Alida Baxter

Renowned London journalist and author

 

View from Soho -

Don't Get Old,

It Could Kill You

Newspapers and news bulletins have continued to report the fallout after the findings of the Care Quality Commission, which conducted a series of spot checks and unscheduled visits to hospitals around the country, and discovered just how badly elderly patients were being treated. The neglect was endemic and appalling – lack of the most basic care was common. And to underline these findings, it was recently reported that a woman, alarmed at her mother's deterioration in hospital, paid £1,000 for private carers who, disguised as ordinary visitors, went in and gave the elderly lady food and drink, kept her clean and looked after – all of which the hospital staff were failing to do – and transformed her state of health so radically that she made a dramatic recovery and was able to return home.

Now the General Medical Council have drawn up new guidelines, urging doctors to be guardians of patient safety, reminding them of their charges' basic needs, ordering them to ensure that the elderly do not go hungry or thirsty, and prompting an outcry from campaigners, who want to know how it's possible doctors should have to be reminded that vulnerable people in hospital wards need to be fed and watered and taken to the lavatory.

But my question is, why has it taken so long for any of this to become news? For decades, virtually nobody visiting an elderly hospital patient will have found anything to comfort them in what they will have witnessed. And I speak from bitter experience.

What I would like to know is how and why the elderly became a disregarded, disrespected underclass, expected to endure treatment for which any animal owner would rightly be prosecuted, not just in the privacy and secrecy of their homes, but in open sight on hospital wards.

Cruelty to children is abhorrent, and when the inefficiency or stupidity of professionals fails to save an abused child from those who torture it the outcry is deafening. But when it comes to the elderly, professionals don't just routinely fail to protect them. Their actions can be much more questionable than that.

For years in the nineteen eighties and into the nineties I looked after my mother – years of night-time dashes in ambulances to one A & E or another, of admissions to various wards in seven different hospitals, and discoveries about human nature that I would rather not have made.

In only one hospital (before the very end) were the staff, whether doctors or nurses, all equally and reliably kind – it was small, rather like a cottage hospital, a part of the University College group, and of course, being the best, it has since been closed. I took my mother in on a Sunday, for an operation the following day, and while a Staff Nurse scrubbed every inch of the bed my mother was to occupy before making it up with fresh linen, we were given tea in china cups (a kettle was always singing on a hob in the ward kitchen), and cheerful reassurance about what would happen in the morning.

It was one of a scant few hospitals during those years where my mother was washed, fed, and given her medication by somebody other than me. Everywhere else, I didn't pay carers, I constantly went in myself, and I needed to.

Various instances from the myriad remain unforgettable. My mother had nearly died of pneumonia, which I had nursed her through at home, and when a geriatrician made a house call she told me that I had saved my mother's life but now she needed an immediate admittance to a rehabilitation ward. As soon transpired, the doctor might as well have sentenced the patient to Alcatraz, given the character of the sister in charge.

My first encounter with Cruella de Vil was memorable. She demanded my presence in her office, where she told me that straight hair wasn't acceptable on her ward and she proposed to arrange that my mother should have a perm. I didn't think I could remember my mother ever having had a perm, and she was very frail after the pneumonia, so I offered, panic-stricken, to pin her hair up every night when I washed her and put her into a fresh nightdress. This compromise grudgingly accepted, I returned to the ward, where I watched a stroke victim opposite attempting to eat soup with a fork. Nobody helped her. And she seemed to have escaped notice completely, because her hair stood straight up on her head, since she was unable to comb it. Perhaps the perm rule wasn't real?

Other things were, though. The ward's gesture to rehabilitation was a tiny bookcase, from which patients who were strong and brave enough might choose reading matter. I hadn't looked at it closely, being busy bringing in edible food, filling bowls of water for washing and providing changes of underwear and nighties, but when I arrived for my second round of daily duties one evening I found my mother sobbing heartbrokenly, and though I tried to find out the reason she couldn't speak but only pointed to the books.

Going to look at them, I discovered one by a woman who'd been as close to my mother as a lifelong friend. They'd got to know one-another when they were both young and airing a baby on blankets in a park, before the fellow baby-airer had become a well-known writer. She lived behind Piccadilly, my mother lived behind Regent Street , and by an even greater coincidence, they had Soho in common – the author had lived there until her marriage. My mother had every one of this woman's books, together with many letters. And by an extraordinary coincidence, by chance we'd met and become friends with her husband's family many years later. Still mystified – finding a book by this author, who'd long since gone to live abroad, would have delighted my mother – I spoke to a nurse. She said she knew her! the girl jeered contemptuously. Who does she think she is, saying she knows a book writer!

