A four-year-old boy recovering from heart surgery on a controversial hospital ward was so desperate for a glass of water that he resorted to sucking the moisture from tissues used to cool his forehead, his devastated parents told an inquest into his death.
Parents Steve, 47, and Yolanda Turner, 45, told the hearing how they begged doctors and nurses on Ward 32 of Bristol Children's Hospital to help their desperately ill son Sean.
Mr and Mrs Turner, from Warminster, Wiltshire, gave harrowing accounts of their son's care and treatment on the first day of the two-week hearing at Avon Coroner's Court.
He died in March 2012 from a brain haemorrhage after previously suffering a cardiac arrest - six weeks after he underwent vital corrective heart surgery.
Mr and Mrs Turner accused doctors of transferring their son to Ward 32 from intensive care too soon and said they missed the signs of his worsening condition - with rising blood pressure, vomiting and fluid loss from his chest.
"Sean was deteriorating. We could see it but nobody listened to us. We asked so many times and so many staff - from ward doctors, outreach nurses, cardiac liaison nurse and the nurses - if Sean could go back to intensive care as he had been better there," Mrs Turner, a foster carer, said.
"We were told no beds or that simply he was not critical enough.
"Over four days Sean had increasing heart rate, was constantly being sick and was becoming so chronically dehydrated he was grabbing tissues used to cool his forehead and suck the water out of them.
"He kept asking for drinks but we were told he was on a fluid restriction to clear out his drains and this was normal procedure after a Fontan procedure.
"This was not normal, out little boy was switching off, in terrible pain, struggling to breathe and had an increasing heart rate.
"We tried so hard to get him some help. Nothing happened, nobody seemed to help. Nurses were concerned but they seemed too busy to give the time needed to care for Sean at the level he needed.
"Every nap he had I sat and cried as I felt so desperate and so helpless. Why would no one listen?"
Mrs Turner added: "We will never forget the days on Ward 32 and can never understand how a child can be left to suffer for so long.
"How was this supposed to be a specialist cardiac unit in a centre of excellence, yet no one recognised Sean's deterioration? His arrest was preventable because all the signs had been there.
"Events on Ward 32 dashed Sean's chances of survival."
After suffering a collapse on Ward 32 Sean was transferred to intensive care, where he remained for 11 days.
Mrs Turner described it as the "worst news" when they were told Sean was again being returned to Ward 32.
"This move to Ward 32 from the safety of intensive care was the worst decision ever made for Sean," she said.
Fighting back tears, Mrs Turner added: "And as we now know with the inadequate staffing levels and no high-dependency care, this was the beginning of the end for Sean."
Mrs Turner said nurses did not respond to automatic alarm calls on her son's monitoring equipment, did not complete regular fluid checks and did not fill in his record charts.
He suffered a cardiac arrest on February 16 and returned to the intensive care unit where he remained until dying on March 15.
Mrs Turner said that following the cardiac arrest the family's request for a second opinion from a retired consultant at Great Ormond Street Hospital was refused by doctors.
"We felt helpless because we were desperate for some answers and a way forward for Sean. We wanted to have Sean transferred but were told that he was too poorly to be moved," she said.
"We felt our lifeline of a second opinion had been taken away from us. Sean fought so hard in hospital. There were so many missed opportunities to rescue Sean from the desperate state he was in."
Her husband, a carpenter, described how Sean went limp and lifeless after suffering a cardiac arrest in his arms.
"No parent should ever be put in the situation where they go into a safe environment and have to plead for four days for help and end up having their child having a cardiac arrest in their arms," Mr Turner said.
"We now have to live with that horror for the rest of our lives. The whole management of Sean's care, communication, death review and now our complaint has been shambolic.
"Sean suffered a catalogue of errors and throughout individual nurses on Ward 32 were concerned for Sean but appeared not to have the time or give the level of care he so desperately needed."
Mr and Mrs Turner claim their son's death was not isolated and other children with heart problems have died at the hospital.
Up 10 families are believed to be taking legal action against the University Hospitals Bristol NHS Foundation Trust over treatment on Ward 32.
Doctors working for the University Hospitals Bristol NHS Trust, at the Children's hospital, told the inquest Sean was regularly monitored and his parents' concerns taken on board.
In a number of statements read out to the court staff they said they followed all procedures set down in the "very difficult circumstances".
Sarah Britton, the ward sister on ward 32, described Sean's cardiac arrest as "sudden and unexpected".
The inquest also heard from medical experts who had carried out a review following Sean's death.
Dr Fiona Reynolds, an intensive care consultant at Birmingham Children's Hospital, said the decision to carry out the Fontan procedure was the correct one.
The inquest was adjourned until tomorrow.