Well, my supposedly dying brother now isn't, at least for the time being. He's off the ventilator and everything. All seems to be going as well, no, better than could be expected. I keep waiting for the phone call to tell me he's at death's door, but it hasn't come, and it's been 24 hours near enough now.

They still don't know what caused the pneumonia, and he's not out of the woods, but this is such a strange thing to happen. Steven's Partner had a faith healer in on Monday, and I keep wondering if that had anytihng to do with it.

Bloody hell, I've not got him a Christmas present. AND I'll have to do yet another re-think on euthanasia. And he'l be really pissed off at me if he lives and finds out I've been blogging on his impending death. Serves me right though, dirty linen in public and so forth.

I've also discovered that the mother of his children is using his surname, even though they don't get on and never married. Or did they? With Steven you can never be sure.

Might as well be hung for a sheep as a lamb, mightn't I?

Well after being on his deathbed for two weeks, Steven got out of it yesterday. Didn't quite take up his bed and walk, but it was miraculous enough. He is still ventilated, but is doing some breathing himself. The docs are humming and hahing about replacing his ET tube with a trachostomy, which is a difficult decision at the best of times, more so because he had a trachy for so long after his cancer ops, there's lots of scar tissue. He's by no means out of the woods, but there is now definite hope where once there was none. Looks like I might have to buy him a Xmas present after all.

On a totally different subject, when I was in Scotland, I used to whinge and whine about their abysmal driving in snow. I'd have thought they'd be better at it, given the frequency of it up there. I learned to drive in Scotland, and by the end of my first year I could make it to Rosslynlee Hospital in the snow in a 1.2 Nova. Those who've tried that will know what a feat it is (it entails making it through Roslin Glen/gorge, not to mention dodging da Vinci Code enthusiasts, heads of Christ, the Holy Grail etc etc).

Imagine my disbelief when I moved back to England and found drivers here are even worse! It's a case of, oh, let's not compensate by using a higher gear; let's drive to the T-junction at top speed and then slam on the brakes; let's drive at really erratic speeds, especially speeding up when going downhill and slowing to a standstill when driving uphill; let's not make any attempt at skid control; let's go off-road in a Corsa; and then let's look around and shrug in wonder and astonishment when we end up crashed/stuck/skidded.

Our last outing in Scotland, we went up north on the A9 in a blizzard. It was so bad that we heard on the radio that the road had been closed behind us. All the cars made it through - no-one caused an accident, no-one was stranded. The Bodmin snow was a sprinkiling compared to that. Scottish drivers, I was wrong, and I salute you!

I don't find it at all surprising that so many women are depressed after childbirth:

http://news.bbc.co.uk/2/hi/programmes/real_story/4476068.stm

I'm typical of many new mothers today. I had a successful career, had coped with working all the hours god sent, had travelled alone, had basically always been able to cope with whatever life had thrown at me (aside from a nervous breakdown, but that's another story). Then your desperately wanted baby is born, and life falls apart.

From being a capable human being, you become a wretched tearful bag of milk. The baby doesn't like you, it just wants to eat you. Where you were once a resourceful professional, you are now an ignorant slave. Life, that was once an invigorating bundle of challenges, is now a enervating drudge of chores. But how can it be that a capable woman can be so incapable of taking care of such a small thing as a baby? There must be something wrong with you. People keep telling you how happy you must be. There DEFINITELY must be something wrong with you. But if you admit to that, they'll take your baby away. So you carry on.

And guess what? Somewhere along the way you find that you are coping. You find that you are capable after all. The baby starts to smile and talk, and life suddenly becomes rosy again.

So what gets me is this: if something is 'suffered' by 44 per cent of mothers, why is it classed as an illness? Surely better to tell pregnant women, 'look, chances are your going to feel really awful in the first year after your baby is born. Don't worry about it, it's really common. You'll get over it, and we can pop in regularly and check how you're doing while you do.'

Of course, that won't sell half the pills that labelling a normal expression of human distress 'Post-Natal Depression' will.