So when my mother had recognised and exclaimed with pleasure at the discovery of a book by her friend, no-one had been interested in doing anything but pouring utter contempt and disbelief over her head. I felt the ice down my spine as I comforted my sobbing, broken parent – was this what awaited me, when I was her age? In my flat I had shelves of books written and autographed by people, some dead now, who'd been my friends. I once had a book dedicated to me by a best-selling author. If I were to end up in a geriatric rehab ward, would I too be insulted and called a liar if I claimed to have known anybody who'd written a printed line?

Worse, I thought of all my mother herself had had printed in newspapers, years before, and the files of friendly handwritten letters from famous editors. I looked at the sneering nurse, and asked myself what Hell we were in. This was a ward in a major London hospital. Only floors away people's lives were being saved – so that they could live to an old age when they'd be treated like this?

And it wasn't only useless to protest, it was deeply unwise. The wrong word, the wrong action – I could already do nothing right and was receiving regular demands from Cruella de Vil to appear in her office, where I was berated for my behaviour.

Sometimes, though, just occasionally, things were briefly better. A different kind of nurse would appear. The ward had a central table, so that patients could eat there if they weren't bed-bound. One day I found a delightful nurse who'd got all the women capable of moving up from their beds to sit there and play card games and bingo, and I was so thrilled I went out and bought little toiletries that could be prizes – scented soap, talcum powder, that sort of thing. I took them back to the ward, but the nurse had disappeared, and the activity with her; games weren't played again.

You could always judge the feel of the ward by the presence or absence of Cruella de Vil. Her attitude infected everyone who worked in it, and only much later was I told that she actively hated old people. It didn't make for a good atmosphere.

I was sitting by my mother when a shy little woman called across from her bed, obviously desperate. “I'm so sorry, nurse, but please, I'm wet again – ”

No, you aren't, retorted the ministering angel, her feet up on a chair as she flicked through a magazine. You're just lying. You're always lying.

How could this happen? Because I was usually the only witness who wasn't a member of the staff. Geriatric wards can be isolated places, and none of the other patients here had visitors to see and hear what was happening. A couple appeared very occasionally and looked at the stroke victim for a few minutes, but disappeared again as soon as any food arrived. So she went on trying to eat soup with a fork, and got ever thinner.

Everything changed completely when other visitors were present. On one glorious day an entire family arrived with a grandmother. Meal-time was transformed: a lovely, lively group clustered around the table, chatting to me and the others while they helped the patient to eat. When I left the ward that night they were still there. But the next day they were gone. The grandmother had been transferred to another hospital.

And that evening Cruella de Vil stood at the head of the table that had been so jolly twentyfour hours before. I don't like all this talk! she spat. I won't have it when you're eating! Staring at her, I knew that she'd never have dared to make this speech in the presence of the family who'd crowded there the day before. If she had, I think they'd have lynched her. But now I was, once more, the only visitor. I was the only one to hear that meals were, henceforth, to be eaten in total silence. In what Dickensian nightmare did she conjure up her unique rules?

Only a few days later she was off duty, and an enterprising nurse from a neighbouring men's ward had what she thought was a great idea. The days were so dull for people in hospital, she told me, as she and her colleagues ushered in male patients to join the women around a festive tea table. They were going to bring them all together to be sociable and have a chat!

That poor nurse's disappointment was tangible, as the men tried to talk to the women over their cakes and got no answers. The ones on this ward won't even talk to each-another, let alone the men, the nurse said to me, baffled. What's the matter with them?

They've been forbidden to speak, I told her, and she simply didn't believe me. How could I blame her – if I hadn't heard it, I wouldn't have believed it myself.

Then we acquired a patient who was physically well but mentally confused. She kept trying to leave the ward – well, perhaps she wasn't so confused after all. But she was supposed to stay put and it was decided that the way to ensure this was to tie the ward-doors closed. When I needed to leave after my first visit, the surly girl who'd called a patient a liar had to untie the knotted rope that held the doors shut. The Great Escape lady tried to get out with me, wailing that this was a prison. No, it isn't, I said to her as I slipped past, a prison would be much nicer.

