That no one does anything about the aggressive awfulness of the actual hospital experience makes a person wonder (a) whether slovenliness is a part of our national character and (b) whether anyone in particular takes responsibility for the quality of the experience of being in a hospital, and if the nurses and consultants don't . . . and they don't . . . who does?

I don't know who 'designs' these places. But look around them and see very ill people sliding around helplessly on the plastic covers of their mattresses because whoever should do it is too lazy to tuck the sheets under properly, in tiny cubicles where the cheap and nasty curtain is torn from some of its rings so it always droops, on a bed with hostile rattling, steel protuberances, beside windows that look out on to stained breezeblock walls and concrete paths covered with cigarette butts, while the dying person's visitors stand around the bed because there are no chairs, harassed by nurses because they're in the way, avoided by doctors who don't want to have to talk, forced to visit from time to time the public toilets where every cheap lock on the plastic doors is broken, or to try to face the awe-inspiring fact of death in a smeary cafeteria which obviously incubates the MRSA bug.

If people came back from the dead there would be a powerful lobby to plead with the HSE to at least begin to plan for deaths which, though occurring in hospitals, nevertheless have access to grace and dignity. As it is, shy, brokenhearted people, shocked and bereaved, are bossed around by this functionary and that while comedians scream from the television and the tea-ladies rattle and hum and distraught patients call for their mothers and nurses argue about timesheets and God Almighty in the form of a consultant . . . who himself, unimaginably, will die, though in the fragrant peace of an expensive nursing home . . . sails by.

But there is, unfortunately, no lobby of the resurrected. Far from it . . . there's a counterlobby. People who have been very ill but haven't died are inclined to think hospitals are wonderful.

They are given to saying that nurses are saints, which I myself think is highly unlikely.

What they are is hardworking people in the difficult position that is middle management.

They're hands-on and they're accountable for the care of patients, and at the same time they're obliged to suppress at least part of their own intelligence and judgement because of the layer upon layer of authority above them. There are the hospital bureaucrats and the HSE bureaucrats, and then there are the medical people, and then there are the welfare people, and then there are spares like priests, relatives of the sick, postmen, hygienists etcetera, etcetera, all getting in the way of the nurse's tasks.

No wonder some of them adopt an all-purpose, loud, patronising briskness of manner which, please God, will not be the last thing I contemplate before I die. Though these days, the patients often don't even know they're being patronised because older people don't understand what Filipino or eastern European nurses are saying. Thus incomprehension is added to other fears.

Nurses are low down in the class structure of the hospital because hospital nursing is in general a female occupation. Females have changed, but the class thing hasn't. (And if you're going to deny that there's a class difference between most nurses and most consultants, you try marrying one. ) In my opinion it is the nurses who matter when you are dying . . . it is they who make all the difference to how a person can be tenderly positioned for the end.

It is they, if anyone, who help the bereaved survive the first shock. How well or badly nurses do this rests, it seems to me, less on their personalities, saintly or otherwise, than on how much time they are allowed to give to dying people, and how much pressure there is on them to clear beds, and how much thanks or other reward they get for this aspect of their work.

Another person might give the the problem a different emphasis. A recent article, for example, by Frank McDonald, drew attention to new thinking on the part of the Irish Hospice Foundation about the role of architecture and design in providing an ambiance appropriate to death. There are myriad ways of approaching the subject. But what have the INO and the IHCA to say about it? Have they anything to say about anything but money? We can't have back the orderly, hushed wards where the girls were starched and the tiles shone and hierarchy worked like a dream.

But do we have to go to the other extreme of facing humanity's most solemn passage in hospitals horribly reminiscent of the badly-run bars where long-distance buses stop for passengers to eat packet soup and queue for disgusting facilties?