What’s In An Apology?

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What’s in an apology? And is an apology, finally received many years too late, still as effective as one received promptly might have been? Among others, these are some of the questions I’m reflecting on today because I have finally received a letter of apology from the Medical Director of Shrewsbury Hospital for the harm that was done to my precious son but, as was acknowledged in the letter, this apology has come thirteen years too late.

Why do I say that? Well on the first, most obvious level, Adam is now thirteen years old and the harm was initially done at his birth as medical staff missed the signs of his developing, life threatening Group B Strep infection that triggered Meningitis. That fact alone triggered a devastating admission to NICU, his father witnessing part of resuscitation efforts with a crash team surrounded our one day old baby as his entire body was shaking with convulsions and his face was blue – an image that haunted him for the rest of his life, until his death in 2020. It resulted in Adam being on life support for the first seven days of his life and spending his first 23 days in intensive care. It also triggered eventual diagnosis of a brain injury, dual hearing and visual impairments, severe learning difficulties, complex autism with communication delays, violent and challenging behaviour as he tries so hard to navigate a world he doesn’t understand.

This missed but developing illness could have been treated if caught sooner and, as is now established by the court case, could have resulted in far less severe disabilities if indeed there were any at all. National policy that even now is largely against testing pregnant women for the Group B Strep Bacteria is what actually caused my son’s illness but with prompt detection and treatment, most babies survive unharmed. This could have been our outcome, but because of delays and it not being noticed, our outcome was nearly catastrophic. Adam is lucky to be alive and he is entirely precious to me exactly as he is…but his life has also been irreparably changed because of what was missed. He will need lifelong care, he is unlikely to ever work, and already he lives separately to me and has done for eighteen months.

But I’m getting ahead of myself…

The missed signs triggered a process of trauma for both Chris and I as we had no alternative but to watch and wait to see if our son would live or die. I remained in hospital with a full pelvic split, unable to walk and in agonising pain for 18 of those 23 days. But then we were discharged without much more than a friendly wave and an offer that we could come back if we had any questions. There was no investigation as to why a full term baby from a healthy pregnancy had ended up in that state and minimal support from the hospital afterwards – I believe it was just two visits from a community NICU nurse. Thankfully our health visitor was amazing for years, but that wasn’t really her role and she often got into trouble for dropping everything to rush to us when we were sobbing down the phone.

Then there were the years of legal battles, only reluctantly entered into because we were convinced everyone would work together with us to ensure Adam had the support he needed, if only we could explain the problem clearly enough…how soon we were disabused of that notion and, over the years, took Local Authorities to SEND Tribunal three times as we battled for adequate education and therapy. Of course there was also participation in the Ockenden Enquiry into what became known as the worst maternity scandal in the history of the NHS and years of interviews by Donna, by journalists seeking to tell the stories of those caught up in the horrific events that unfolded in local, national and international news.

There was also the medical negligence lawsuit that we only reluctantly and hesitantly entered into three years after Adam’s birth and near death, but that rumbled on from 2014 until 2023 before it ever even got to court, and the hospital – or perhaps NHS Resolutions – fought us every single step of the way, trying to deny liability right up until the pre-judicial meeting between legal teams just a month before the court date. Finally, after a full day of arguing, they agreed to admit 80% liability for Adam’s injuries, which was affirmed by the High Court a month later. But even now, nearing the end of 2024, I’m nowhere near the end of the lawsuit because that part only admits liability, the debate over how that translates into costs and compensation will take years longer.

As to that last, because Adam cannot speak for himself, that means I continue to be his advocate and “spokesperson” so to speak; so it is me who endures the endless assessments with experts instructed by either side, as they are tasked with going through the events of his life to date and deciding what his future prospects and needs might be. It is me who has to relive those events every single time and sit neutrally as experts decide whether or not my son can expect to live a full life and what form of residential care and staffing he will need just to get by. It is me who ends up bending the ears of various counsellors, psychologists and trauma therapists to cope with these things.

It was also me who had to make the utterly agonising decision to place my precious boy into residential care to ensure he could receive the support he so desperately needed, because he had become too strong and violent for me to manage at home alone. One particular weekend of pulling him out of traffic, getting between him and the furniture he was overturning and windows and pictures he was trying to smash in two separate doctors offices, stopping him from throwing things at other patients waiting in the surgery and the same towards elderly people in church…before realising that love just wasn’t enough to manage this situation anymore. It was me who had to sign that paperwork acknowledging that while I desperately loved him, I could no longer provide a safe environment for him at home. He was just eleven years old then.

And it is also me who, admittedly now with the support of school and care staff, takes my boy to dozens of clinic appointments for consultants, specialists, hearing tests, eye tests, paediatricians, incontinence, and others by the score. More often than not, it is also me who is forced to answer the questions of, “And tell us, was Adam a full term normal birth? Were there any concerns at birth…..?” Because they haven’t read his notes or even skimmed his foot thick medical file.

Finally, it is also me who still has to have regular meetings with his very supportive legal team as we try to work out how he can safely spend more time with me, to recruit staff to facilitate this, to consider moving me to a different property with space for staff, to eternally try to answer the question of, “What will Adam need both now and in the future?”

So, in the context of all this, what’s in an apology? Is an apology received so many years too late still effective?

Me, being me, I feel the need to acknowledge that it’s a very good letter – entirely contrite, accepting of the impact of what happened to Adam then and what continues to happen to us now, acknowledging that the complexity of legal processes only made the process worse and longer. Noting that the specifics of Adam’s story will remain with them for a long time to come, boundaried as it was with my tears in the first ever meeting with the hospital medical director and associate medical director just last week. They seem to be decent human beings, probably good doctors, and offered kind empathy as we spoke – I can’t and won’t judge them harshly for the unenviable role they now have in being the face of the hospital as they met with me and with other families in the months to come. But even if they’re the nicest people in the world, they are still the face of the hospital that should have brought my son’s life into this world gently and with care, but instead stood by as he nearly died, only acting much too late.

So what’s in an apology? Without doubt, I appreciate it and in fact, I asked for it – such a letter was promised to me nearly two years ago as part of the court process but has only just arrived, something else they acknowledged wasn’t good enough. But all these years later, even the best of apologies is only ever bittersweet. It can’t undo the harm that has been done. It can’t undo the trauma, the pain, or wipe the tears shed. It can’t undo the bruises that no longer show on my skin but that are still lodged in my heart, together with other bloody and violent injuries inflicted on me by my son over the years.

It can’t return my son’s life to him as it should have been lived. It can’t bring my son home to his mother’s loving care as he needs the support of skilled residential staff. It can’t refund the hundreds of thousands of pounds spend on legal processes – thank goodness for charities and Legal Aid. It can’t ever be known about or read by Adam’s late father, who never even heard the outcome of the Ockenden Review, much less the admission of liability on the part of the hospital. It can, and did, pay tribute to my strength and devotion to Adam, as did the legal teams in court in 2023, as did the High Court Judge, as did the Medical Executives themselves in the meeting a fortnight ago and as have so many people who have known me only a little bit. It helps…a bit. It’s better than not receiving one at all. But what’s in an apology…really? Maybe just an acknowledgement that things didn’t need to be this way, but I knew that already.