It had been such a casual remark, but how I paid for it. When I returned in the evening I had to stand in front of the sister's desk and be castigated. How dare I speak like that, and I was to apologise immediately. I was made to go to the young nurse who'd been so insulting to a wet elderly lady and say how sorry I was for offending her. She required the apology to be repeated twice, her feet on a chair again, and I stared into her vindictive little eyes and raged inside.

Two successive geriatricians had told me that my mother required too much assistance to come home to me, and I spent every spare moment covering the Home Counties, inspecting care homes. None of them resembled my mother's cosy, cluttered flat full of books and memories and, always at the forefront of my mind, there was the fear that here too she might encounter a power-mad Cruella.

When I did find nice places they were mind-blowingly expensive, or – more difficult to deal with – made it clear that they weren't nursing homes. If my mother couldn't look after herself she wouldn't be an acceptable resident.

It was at this baffled point that, one evening washing my mother, I noticed a dark patch on her thigh. She told me it was terribly painful, so I asked a nurse (suitably humbly) if she could look at it. She shrugged. That's nothing, she said, she bumped into something, and wandered away.

But the next day I had the luck to find my mother's geriatrician on the ward and asked if he'd mind looking at her. His reaction was immediate: my mother had the beginnings of a bed sore, which must be treated and taken seriously. I could have kissed him, and took the opportunity of explaining the problems I was having in finding somewhere suitable for her to move to. He repeated that I couldn't possibly provide the amount of help she needed, and suggested I make an appointment to see him and discuss everything when he returned from a short leave.

But only days later another consultant, who normally dealt with other patients, appeared on the ward, and I saw Cruella go over and speak to him. The next thing I knew I was being told my mother had made such sudden and remarkable progress that she being discharged and sent home. When I tried to repeat what her own geriatrician had said, I was told that in his absence this doctor was in charge, and the sister was the medical expert when it came to my mother, not me. I couldn't contradict her observations.

Between caring for my mother on the ward and searching for an alternative, I had neglected her flat and mine. A high wind had broken a window, which needed replacing for her, and I hadn't been there to have the work done. I confronted Cruella. I don't care whether your mother's got a bed to sleep on! she hissed. I'm having her out of my ward – you and your complaints about bed sores!

I hadn't complained, I hadn't even known what the sore was, but because of my question a geriatrician had seen it and that had sealed my fate. Mine and my mother's. She came home and the relentless wheel of caring turned, but no matter how tired I became, at least we didn't have to face Cruella. A year later, some of the patients who'd shared my mother's incarceration were still on the ward, but Cruella had gone. I bumped into a nurse I knew (a nice one) and asked about the monster. Her! came the yelp. She was stark raving mad!

But you have to ask yourself why someone so patently unfit to be in charge of anybody, let alone vulnerable patients, could have been left in place. I didn't get an answer in that hospital, but I got it somewhere else.

When someone is so ill that an ambulance has to rush them to A & E, you have no choice as to where they are going. One such night-time dash ended up at a hospital I didn't know, in a district I didn't know either. When my mother was finally admitted, I emerged into scarily empty and very dark streets, and walked for ages before I found a taxi.

The place proved to be a nightmare to get to, even by day, and from the first I was terrified by what I saw. My mother had a raging fever, and (by now a veteran of medical confrontations) I stormed at a doctor that her medication was being left on her locker although she was too weak and ill to reach or swallow it without help.

Oh, please, he begged me. “Don't say anything! This is a geriatric ward!

Nobody wants to work in geriatrics, we have to take what we can get!” He looked very young and very frightened. Whatever you do, don't complain!

It was one of the few times in my life when I was left speechless. So the patients who needed the most help were getting the worst – and the system connived at it. If I didn't come in here and care for her, my mother might not survive.

One evening she began vomiting, and the sickness was relentless. Anyone who's been sick like that will know how awful it is, and after hours of it, as I held yet another bowl for her, she whispered hopelessly, You said you'd take care of me. By now she was vomiting blood, and I was frantic. A helpful nurse had actually made a call, requesting that a doctor attend urgently, but it was night-time, and hospitals at night-times and on weekends are short of doctors – any on duty are usually up to their armpits in A & E. It was midnight before one arrived. He said that my mother was reacting badly to aggressive medication, prescribed other drugs, and told me to be back for the ward round the following morning, to discuss my mother's case.

By the time I got home I had just enough of the night left for an hour or two's sleep before getting up again, but I was in time for the ward round and a review of my mother's treatment. I stayed through the day, but rang a friend and asked her if she could come and help my mother to drink and eat a little that evening, to give me a break. I was ragged with worry, and exhausted, and grateful beyond words when my friend arrived. But as I made my way towards the ward doors a staff nurse barred my way.

