Friday, May 2, 2014

What Does "I'm Sorry" Really Mean?

An Apology

Is an apology OK if it’s from over 20 years ago? Is it OK if it comes through someone else? Is an apology always healing or meaningful or even necessary?
My friend Rachel, a critical care nurse, who is warm and gentle, passionate about patient safety and patient’s rights, asked me a few weeks ago if I had ever sat down and spoken to the doctor who did my son’s surgery. I told her I hadn’t but the truth is, the conversation I would have had with him has played out in my head over and over again. I spoke to him briefly immediately following my son’s death. He sounded concerned. But that could have been because he was nervous. I barely remember the conversation, but I was happy he’d called. My mother also spoke to him briefly. She remembers the conversation better.
Maybe if I had moved on, continuing my job at the post office instead of throwing myself into the world of patient safety, not knowing what happened to that doctor who was the last to see my son alive and said he was fine, wouldn’t matter. But after speaking to hundreds if not thousands of people who have lost loved ones over the years. I have become haunted, as I know others are too, by questions about what that doctor’s life has been like. Does he think of my son? Have any lives been saved because of him? Did his death ever lead this surgeon to pause and do things differently? I have been confident that I would never get an apology, but just knowing that his life has been affected still matters to me — yes, 24 years later.
I never “blamed” the doctor. I never felt he was the direct cause of my son’s death. After all, we saw four other physicians about my son’s bleeding in the week after his tonsillectomy. None of them picked up on the possibility of my son Michael bleeding to death, or on the infection that ravaged his young body. I always told people who asked that he was a good doctor and a fine surgeon, but something that I will never understand went terribly wrong.
Rachel asked me if she could call him and if so, would I be willing to talk to him. She told me, “I had this vision in my head of the two of you sitting down to say things that you may have both thought over the last 24 years.” I told her, “Of course.” In a perfect medical system, Rachel and I both agree, when things go wrong, patients, their families and the medical team should be able to have a conversation in order to learn what happened, to heal and make improvements. That didn’t happen for me and it’s still not happening for the millions of families affected by unplanned outcomes since Michael’s death. I sent the surgeon a book, Wall of Silence, about 10 years ago, in which my son’s story is described in detail. The doctor never responded. Earlier I wrote him a letter, to which he also never responded. In that letter I wanted him to know about Michael. I realized I would never have an answer to the question: does he ever think about what happened?
Rachel called me this week and casually began the conversation by telling me that she had spoken to the surgeon who did Michael’s surgery 24 years ago. She continued telling me about her conversation, which didn’t register. I had to ask her to go back and repeat it. I thought that call was something Rachel was thinking about but would never be able to pick up the phone to do.
Rachel said the surgeon sounded annoyed at her calling but he stayed on the phone for 25 minutes. She asked him if he would sit down and talk to me and he said “no.”
He explained to Rachel that the hospital directed him as to what to do, and he did it. He now has health issues of his own. The surgeon, now probably in his 60s, told Rachel that he has “hashed” this over in his head.
Rachel told him about my work helping others come to terms with their new lives after an unplanned outcome. The injury or death is actually just the beginning of the patient’s or family’s new life. For years I have been helping people dealing with the guilt of what could have been done differently when they placed their loved ones in the hands of those who caused injury or worse. I have spent time with families facing the trauma and heartache of a medical malpractice lawsuit, encouraging medical mediation, and working on fixing the system through educating patients and their families. Rachel told him I said he was a good doctor.
She explained to the doctor that she wants to work in a hospital where there isn’t blame and mistakes aren’t hidden.
The doctor wished me well, and told Rachel that he is sorry for what happened.
Now I have to wonder, did I finally get an apology? And why have I been saying for years that he is a good surgeon? Was it actually to protect me?
I got my answer, finally, because one person had the nerve to reach out to make a difference.  And that makes a very special person and a very special gift.

5 comments:

Lenore@leahslegacy said...

I have spent a lot of time recently comparing the lives of families who received either, answers, or apologies with those that were shut out. I think this plays a very big part in the healing process, and how we continue with the rest of our lives. Perhaps because you saw other doctors, and didn't feel one was specifically at fault, it has given you an escape from really dealing with this man all these years.
I know, for me, not getting any admission of error, and no discussion, along with coverups and changing records has effected my sense of my own responsibility all these years

Trisha Torrey said...

This just breaks my heart, Ilene. Your questions will remain unanswered and it actually makes me angry that he won’t meet with you. The “I did what the hospital told me to do” is no excuse.

IM(not so)HO he took the easy way out by apologizing by proxy. Kudos to Rachel for having the conversation and sharing it with you, but a pox on the surgeon's house for not doing any better than that for you. I don't know how he sleeps at night.

To Lenore's point - an apology makes an enormous difference to those of us who have been wronged by the system. I have my own tale to tell about that. http://patients.about.com/b/2008/02/11/a-doctors-apology-an-intensely-moving-experience.htm

Thanks for this post, Ilene. It can't have been easy to write.

Trisha Torrey
Every Patient's Advocate

Jeni D said...

So many tears through so many years. Ilene, it is like yesterday that we first spoke and connected. I am so thankful for people like Rachel in this world. Her courage and caring heart are what keep my faith that someday all of our hard work, tears and fortitude will protect patients and families from our nightmares. I too have connected indirectly with the doctor who cared for my mom. As he too thought of her through the years and communicated that, it is clear by his words that his perception and mine of what occurred were not the same and he too was sorry that it happened. Being sorry it happened is very different then being sorry for errors in judgement that might have led to different outcomes. Sometimes when patients and families question outcomes clinicians find themselves thinking of the patient who was lost or harmed, but rarely do these providers actually take responsibility for the outcome, instead they express grief of a loss that they must think would have occurred no matter what they did or did not do. It is important that we recognize this sort of apology with one of regret and sorrow. It is all about perception, ours and theirs. Providers like Rachael will someday create the changes and bring to healthcare the compassion, understanding and education healthcare truly needs to become safe and sustainable.

Lisa Morrise said...

Wow. I understand, "the hospital told me to." As human beings we want to do the right and decent thing, but fear tends to overshadow that. Hospitals have been urging silence for years. They are only now, thanks largely to advocacy work from you, Lenore, Leah, Trisha and our other friends, learning that being decent humans creates better outcomes all the way around. I'm glad you feel Rachel's outreach was a gift. I hurt for you and your incomprehensible loss.

Danny Long said...

Sitting quietly out of respect..