Every shift, I decide who lives and who dies. Every night, I wonder if the NHS will survive long enough to save the next person. This is the unflinching memoir of a trauma surgeon working in one of Britain's busiest emergency departments. For twenty years, this doctor has operated on gunshot victims, stabbing survivors, and car crash casualties-but increasingly, the greatest threat isn't the injuries themselves. It's a healthcare system stretched beyond breaking point. From the operating theatre to the ward, readers witness the raw reality of modern trauma medicine: the 14-year-old gang member who'll never walk again, the domestic violence survivor with injuries that tell stories she cannot speak, the soldier returned from deployment carrying invisible and visible scars. But woven through these cases is a darker narrative-one about NHS underfunding, staff burnout, and the moral weight of rationing care in a first-world country. This memoir challenges the public narrative that celebrates the NHS as a sacred institution. Instead, it asks: what happens when dedicated doctors and nurses are asked to do the impossible with impossibly few resources? How do you maintain compassion when the system itself is collapsing? And why do we celebrate medical heroism instead of fixing the system that demands it? Honest, haunting, and occasionally devastating, this account exposes the human cost of healthcare neglect-told by someone who sees the consequences on the operating table every single day.

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