Where do you think you're going? she demanded.

Confused, I said that I was going home.

Going? The food's just come – you get back there and feed your mother!

I had to be hallucinating, this must be a nightmare. So tired I had to struggle to speak clearly, I said that I had arranged for a friend to feed my mother. I was here till after midnight last night, and all day to-day.

Your mother's your mother – you feed her! If you've got a friend she can go over there and feed that woman! She was pointing to an unknown patient.

The shock and incredibility of what was being said to me didn't make me fight back, it made me do the worse thing possible – try to reason with the completely unreasonable. I kept repeating how long I'd been on ward, until my friend seized my shoulders and propelled me out into the corridor, where I started weeping. I could still hear her telling the Staff Nurse just how much care I'd been providing, and the nurse snarling at her, when the lift doors closed.

At the ground floor there was a reception, with a man on duty whom I'd got to know. I hadn't been able to stop crying, and he asked me if I was all right, whether something had happened to my mother. He had to sit me down, because now I was shaking, and I told him what had happened. I'm calling someone, he told me. She's the nurse in charge tonight, and you're going to repeat every word you've said to me.

At some point a serious young woman appeared, and listened with increasingly grim concern. You have to make an official complaint, she said, and it's got to be in writing. If you don't complain it'll go on happening, and verbal complaints can be ignored, but they have to do something about a written account of what happened.

So, as soon as I could, I wrote to the upper echelons whose details she gave me, even supplying my friend's name and details as a witness.

Many weeks passed and my mother had long since been back home before I finally got an answer. It was a short paragraph stating that the Staff Nurse concerned had merely been trying to involve me in my mother's case. I didn't know whether to flush it down the lavatory or frame it – I couldn't have been more involved in my mother's case if I'd got in bed with her – but I'd learned again that complaining was no use.

If I flick through the incidents that peppered those years, it's easy to see how much the attitude of doctors mattered. The caring geriatrician, back in our lives, was responsible for a brief spell of respite care in the bright, modern wing of a long-stay hospital, where the only thing amiss was that my mother lost some of her best cardigans.

But when he moved and was lost to us, everything that could go wrong, did. In a psychogeriatric unit where her medication was supposed to be regulated and a satisfactory drug regime set up, my mother told me she couldn't sleep on her bed, and I turned back the covers to reveal what looked like a rutted farm track. The thick waterproof that covered the mattress (my mother was never incontinent) had formed into hard, sharp ridges, and a bedspread had been thrown over this rock-hard base and a knotted tangle of sheets, hiding a surface worse than a bed of nails. Asking if something could be done about this achieved nothing – of course it didn't. Once it can be said that there's something not just physically but mentally wrong with a patient, anything objectionable can be just their imagination – and yours.

But it was nobody's imagination when the drug regime that was supposed to improve everything had such horrendous side-effects that we were soon dashing through the night in an ambulance to an A & E again. Back off those drugs and on to a medley of others.

I needed minders and sometimes kind volunteers to watch over her for a few hours about twice a week, while I cleaned my teeth, bought food or occasionally even met friends (who christened me Cinderella because I fled before my curfew), but showering her, dressing and undressing her as she became more helpless, and of course the nights, were always my responsibility. And the nights were, strangely enough, the best time. We talked about the past, we shared memories, she became completely clear-minded and the person she used to be.

Then suddenly there was a deep vein thrombosis in a scarlet, agonising leg – another ambulance, another hospital, another ward, but a good one this time. And a doctor who warned me my mother might die. She didn't, but she was left with great difficulty in walking. And life-threatening illnesses, like anaesthetics, can affect elderly patients badly, as though they knock out or alter brain cells: my mother started calling for me whenever I was out of her sight.

The ward sister, who was Cruella de Vil's polar opposite, said she'd try and arrange another brief spell of respite for me, right there on her ward. It seemed fantastic when it happened, and it would have been, but now the geriatrician in charge was the man who'd told me Cruella was the medical expert. (Consultants can circulate around a group of hospitals, sometimes like a refreshing breeze, sometimes like a bad smell.) And strangely enough, he didn't apply his rule to the excellent sister here, or her colleagues. He came on the ward, heard my mother calling my name, and decreed she should be banished because he could hear her. I'd been visiting every day, despite the supposed respite, and I had a call from the sister, who was trying not to sound panicked – my mother was to be transferred to another hospital. Not another! I'll have her home, just let me get dressed and come with a taxi! (It was very early morning.)