[Disclaimer: I am not talking here about post-natal psychosis, which I recognise needs more serious intervention, as will the worst of the depressive episodes. However, even here, I think recourse to drugs is usually premature - but I'm straying onto another mental health soap-box now so I'll save it for another time]

No change so far with Steven. The longer this drags out, the more I'm again re-thinking the euthanasia thing. I've got grave reservations about legalised euthanasia, mainly because I think it would be very hard for elderly, frail people (amongst others) to resist the tacit (and not so tacit) pressure to 'do the decent thing'. I also don't think there is any reason for a person to die an undignified death in the modern NHS. Nevertheless, it does happen. People die in pain because the medical staff are somehow afraid to give adequate analgesia. People suffer because their nursing isn't up to scratch for whatever reason.

In Steven's case, he was totally opposed to ventilation before he went into hospital: he had signed a 'Do Not Resuscitate'(DNR) order, and was clear that he wanted to die at home. When push came to shove, he opted for the ventilator, mainly (I think) because of the intolerable strain it was to him to keep on breathing. He was offered ventilation because the doctors thought his pneumonia was treatable. The longer he's on the ventilator, the less that would appear to be the case.

Similarly to George Best, is there really anything to be gained by this vast consumption of money and resources (ITU is an expensive place to be treated)? Had Steven had the option of taking a pill and dying swiftly in place of being ventilated, I think there's every chance he would have taken it. He didn't so much want to live, as want to rest.

So I've no idea what I think. Again.

Steven was even better yesterday - he is now able to mouth words, and write. All those curmudgeonly types who moan about text talk would do well to remember that when writing is your only means of communication, and when writing is an effort, text talk is invaluable.

But what would you guess was the first thing he communicated to his partner (SP)? 'I love you'? 'Thank you'? 'You are in danger'? You're right, it was the last. Turns out I'm not the only one treated to the nurses' opinions of SP. You'd think that such clever nurses would have common sense enough to realise that just because a person's eyes are closed, it doesn't mean they are asleep.

Which neatly brings me back to yesterday's thoughts on the changing training of nurses and Allied Health Professionals. When I trained, the qualification for physios was examination leading to Membership of the Chartered Society of Physiotherapy. This became recognised as being the equivalent of a closed shop, and so the qualification was changed into a Graduate Diploma in Physiotherapy. Degrees in physiotherapy swiftly followed, and by the time I was working as a clinical tutor they were the norm.

When I applied to physiotherapy school, it was because I wanted to be a physiotherapist. You needed better grades than for most degree courses, but it wasn't a degree course, so there was no other use for your qualification. Once physiotherapy became a degree course, the field was wide open for candidates who intended to use their degree as a qualification for work outside of healthcare, but who would find a fall-back position useful. There's always work for physios. (This is no longer true in the case of junior physios, but that's another story).

When I was selected, it was because I had the makings of a physiotherapist. You don't need to be academically brilliant, you need common sense and the ability to get on with people. When your establishment is judged not on how many physiotherapists you provide for the NHS, but on how many people pass their degree, this need to get sensible folk on the course flies out of the window. It's the academic high-flyers you want. Some of these are sensible too, obviously (and I am arrogant enough to count myself in that category). Some aren't.

To this day I cannot forget the ordeal of trying to teach one of the students I had on placement at Birmingham Accident Hospital's Burns Unit. Let's call him Robin. As usual, I showed him how the unit worked, introduced him to his first patient, and treated her with him watching for the first day. So far so good. Second day we go up onto the Unit, and as I went into his patient's room (we'll call her Mrs T), a nurse began to lose her grip on a patient she was supporting. 'Quick, help me', she yelled to Robin. 'I'm only here to see Mrs T,' he helpfully replied. Leaving me to push my way past him to catch the now-falling patient. As I walked back into Mrs T's room, he muttered, 'I wasn't wearing an apron'. As if this could possibly excuse him, when neither was I.

After checking all was well with Mrs T, I instructed him to pop on her elastic bandages (these are support bandages which are just wrapped around the legs from the toes upwards - takes about five minutes max) and bring her down to the gym, as per the day before. I prepared another patient and took him down to the gym.

