Orla Tinsley: After a crash in a taxi, I am left wondering who has the duty of care to patients like me

I asked what the noise was as we stopped at the traffic light. Even though a creeping physical sensation told me clearly, my mind could not yet articulate what had happened.

“We’ve been hit,” said the driver.

It was the evening of my third daily dialysis treatment. This week required energy, practicality and, as usual, self-advocacy so that I could get through the removal of fluid and toxins in one piece. Was I in one piece? Moments before we were hit I told the driver how long I had survived now: it was five years since my double lung transplant. As the blunt force of the car behind us propelled my back forward, the black leather seats scrambled and the air thinned out.

I located my body and began by wiggling my big toe. Then I moved outward, feeling my way back into the moment. The driver was gone. Voices outside the car ran at each other like anime cartoon characters bigger than life, and louder too. I ran my fingers gently over my rib cage, to check that everything was okay. In that moment I was grateful for my meditation practice, which immediately kicked in and held me in space as I explored whether my body was injured.

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I was worried that a lung might have collapsed, and, as shock is the great buffer between experience and feeling, I worried that pain might be hanging out in that third space, waiting to connect. I felt into my legs and moved them out of the car so that I could stand. It was then I saw the driver and the man who hit us arguing.

Each week, three times a week, I fulfil my responsibility as outlined in the HSE document. I am ready to be picked up and I am respectful even when I want to scream

The driver, a quiet and gentle man, kept asking if I was okay, but I did not know the answer. I had fought so hard for life, and anger engulfed me. I felt like I might go Katie Taylor on anything nearby, so I quickly got back into the car. I heard the man who hit us say, “I was just checking on my daughter, I’m sorry.”

When the driver got back in he did not have the man’s details. He was shaken, so I suggested maybe he take a minute. We got the details and I rang the dialysis centre, from where I had just come. It was an act of trying to comfort myself. Even though I was starting to feel physically okay, I needed to know someone out there agreed. We drove home.

[ Orla Tinsley: Returning to Covid-19 Ireland after my lung transplant ]

The worst part about the free taxi-transport system that brings patients to life-saving treatment is that it has been nothing but problematic from the beginning. Most dialysis patients who attend my unit are affected by this. There is a nationwide taxi shortage, but this burden should not be on patients.

The car arrived on time on the first dialysis day. It was 45 minutes late the second day; the driver, an older gentleman, had gone to the wrong address. I understood that. On the third day the taxi company rang to say a concert in Marlay Park meant the car would be late. How late? No one knew. An hour late.

I’ve met some remarkable and kind drivers who have discussed this with me. Drivers prefer noncontract jobs because they make more or they dislike that the contract is already negotiated at a reduced rate. But bringing a patient to any medical treatment should be honoured in simple ways: there should be clear communication, the car should arrive on time, the car should be clean, and the driver should undertake the journey with the understanding that they are bringing a person to life-saving treatment.

Every time a taxi is late – especially when they phone once and hang up – I am reminded of how insignificant one can feel when encountering the Irish health system

This means, where possible, that they are not negative. Patients should not have to experience the issues. Sometimes the cars are so filthy I have to lift my feet off the ground for the entire journey to avoid what looks like an empty pot of Dolmio stir-in sauce or an empty bottle. And sometimes the driver is amazing, the cars are clean, and the ride is a dream.

But that should be the rule, not the exception.

The contract is between what the HSE guidance for nonemergency haemodialysis transport calls the “patient/carer”, the “hospital/unit” and the “transport provider”. Each week, three times a week, I fulfil my responsibility as outlined in the HSE document. I am ready to be picked up and I am respectful even when I want to scream. Maybe screaming would be better. I never know if my driver will be on time. Sometimes, I get a text to say they are on their way and sometimes I do not.

A study from the University of Ghent on dialysis transport found some patients had difficulty bonding with drivers because there were always different drivers. Some patients preferred continuity but others didn’t care as long as they got home. Those who preferred continuity found the experience easier. Everything should be done to manifest an easy experience for patients in Ireland.

The issue around time relates to the dignity of the patient — the ability to own and delegate what happens to one’s body when and where. Every time a taxi is late — especially when they phone once and hang up — I am reminded of how insignificant one can feel when encountering the Irish health system. And how, over time, these encounters accumulate and feel like an erasure of self. Patients who are sicker than me — many who are much older, overweight and in need of mobility support — should not deal with this. Late patients means nurses must stay later to finish treatment. The lateness of a taxi weighs on a system already under too much pressure.

[ Ireland must ring-fence ICU beds for ‘gift of life to occur’ – Orla Tinsley ]

Why should patients and healthcare workers endure this?

The solution is to create a competitive contract where more than one company is responsible for patient transport. For example, if a taxi company cannot deliver patients to the hospital on time — because of the pressure on drivers — patients should be empowered, and facilitated, to book on a taxi app. It’s simple: if the car is more than 10 minutes late the patient can book elsewhere and be reimbursed. Make it a competitive contract. Prioritise mindfulness and compassion when picking up patients, and wear a mask.

After the crash I did not hear from the taxi company. And even though I phoned in what happened, my remarkable team was still unaware a week later.

With the great taxi debacle, I am left wondering who has the duty of care to the patient and, when it comes down to it, if they really care at all.