I don't know if you can get here in time – I'm going with her.

I ran all the way, and found her being bundled into a car at the hospital doors. Pleading didn't change the direction, and the flustered sister kept telling me that the next hospital was really a good one. It was quite some distance, no question now of running in all the time to give reassurance. The nurses seemed nice, and the ward pleasant – but I stood there, overwhelmed by the sudden turn of events, knowing only that this wasn't what I had wanted. Just give it a try, said the sister. She meant well, because she too had been put in an impossible position, but I should have called a cab and taken my mother home there and then. My only excuse is that when you're given no warning, you can make bad choices.

Just how bad this one would prove to be, I could never have guessed. A hospital chaplain who'd become a friend was so outraged he cornered a junior doctor, who admitted the whole thing should never have happened in the way it had. Your mother isn't a parcel! the chaplain stormed to me. But I was visiting her in the other hospital now, and getting ever more frightened. She was clean, she was being fed, but her head lolled insensibly, and she was wearing unrecognisable garments. I was told that all her things had been taken away to have name tapes sewn in them. But she's only supposed to be here for a few days!

No, yet another consultant was prepared to offer me a whole fortnight's respite care. How come such an offer? And my mother wanted to return home, I knew she did – except that she was so changed, so helpless, so different. I sat beside her, while she asked for me wretchedly, unaware of my presence. I had no idea what had happened, but I wasn't just worried, I was scared. In my ignorance, I feared that the shock of the transfer had somehow made her deteriorate like this, had made her unreachable.

Nobody told me the reason for the change in her, or that I could have prevented it if I'd followed my first instinct and somehow forced the transport to let me have her back and not drive her here.

When she was brought home, she was in a wheelchair, and the accompanying nurse told me they had to use the chair to take her to and from the lavatory and the bathroom. Then I'll need it here!” I said to her – but no, I couldn't have it. Yet it wasn't just a question of difficulty in walking now – my mother couldn't stand. I held on to her when we lurched about together, but I couldn't make her understand that she should wait for me to help her, and not try and get up unassisted. She fell and fell and fell. My GP's locum examined her in a fury. They wanted a quiet patient and they got one! She's been doped to the eyes – doped till she couldn't move!

I had a desperate conversation with the doctor involved in the two-week respite. You accepted it, she said silkily. If it was so terrible, why didn't you take her home?” Because the move had been sprung on me, because I didn't know what was being done to her, because I thought she'd suddenly deteriorated beyond recognition, beyond what I could cope with, and I was frightened. Why wasn't I allowed to keep the wheelchair for her? I demanded.

She didn't need a wheelchair when she went in

Precisely!

So she wasn't going to be discharged with one! God forbid anyone should admit that two weeks in the tender care of that hospital, taking that doctor's prescribed medication, had deprived my mother of the use of her legs!

Our caretaker became my assistant, getting my mother up off the carpet again and again. And at night there were paramedics. Immobilised, my mother became much heavier, although she was eating no more than usual, and my strained back protested. I couldn't risk giving her showers any longer, and resorted to daily bed baths. Still the falls continued, and sometimes required much more than merely getting her up. She fell against a radiator, and burned herself badly. She fell so often that she simply had to be admitted to a hospital (another!) and walked between two nurses till she got some use of her legs back. But it was only some; she still fell.

And all the time there were other illnesses and infections. If she ended up in one of the hospitals patrolled by the bad-smell consultant, she was immediately discharged again, no matter how high her temperature.

I was told that she should be in a long-stay hospital, and that was the only option he would permit. But he wasn't suggesting the bright, modern building where she'd been sent under the aegis of the kind, caring consultant – what this man was offering chilled me to the bone. The hospital had two sections – the low-level new one, and another that looked exactly like the house behind the Bates Motel in Psycho. She'd been in it once before, briefly, and when I found the lavatory doors fastened back and male patients going in and watching the women I'd gone madder than any of the inmates. Yet it was this option, and only this, that my mother was being offered.

Why not the other building? That was for people with physical problems and not mental ones, I was told. But she'd still been able to trot about when she'd had the respite stay there, and the elderly ladies around her were so confused they hadn't recognised their own undies and had furious rows about garters! Why, now she had so many physical problems, wasn't this the place for her?

The ruling wasn't up for discussion. It was the Bates Mansion or nothing.