Thirty minutes later, and no Robin. I phoned the ward. Yes, he was still with Mrs T. Patients with burns can often be quite slow, so I made the mistake of assuming the nurse meant they were on their way. Another fifteen minutes pass. I return to the ward with my patient, to find Robin and Mrs T just leaving her room. 'Where have you been?' I ask. 'It's not my fault,' says Robin, petulantly. 'You told me to put on her support bandages.'

Next day we are both in the gym with our patients. Robin is at the horizontal bars supervising Mrs T's grand plie squats. I am with my patient who is on the static bike. Suddenly Mrs T's legs give way, and she slowly sinks to the floor. My eyes widen as I run towards her. Robin shrugs, mystified. I pick her up on my own.

It doesn't help that each day he appears late, unshaven, and with bits of lunch peppering his stubble. It's the lateness that really irks. Each day my heart lifts at the thought that he will not be here. Then just as I begin to inwardly rejoice, he appears at the office, cruelly shattering my hopes.

At the end of the first week I sit him down and berate him for his poor performance. I even mention the lunchy stubble. He sits impassive, wiggling the end of his nose with his thumb. I begin to doubt myself. 'Look, if there's anything I haven't done, anything you think is wrong with how I've taught you, you know, just say, and I'll try and put it right.' He shakes his head. I am desperate. 'Robin, come on, don't you have ANYTHING to say?' He takes a deep breath. 'Is it home time yet?'

His tutor visits in the second week to see how he is doing. I tell her, without the expurgation that space and attention-span necessitates here. I plead with her to help me. She shrugs her shoulders. 'There's nothing we can do. He's like this on all his placements.' By this time I have given him a nickname - 'Robin Me-of-my-sanity'

At the end of his third week, the end of his placement, I have to grade his performance. Various attributes are graded on line scales. My marks are all to the far left, aside from the ones on knowledge - I can't deny that he has learned everything on the handouts and talks I have given him. He is merely incapable of putting that knowledge into practice. Burns is a hard placement emotionally, but it is an easy one physio-wise (it was my own first student placement). If he can't cut it here, he can't cut it.

But the clinical placement scores aren't used towards the degree. When the results come out at the end of the year, Robin has passed. He is second in his year.

Sometimes I have a nightmare that I have been in a car crash and I awaken to see Robin's face grimacing over me as he attempts nasopharyngeal suction. Small crumbs scatter in front of my eyes......

The news today is so much better really. Steven is needing less sedation, is awake enough to communicate, and to cry. No change on the chest infection (he is doing a bit of a George Best: has done most of his life, come to think of it), and he's a slightly scary shade of red, but this is apparently down to the infection. So maybe it isn't the end.

Steven's Partner (SP) is also a lot happier. Yesterday she got to see the doctor who made 'the face-mask cock-up', and he has admitted responsibility, and has gone so far as to say he has learned something. For a few minutes I thought I was in some strange parallel universe where medics treated patients and family like human beings. But then SP explained that she'd spun them a line about her family friend in London being a lawyer. This achieved in half an hour what a week of pleading had failed to deliver: the person who had made the mistake apologised. That was all she ever wanted.

I wonder if a time ever existed when nurses really cared about their patients? I'm not talking every nurse here - I've known quite a few selflessly dedicated nurses in my time. But for every caring nurse, there's another ten who care far more for their paypacket and their boffing opportunities than they do for their patients.

We tend to hark back to some era pre-Thatcher and imagine that it was all fine then. Yet my first experience of a hospital ward was proof that this wasn't the case. I was doing voluntary work, and it soon became clear that this meant I was going to be doing all the jobs no nurse wanted to do. My day was an endless round of toilets and mouthcare. There was one patient with oral cancer, and his mouth was a stinking pit of globular (yet somehow also flaking) crud. It obviously hadn't seen an oral care kit for about a century. By the end of the week, with my twice daily haphazard cleanup jobs, it wasn't looking half bad. I was proud that I'd actually achieved something, had something to show for my week's efforts other than a ward full of empty bladders and sparkling clean bots. Come Monday, I was back to square one.

These nurses weren't bad people, neither were they unusual. They just represent the way most staff in hospitals choose to put themselves before their patient. No-one wants to clean a minging mouth, or pressure sore, or bum. But if it was their parent or child, surely they would overcome their qualms and get on with it? Why is another person any less worthy?

