Saying Sorry – A Reflection

Do you remember being little and your mum or dad would say, “Say sorry!” and you would mumble a half-hearted “soz” after nearly hospitalising your sister. (No? Just me then).

Being genuinely sorry and humble has always been disarming. Saying sorry is one of the most powerful things to say. To the receiver of the apology, it is always therapeutic and healing.

We are not just nurses. We are people doing our best, who come to work as our whole selves. We can be tired, overwhelmed, distracted, sometimes balancing complex home situations. We make mistakes, it is never intentional, but they happen. Most of the errors in this blog I have made myself.

11 years ago, my dad was admitted to hospital with epigastric pain and vomiting. He was on a busy acute surgical ward. For a week he was in severe pain and dehydrated. In that week he never received any analgesia that was not oral. He went in a fully active man who still worked as a plumber, played football and was always the first one out for a snowball fight. He was the quietist man on the ward, uncomplaining and compliant. After seven days of agony, he had pressure sores, confusion, no urine output, and NEWS (National Early Warning Score) of 7. After no clinical review, he went to the bathroom and died alone on a hospital toilet floor. By the time he was found he was in rigor mortis- cold, stiff and mottled and it was clear he had been dead and undetected for hours.

There was hesitancy from staff when we arrived at the hospital, with no clear sequence of events explained. We were not warned about his physical presentation. To be blunt, that he had been dead for some time. He was very cold, stiff, his eyes and mouth wide open. We were left trying to put all the pieces together.

It was the perfect storm, winter pressures, busy staff, poor communication, ward transfers, not seeing the whole person.

We entered a whole world of officialdom, hospital letters that often were bland and devoid of detail and integrity, confusion and anger from us trying to figure out how this gentle man could have had such an undignified death. We were a family already grieving, my sister had died two years previously at the age of 44. Sometimes in life you are just keeping your heads above water.

As a family we did eventually apply for and review his medical records. There is nobody as thorough at reviewing records than an angry relative. I remember one of my sisters and I finding an entry of IV antibiotics being signed for after my dad was already in the morgue. My sister did wonder, with bleak humour, how this was possible without a functioning circulatory system. I learnt a lot about myself as a nurse from reading those records.

• Nobody is impressed by clinical Latin – is it necessary?
• Meaningless stock phrases such as “settled and slept well.” Did they?
• Abbreviations mean different things to different people.
• Is it personalised? Can you hear the patient’s voice and wishes?

It is in our professional Code that we must be open and honest when something goes wrong that has the potential to cause harm and distress. It is a duty. But is it only a duty? Or is it the right thing to do, the human thing to do.

How often do we try and see things from the perspective of the people receiving our care? How often do we reflect on what is like to be on the receiving end of us?

We did eventually have a face-to-face meeting with hospital staff. To start with, this was formal and intense, they were numerous, in suits and uniforms, we were on their turf, in a meeting room, in the hospital where he died.

I started the meeting. I talked about my dad as he was, a person, his strengths, his personality, how full of love and life he was. I like to think we helped them remember that we are people first, patients second.

We looked them in the eye and saw humility, honesty, regret, sadness, motivation, and action for change. They said they were sorry; it was genuine, and we believed them. There was human emotion, we connected with them as people, not as staff. They articulated everything that had gone wrong and took ownership of it.

My learning from this as a person and a nurse is as follows.

Being over officious and using overly medicalised language is unnecessary and a barrier. It does not make you appear more professional; it makes you less understood.

Get into the habit of writing records imagining your patient or their family is reading them.

If something goes wrong, be sorry, genuinely. Not because your manager told you to, not because of mitigation risks. Don’t say, “I apologise if you feel…” That is not an apology. Don’t say I apologise, say sorry. Words are so very important. Own the intention.

Say sorry because you are, because it’s the right thing to do. Be personal, scrap the template letter. Authentically and honestly report the mistake that has been made, and how you will learn from it. Give a human answer, and it’s more likely you will get a human response.

So, what would my Dad have made of all this? He would have found understanding somewhere. Joy, kindness, love, and gentleness filled every essence of him. He believed in the goodness in people. He lived simply. If someone really was sorry, you forgave them without question, a lesson probably learnt from having four daughters!

I will leave the last words to him. “I’m not sleeping, I’m just resting my eyes.”

Liz Keat QN

Twitter: @KeatLiz

Cover photo courtesy of Liza Summer, pexels