Fighting 'flu and recurrent back strains, at last I found the perfect solution. It was a sweet little home on the fringe of South London , with friendly girls who showed me around. There was thick carpet everywhere, and cosy bedrooms, wheelchairs to get people about, and the kind of baths that patients could be helped to sit in. Clearly they were well used to residents with mobility problems. The atmosphere was exactly right and, in the depths of a bleak winter, it was as though the sun had finally shone through the clouds.

I hadn't wanted to send my mother anywhere, but the falling was terribly dangerous, and I was coming to the end of my reserves. There were innumerable telephone calls, dates decided, arrangements made. And then, when I rang one last time to confirm my mother's arrival the following week, the woman who ran the place said, as casually as someone turning down an offer of tea, she wasn't going to accept her. You can take for granted my screams of What?

Suppose she falls. The voice wasn't really interested.

But that's the whole point – I explained! I'd disguised nothing – not my mother's needs, not her state of health – I'd told the staff everything, and received smiling assurances: they were used to coping with all that. Yet now I was being told that they couldn't be responsible for someone who might fall.

What about all the others – the baths that could be sat in, and the wheelchairs? On the far end of the line, the response was an audible shrug. She wasn't interested.

I never received a real explanation, but much later I formed my own conclusions, having heard of other, similar cases, involving various homes. It was a form of gazumping, although no money was mentioned. Fees were fixed, after all. But the less help and care a patient needs, the more attractive and economic they become. You may think you've found a place for your relative, but until they're actually in residence, don't bank on it. If someone comes along with a fitter, more ambulant, more with-it patient, they may well end up in the room you were promised. That was what I learned, the hard way.

Meanwhile, whatever the reasons for having the carpet pulled out from under us, we were left with the effects. A favourite minder was going into nursing full-time, and wouldn't be helping us any more. I couldn't find another. It was December, and my mother had been rushed to hospital again, but was to be sent home if I didn't accept the consultant's offer. I wrote letters detailing everything that was wrong with her, and most particularly the fact that she fell constantly if left unattended, and sat up all night sewing name tapes into everything she possessed. She was especially fond of a hand-made knitted quilt and I edged it with her name and took a taxi the next day to meet her at the Bates Mansion. She was sitting in a large, bleak room, looking totally bewildered.

When I left I knew she couldn't stay there. I'd check on her all the time, catch up on some sleep, and try and find somewhere else. Failing that, I'd take her home whether I'd worked out an acceptable alternative or not. If I found the other residents alarming, what must they be like for her? In an ugly day room, a little woman whimpered and cowered back in a chair while a large lady windmilled her arms and struck her. None of the staff intervened.

It was a long way away, but I kept making the journey: she was frightened, and so was I. There was a bath rota in my mother's room, from which it looked as though no-one had more than one bath a week. But her name wasn't on it. I asked a nurse and was told she wasn't due for a bath yet. Meanwhile the silky skin of her face (she had a far better complexion than mine) because peculiarly flaky. I touched it, and discovered someone had wiped her with a soapy flannel and hadn't rinsed the soap off. I found a wheelchair and took her in it to a basin, where I washed her hair and set it. The windmilling woman was still attacking the little lady.

Christmas was on us, and a friend and I took her presents. When I hugged her, she winced, and I saw unmistakeable bruises on one of her legs. Everybody said they knew nothing about it. She was sitting alone, and I spoke anxiously to a male nurse and reminded him how easily she could fall, if she was left. He was surprised – really, he hadn't known that

I didn't celebrate Christmas Day – I didn't do anything but plan and worry. I'd insist on a meeting with a consultant, I'd beg that she be transferred to the bright, modern wing of the hospital. That section, and the care there, were so different, and at least it would give me more time.

But time was running out. On a brilliantly sunny, freezing cold Saturday in the New Year I walked into the building and a nurse on reception gave me a strange look, not meeting my eyes. Concentrating on the desk surface, she told me my mother had had a fall. A fall? The dozens and dozens of times when my mother had fallen at home, on thick carpet, were in my mind as I went to her bed. But she wasn't struggling to get up, she wasn't calling. She was the colour of tallow, barely conscious, and I stared at the strange shape of her leg.

She was to be sent to another hospital. What does the doctor say? I asked, and learned there was no doctor here at weekends.