This is by no means the worst thing I've seen. For that, you have to go and work in elderly mental healthcare. When people are demented, they become non-human. Nursing staff, especially the unqualified ones, put these patients on a par with dogs who should be put down - and that is a comment I heard from a nursing auxiliary. I've seen fingernails cut so short that the nailbeds were still bleeding six hours later. I've heard patients shouting in vain for assistance, and then being told off like children for wetting themselves. I've seen people hauled around like sacks of potatoes, because 'what's the use of lifting them properly? They can't feel anything.' My physio assistant told me how upset she had been to hear two nurses verbally abusing and threatening an elderly demented lady who was trying to use the toilet. I reported this to the Nursing Officer, who promised action would be taken. It was. My assistant was ostracised by the whole ward.

I learned very early on in my career that the way for a physio to gain the approval of ward staff and patients alike was to use walking practice as an expedition to the toilet. It's a place most of my colleagues wouldn't go. 'It's not my job to toilet patients,' was the constant cry of all grades of physio, and students too. Well it doesn't appear to be the job of our degree-armed nurses either. And hell will freeze over before a radiologist or a doctor toilets a patient. Presumably the less mobile must wait for their weekly Occupational Therapist appointment to empty their bladders.

When I began physio school, I was a bit of an oddity. The other 23 'gels' were all middle class and well spoken. I only had to open my mouth to reveal my Black Country working class origins. I lost my accent, but I never got too uppity to wipe a bum.

Now physio education has changed out of all recognition (more of which tomorrow if I remember). This is great in that it means it's not full of lassies in pearls biding their time before getting married. It's bad in that making physio, nursing and the like into degree subjects means that they become academic disciplines, when they should be about employing people who are capable and caring. When they've spent three years in a library and written a dissertation, can we really blame nurses for finding shit, piss and spew a bit beneath them?

Tony Blair wants the NHS to become more patient-focussed. His reforms have had the opposite effect. NHS staff have become more focussed on statistics than on patients. Throughput is more important than quality of care. Fixing the books is at least as important as fixing the person. Most of all, staff have been put under ever-increasing pressure. The patient has always been the 'them' to the 'us' of hospital staff. Is it any wonder that stressed-out staff neglect their relationships with patients before their relationships with other staff?

When I joined the NHS, it was rubbish, but we were all in the same boat. We had no money, and the government had no money to give us. They at least appreciated us. The hospital manager couldn't reward us financially for our efforts or overtime, but he knew our names and he said thank you. The NHS survived on the goodwill of its workers.

Somehow that goodwill doesn't last when you are asked to record every detail of a patient encounter on a form which is inputted to a computer that constantly malfunctions and gives nothing useful back (thank you, Kohner). It doesn't last when your small and excellent hospital is closed and you become part of a huge establishment where nobody knows your name and there are more managers than doctors. It doesn't last when the government is constantly telling you that the NHS is inefficient - and that inefficiency is never to do with with managers: it's always down to staff.

When staff are kicked, there's only one group that is left to be their cat. Patients.

I'm feeling better today: mum and dad were dragged kicking and screaming (read: hobbling and moaning) to Steven's bedside yesterday by Little Sis and their next-door neighbours. Dad insists he can't do anything. Dunno what he thinks I could do. Little Sis is pragmatic, and copes better with Steven's Partner than I do. I feel like I have to somehow give her comfort. Little Sis (LS) is relived of this burden by plainly being unable to understand how Steven's Partner(SP)feels. SP is constantly going over all that has happened in her mind, she gets no rest from it.

On the night before Steven was ventilated, he was due to go up to the High Dependency Unit (HDU) for non-invasive positive pressure ventilation (NIPPV). It's basically a face mask that forces air/oxygen down your lungs. This never happened - when he got to HDU the face-mask instruction had been countermanded by a doctor who hadn't examined him; who hadn't even seen him. Who knows whether this intervention would have chenged the outcome? Either way, we're now where we are. SP can't let it go though. She wants to see the doctor who changed the instructions. I think she wants to make him see the consequences of his actions. She's assuming that looking at Steven on a ventilator would in some way bring home to this doctor what she and steen had been through, and I've known enough doctors to doubt that.

