t’s 4am and resus looks like a bomb has hit it. We have had to open almost every piece of kit available to keep the patient in front of us alive. Wearily, I register there’s blood spattered across my shoes. It’s been a long night, and there’s still another five hours to go. “What will you do after this?” the nurse asks. I’d love to say I’ll go for a run before crawling into bed. But on night shifts it’s all I can do to eat, sleep, work, repeat. “No, I mean after intensive care,” they say. “I think I’m going to retrain.” It’s a conversation I am having more and more. Some days, it seems like all of my colleagues are making exit plans. I can’t blame them, really. The pandemic has hit us hard. I think we all knew from the start that we weren’t going to come out of this without some wounds. Still, we braced ourselves, determined to rise to the challenge. After all, this was what we were trained for. But the truth is none of us were ever prepared to witness suffering on the scale of the past few months. This time last year, it was quickly becoming clear that our resources were going to be overwhelmed. Emergency departments became war zones. As patient after patient arrived fighting for breath, our intensive care units (ICUs) filled up all around us. We enacted our surge plans, creating beds from thin air, finding ventilators from theatres and anaesthetic rooms. But it wasn’t enough. It could never be enough. Looking back at that time, it feels like we were set up to fail. The NHS had just come through its toughest winter yet. A&E waiting times were the worst on record. Morale had hit rock bottom, and as a consequence our rotas were threadbare. Across the country we were having to close beds in ICUs because we didn’t have the staff. How did things get this bad? In truth, it was years of neglect of both the NHS and its staff. Decisions made under the previous health secretary came home to roost as the pandemic hit. Cost-cutting was a gamble, and ultimately the NHS paid the price. Months later, the UK would end up with one of the worst death rates in the entire world. The psychological harm of this is barely talked about, but it is palpable every day in the ICU. While some people are suffering from post-traumatic stress disorder, almost everyone is experiencing some form of moral injury, our own epidemic among healthcare professionals. We talk about the “talk and die” patients in medicine. They are the hardest: those patients who would come in, often young, fit and well, and would be talking to us, cracking jokes, even as their oxygen levels were critically low. My voice would be the last they would hear as I administered the anaesthetic to go on to the ventilator. How do you know what to say in those last moments? Having to then tell someone on FaceTime their loved one is not going to make it has been one of the worst things about this horrid disease. Often we could bend the visiting rules at the end of life, but only then. You would be forgiven for thinking that this is why people are now leaving the NHS. But when you listen, really listen, to people about why they want to leave, it isn’t that. There is no doubt that our jobs are hard, but they are made so much harder by things that really should have been fixed a long time ago. These are called the “legacy issues”, well known secondary stressors that exacerbate moral distress. During the pandemic, NHS staff gave everything they had. So many of us are running on fumes now. But there was a sense of relief that this crisis had revealed exactly who the key workers of the country really are; that, finally, things would have to change. But they didn’t. In fact, things got worse. The earliest signal was the PPE scandal. As the public were continually told there was no issue, nurses and doctors were going on to the frontlines armed with little more than bin bags. Risking your own life is bad enough. But then our colleagues started getting sick. We were never prepared to have to ventilate our own colleagues. To clap as their hearses drove past. I’ve lost more than one. We owe them a debt we will never be able to repay. As we started to lose colleagues, conditions deteriorated on the frontline. Simple things would have made such a difference. But in many places there was nowhere even to rest; on-call rooms and messes had long ago gone to make way for office space. You might be surprised to hear that in most hospitals there is nowhere to buy hot food overnight. Or that we have been banned from using supplies of free tea and coffee. The kindness of the public got many of us through this year. Food was delivered. Coffee machines were donated. But even before the end of the first wave these were being removed in many places. Free staff parking has already been taken away at some hospitals. In England, NHS staff have just been handed yet another real terms pay cut. The fact that politicians stood on the doorsteps of No 10 clapping while treating NHS staff with such contempt has angered even the most mild-mannered of my colleagues. And it is this deep, impassible feeling of betrayal which has made people feel they have no option but to leave. A mass exodus from the NHS is no longer a case of if, it’s a case of when. Staff morale will probably never recover fully. But there is a small window of opportunity now that, if lost, will never be regained. If we don’t start caring about our staff now, there will be no one left to care for our patients. Dr Samantha Batt-Rawden is president of the Doctors’ Association UK and a senior registrar in intensive care medicine.