When was the ambulance due? It was coming. But no-one can have uttered the word “emergency”. I'd got to know the ambulance service very well over the past years, and we'd never been left waiting for hours. That day we were. I sat in the room where my mother's name still hadn't been added to the bath rota, while a nurse pulled her possessions out of her bedside locker and heaped them all into a huge plastic sack. Had she fallen here, by her bed? No, in the toilet. I thought of the bare, hard, cement-floored lavatory, and felt like throwing up. It was all her fault, apparently – she didn't wait for someone to help her, she tried to get up by herself. All of this without looking at me, me and my letters and warnings that'd done nothing. My mother only stirred when the ambulance men finally arrived, and took her on a stretcher to the ambulance – the movement made her cry out piercingly.

I thought she was going to die, on the journey, but she survived to reach an A & E where a doctor and nurse flirted with each-other over her body. Occasionally muttering, some way off was the nurse from the Bates Mansion, who'd come with us and was still dragging the plastic sack along the floor.

The prognosis was never good in a case like this, the doctor told me casually. A bad fracture – he'd call a consultant, but elderly patients were usually left wheelchair-bound, if …. I don't know what else he said, till we were on a ward. An orthopaedic surgeon had come from home, standing in his overcoat and saying he'd operate on Monday. When he'd gone the young doctor was there again, asking me what I wanted done if my mother needed resuscitating. I want you to resuscitate her!

The sack of her things was in the ward office, and so was a nurse having a telephone conversation. She gestured at me to wait when I took hold of the plastic, so I sank on to a chair while she chatted. It was a long conversation, and it was very late at night now. But she was as fresh as poison ivy. She put down the receiver and told me just what she thought of me and my ignorance. Obviously I didn't know what resuscitation involved, and she went into lengthy detail. Her high, scornful voice bored through my head until I couldn't bear it any longer, and I left to find a taxi before she had finished, dragging the sack behind me and gaining another enemy.

The next day my mother was on an air mattress, and a sister was supervising regular turning – the mattress and the turning were because of bed sores. But she'd been here less than twentyfour hours – she couldn't possibly have got bed sores already! Nobody answered me. I was left to divine that she'd arrived with them, just as she'd arrived with that shattered leg.

This was an orthopaedic ward, not a geriatric one, and a middle-aged woman who'd fallen down an escalator gripped her bed at the screaming agony caused by the turning. Somehow we reached the beginning of the working week, and the endless hours of the operation. After it, the casual young doctor looked shaken for the first time. It was terrifying,” he told me. “The bones were just dice.

I was shown the X-rays. Some of you may remember a motor cyclist named Barry Sheen, who had an horrific accident many years ago, and the X-rays of his legs that were published – a jigsaw of metal screws and bolts and plates. Now I was looking at the same pictures, but they were of my mother. As soon as I heard she was on strong antibiotics, I warned a nurse she'd need treatment for a painful problem they always caused her – and she was in such horrific pain already. Unfortunately the nurse I warned was Poison Ivy.

I rang the Bates Mansion 's administration, and made a formal complaint. She may not survive! I railed at the laid-back man who'd taken my call, and he said there was no need to be so pessimistic, I was being over-dramatic: She's only had a fall. I told him to ask for a report of her X-rays, and slammed the 'phone down.

I have no idea what pain-relief other patients were getting, but my mother's was something I'd never seen before – she was simply moved to a side room where her screams of distress were less audible and disturbing. I couldn't seem to find any doctors, no matter when I was on the ward, or for how long, and the nurses were casual. When I questioned one she said, I don't know why she's screaming, she's getting paracetamol.Paracetamol – something you take for a headache ? The nuts and bolts and screws in her fragmented bones flared in my eyes and I wanted to scream like my mother. Nothing I said or did changed anything, and ten days after I'd warned Poison Ivy, even the side effects of the antibiotics still hadn't been treated. I was in the side room with the sweat, the writhing, the quietness that only came with total exhaustion, and thought I'd lose my mind.

My mother was even now, I learned, officially in the care of the bad-smell consultant. Failing any other recourse, I rang him and pleaded for adequate pain relief for such agony. What did I have to lose any more, he couldn't send her home again this time, and he was responsible for her being in the place where she'd fallen. For the first time he spoke to me reasonably. He even sounded – could it be shifty? And astonishingly, within days I was walking beside the trolley taking her to a geriatric ward, where she was given morphia.

The effect was immediate. She relaxed, as though she'd been taken off a rack, and I was able to help her eat a meal. But nobody explained anything about what would happen. At another meal-time, a charming female doctor came and smiled at her and said, “She'll be out of all this very soon now”. I stared, puzzled, and she smiled again and went away. No-one had told me my mother was dying now, or whether the morphine relieving her pain was also precipitating her death. To this day, I don't know whether she'd have died if she hadn't been given the drug, but I do know her pain had been unendurable without it.

