ultimate achievement because you're running the NHS or whatever you do, although I have electricity, still does clinical shifts, as does hour or so, that you don't have to give up.

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 do other things. I thought actually what I want to do apart from medicine is stuff outside of medicine completely turns a bit of a turning point for me.

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 that? 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 being a doctor, surrounded by doctors. And my brother and I 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, just to be sure. And looking back as 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, yeah, I want to do that.

And I can't quite remember why. I think it was that personal interaction with a purpose. I guess I'm not going to claim it's because I wanted to help people or it was an element of interacting with people. But it wasn't just some 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 the 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 practising staff, or is that something that we civilians sort of project onto you?

So I'm going to be shot down by everyone work for this. But I think those nice doctors and our doctors, that's not fair. Probably I don't think there's not many malevolent doctors, but they're a spread of society like everyone else on the 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, you know, so amazing.

And then there's a lot of people in the middle of a 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 a good job. The breadth of things you can do in medicine is huge. I think it's good job. I've had periods where it's made me very anxious in anaesthetics, particularly 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, you know, I've known people who've gradually got the fear of that and then that stop, I've not stopped, but I've had times when I've had to really think about it and we address 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 imagine that that sense of responsibility weighs heavily and you have to have periods of time going away and thinking about that. What does that look like, that period of time going away, thinking about it? How do you do it? How do you cope with that?

Wait, 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 thinks, 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 if 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 categorize 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 realized that for about two months I've been getting to my scooter and then saying to myself outside out loud, don't crash a scooter and make that the last time you talk to the children and don't kill anyone.

And I thought, 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, 3:00 in the morning when I couldn't call a friend for help. And that's the case all the time. And in fact, is the only piece of advice I give to new consultants starting is ring one of us any time, whatever the problem.

And I think that is the key thing that you've always got to meet.

And how do you relax when you get the chance? I mean, do you please tell me you have a penchant for just terrible television or just something?

Oh, yeah.

This is dreadful. Dreadful, in fact. Well, obviously, long term, that's being exaggerated.

Have you been watching Bridgton now?

As I said, I couldn't quite cope with Brigitte and I couldn't to know what have I did. The Queen's Gambit. I love the Queen's Gambit. We've got a sort of family thing going on. Modern Family at the moment, which about 15 years too late 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 twenty five years ago. It's totally bizarre.

Well, talking about sharply written comedy breaks also into your third failure, which was a very unexpected one. 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, Hugh Grant has two records. And that was hearing that was absolute music to my ears as I don't have any records. But what the thing I was obsessed with was comedy and it was kind of my music petcoke and Monty Python and the young ones, all this lot. I mean, that really doesn't it?

They were performing 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 of the obvious things to ask and become a stand up comedian, which was a massive mistake. But I went and did evening classes.

I mean, it's hilarious.

Did you find the time?

Yes, it was a little bit unpopular with young children, I have to admit.

I did say with your wife, like, this is a mid-life crisis. It was. But I argued that it was better than a course, you know, or an affair. I suppose it's not a great idea, is it? But I bet 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 helpful because it meant I went on and did more, which went very badly because I sang it for the first time was okay. Repeating these things that you sort of just thought of ostensively I found just unbearable. But I did I did about 50, 60 gigs.

I think I have a totally bizarre I as a middle aged man surrounded by twenty 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 fifteen rows, which I just never understood.

I've got so many questions, Jim. My first is, did you make being a doctor part of your schtick 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 job. 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 was the. 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 special 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 writing, 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 realized that what I stand up to me, 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 and 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 maybe yourself self aware of what people's perception. I think being a doctor and I'm certainly making this up, but, well, completely making it up. But I think it's sort of naturally it's a slightly high status position in that people are rely on you. And so people may not tell you that if you're passing them off, you know, they might feel a little bit inhibited to say actually easy, maybe that's not very nice and say, well, whatever it is.

And so it made me quite aware of reactions. And in fact, in through my career, the odd time when I 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've 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 required 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 particularly if this is a paucity of it, the mantra we don't learn from our successes. Do 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? It's about sort of four or five things over my career. I've 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 as the person is 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 it's almost like you need a sort of refresher in a failed to get you back on the straight and narrow, as it were.

Now, you mentioned 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 and it was something I wanted to do anyway writing. And it was an experience. It 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 patients and what have we 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 to bring round the people in it and see if they'd be alright with being in it. And that was harrowing. I mean, it was amazing in that the people were amazing, but ridiculously, it made me realise 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 the ICU, 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 Patricia'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. So, yeah, that was really tough because then I questioned whether it was okay to write about. 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 and people did.

Do you want to be in it? 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. And that's 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 then sort of November I was in didn't know whether I should be doing at all, but I think it's okay to publish it now.

I think oh, I think it's necessary as well as OK.

But how did that come about?

Was it someone who saw you on the BBC and then got in touch, or was it an idea you already had last year?

I'd been doing another evening class of playwriting and battered slightly ground to a halt, but we had one project left to do, which was a one act immediately. And so I wrote very quickly, almost sort of verbatim, wrote one of our consultant meetings as a play. And I didn't change in the end it was. And when you couldn't repeat that, because I'd be called libel and slander, whatever it is. And then a friend of mine is a book literary agent and knew I'd been interested in writing before, just sent me a text saying, you keeping a diary, you know, we should keep diaries.

And I think she took me on the BBC thing. So I said it was funny that I've just written this thing and I sent it and we said, why don't you try and make this into a book? And she's been amazing. George 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 covered ward is 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 honoured 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. Jimtown.

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.

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