I worked in the NHS for 15 years, and I know exactly how the staff look upon my brother. All patients are patients. They are never someone's son, husband, lover. Steven is even less. He's an addict.

The Charge Nurse of the ITU sat with a doctor when I was there with SP, and they went through all that had happened and why. They made all sorts of excuses: 'the doctor can judge on blood gases how a person is doing'; 'the mask wouldn't have made any difference anyway'; 'Steven has received the best of care'. They knew I was a physiotherapist. They knew that I knew that making a decision without seeing a patient is questionable, and that should this lead to a mistake in treatment, the doctor doesn't have a leg to stand on. But they also knew that I was worried about SP, that I wanted her to be calm, that I didn't see the point in letting her know it had been an almighty cock-up. They gambled correctly.

I sat there and let them say it. I keep telling SP that she needs to move on: I genuinely believe she should, because there's nothing can change what's happened. I am not happy that a doctor gets off scot-free and that other staff are able to cover up gross errors of judgement like this. I'm different to other relatives only in that I KNOW when I am being fobbed off.

I'm guilty myself of the things I'm berating others for. I've looked upon patients as obstacles between me and my bed. I've glossed over some errors of judgement on the part of others, and I'm sure I've made mistakes that have similarly been concealed. 'Bodies' on BBC Two is as accurate a portrayal of hospital life as I've seen (Ged Mercurio worked at Birmingham Accident Hospital at the same time as me. His writing skills far surpass his medical ones). Hospital staff quickly learn that you shouldn't get involved with the patients, and that's a mistake, I think. My practice only changed when I let myself get totally involved with my patients. It does your head in at first, but eventually you become a far better practitioner than you were.

If I were a nurse on that ITU, I couldn't sit and watch SP cry without feeling some guilt. I couldn't gossip about her with colleagues while her ex-sister-in-law (that's me!) was in earshot. I couldn't victimise her for daring to complain. That's what happens when you start to identify with your patient and their family rather than with your colleagues - your practice changes. You become more, rather than less, professional. From a patient's point of view at least.

My brother is dying.

Everyone who reads that will have their own instinctive reaction to the words above. Depending on whether you have a brother, depending on how well you get on with a brother you have, you'll be attributing feelings to me that aren't really my own.

I'm writing this because I don't know how I feel any more.

Steven has cancer - I think it is squamous cell carcinoma, but I'm not exactly sure - that's how it is between Steven and the rest of the family. Anyway, they had to take away part of his face and he can't talk or eat properly. He was re-admitted to hospital two weeks ago with pneumonia, and went on a ventilator last Tuesday.

Tuesday afternoon I saw him. I'm a physio, I've worked in ITU (six years experience of it). It's a totally different experience seeing your own brother there. Really, he had no right to be looking so good - bar the tubes and pipes, he looked better than I've seen him in years. But he was helpless: even more helpless than he's managed to act all these years.

As I sat by him, it really wasn't so very different from all the Christmas Eves I'd sat next to him talking, long after he'd fallen asleep. I just didn't have to check that his fag was out. My brother is like a reverse Santa: you don't see him the rest of the year, then he turns up at Christmas and takes your presents.

But my brother isn't a bad person. He's never any trouble to anyone. Every Christmas he sits in the corner, drinks himself quietly into oblivion, then rouses himself sufficiently to insult my little sister before hitching off back to wherever he's living, pawning his(and our)presents on the way. That's no reason for my parents to refuse to go to see him when he's dying.

I'm trying to be charitable: it wasn't real for me until I saw him lying there. Now I can't stop crying, but I don't know why I'm crying. It's not like we're close.

His partner is fine when someone is with her, but when she's alone, she falls apart. She thinks there's something she can do, and flails around tring to find someone to blame, or someone to do something. There's nothing to be done except wait. Which is, of course, the hardest thing.

I'm resentful of her for needing me; I'm resentful of mum and dad for being so weak; I'm resentful of my little sister for not understanding why his partner needs support and thus throwing that burden onto me. I even resent Steven for dying near Christmas, because it is highly inconvenient, and it is disrupting my little boy's life.

Maybe I'm crying because I hate that I am such a resenting person.