The nursing care, at long last, was exemplary. If only she'd received such care, years ago. The nurses on the ward were kind and gentle beyond any possible expectations: dashing in from a visit home to have a shower, I found a young male nurse gently massaging my mother with Lavender Essential Oil. He talked to me (they all did) but he was especially vocal because he'd worked at the Bates Mansion and described it as a Hell on earth. You never leave a patient with dementia, who might fall, alone in a lavatory, he said bitterly. This should never, ever have happened to your mother in a hospital.

But if I was making a complaint he couldn't testify for me, despite what he himself had witnessed. I'm so sorry, he said, “but I want to go on working in the NHS.”

The newspapers were full, just then, of revelations made by a senior geriatric nurse about the conditions he'd seen, but if you check, you'll find he's not in the NHS any longer, the young man told me. Whistle-blowers never get another job.

My mother had lost the ability to swallow food, and now she couldn't drink either. I soaked sponge swabs in tea, and she sucked at them. She'd fought for survival so many times, and she still wanted to live. Despite everything, despite developing pneumonia, she battled on.

I'd go home to wash, to make a sandwich, and the call would come. I think you should get back – Thank goodness I was so nearby. I sat through days, I sat through nights, and she defied all predictions about an ending. On and on, till finally one morning, when I was holding her hand, it was over. And gradually all the strain of fighting ebbed away and her face became smooth and young.

The ward sister and a male nurse attended her funeral. Much later I showed a photograph of all the flowers to somebody, and was asked about the young man who looked as though he was crying: it was the nurse who'd massaged her with lavender.

I got nowhere with the Bates Mansion administrator, despite enlisting the help of the local Community Health Council. They spent an enormous amount of time and trouble trying to assist me, but they aren't around to do anything in England now.

Community Health Councils were set up in the 'seventies to assist patients and their families, to give them a voice, with the avowed aim of improving the NHS. But these days they survive only in Wales – in 2003 they were abolished elsewhere, and were already being ignored more than ten years before that, if my experience is anything to go by.

I didn't want to go to law – this wasn't a question of money – so in the end I went to the National Health Ombudsman, and the eventual report was sickening.

The complaint I'd made immediately to the Bates Mansion hadn't even been registered for six months. And, far harder to read, in the few weeks she'd been a patient there, my mother had fallen fourteen times before the final incident that led to her death, but on not one of the fourteen occasions was a record of her fall part of the next nursing hand-over. No extra precautions were taken; I wasn't told.

There were all sorts of comments about procedures, all sorts of findings. But it didn't appear anybody was actually going to suffer. Nobody, apparently, was going to be sacked. Certainly no-one was going to have their legs broken so they could know what it felt like – and you'd be amazed how much I wanted that.

I met someone who was pursuing a legal case because his mother, too, had died in a medical unit where she should have been protected. But he was stonewalled for years, till any remaining money, and Legal Aid, all ran out. We agreed that we'd both wanted justice, retribution, (in my case even primitive vengeance) and had to accept that we'd never get it.

As I write these final paragraphs, the Patients Association have issued a report cataloguing horrific lack of care of the elderly in hospitals – patients unwashed, unfed, left without bed pans, without pain relief. And I repeat, there is nothing new here. Except perhaps that it's being dragged out more often into the open. I watched a spirited ITV news reader interviewing a representative of the Royal College of Nursing, and pointing out the cases in the report were far from the exception – she and her sister had also had to clean their mother themselves when she was in a hospital, and how could that be right.

It's true that whistleblowers aren't penalised as they used to be, and there is talk of zero tolerance of bad care on wards. But what is needed is a complete change in the attitude of medical professionals to the elderly and vulnerable. They aren't a sub-species, which is how too many doctors, as well as nurses, treat them – revolting racism has been superseded by equally revolting ageism, in our society, and I wish I could see the end of it.

The Health Service needs to train and employ doctors who have standards of decency as well as qualifications, and respect their patients. And, along with them, nurses who are taught and encouraged to aim for the kind of care that makes a real difference to the hospital experience – it can be done, I saw it, on the last ward where my mother died.

Until then we'll continue to hear the same awful news and read the same headlines. All we can do, until those in authority stop talking and start acting, is hope. And avoid getting old ….

© Alida Baxter

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