By | September 20, 2022
Orla Tinsley: After a crash in a taxi, I wonder who has a duty of care to patients like me

I asked what the sound was when we stopped at the traffic light. Although 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 for me to get rid 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 had been five years since my double lung transplant. As the blunt force of the car behind us drove my back forward, the black leather seats clambered and the air thinned.

I found my body and started wiggling my big toe. Then I went outside and felt myself back into the present. The driver was gone. Voices outside the car ran at each other like larger-than-life cartoon anime characters, and louder too. I gently ran my fingers over his chest to make sure 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 damaged.

I worried that a lung might have collapsed, and since shock is the great buffer between experience and sensation, I worried that pain might be hanging out in the third room, waiting to make contact. I felt my legs and moved them out of the car so I could stand. That’s when I saw the driver and the man who hit us arguing.

Every week, three times a week, I fulfill my responsibilities according to the HSE document. I’m ready to be picked up and I’m respectful even when I want to yell

The driver, a quiet and gentle man, kept asking if I was okay, but I didn’t know the answer. I had fought so hard for life, and the anger consumed me. I felt like I could ride 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 didn’t have the man’s details. He was shaken, so I suggested he might take a minute. We got the details and I called the dialysis center I had just come from. It was an attempt to comfort myself. Even though I was starting to feel physically okay, I needed to know that someone out there agreed. We drove home.

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

The car arrived on time on the first day of dialysis. It was 45 minutes late on the second day; the driver, an elderly gentleman, had gone to the wrong address. I understood it. On the third day the taxi company called to say that a concert in Marlay Park meant the car would be delayed. How late? Nobody knew. An hour late.

I have met some remarkable and kind drivers who have discussed this with me. Drivers prefer non-contract jobs because they earn more or dislike that the contract is already negotiated at a reduced rate. But taking a patient to any medical treatment should be honored 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 taking a person for life-saving treatment.

Every time a taxi is late – especially when they ring once and hang up – I’m reminded of how insignificant you can feel when dealing with the Irish health system

This means, where possible, that they are not negative. Patients should not have to experience the problems. Sometimes the cars are so dirty that I have to lift my feet off the ground for the entire ride to avoid what looks like an empty pot of Dolmio sauce or an empty bottle. And sometimes the driver is great, 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 on non-acute haemodialysis transport calls the ‘patient/carer’, the ‘hospital/unit’ and the ‘transporter’. Every week, three times a week, I fulfill my responsibilities according to the HSE document. I’m ready to be picked up and I’m respectful even when I want to yell. Maybe it would be better to scream. I never know if my driver will be on time. Sometimes I get a text that they are on their way and sometimes not.

A study by the University of Ghent on dialysis transport showed that some patients found it difficult to bond 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. Every effort should be made to ensure a seamless experience for patients in Ireland.

The question of time relates to the patient’s dignity – the ability to own and delegate what happens to one’s body when and where. Every time a taxi is late – especially when they ring once and hang up – I’m reminded of how insignificant you can feel when dealing with the Irish health system. And how, over time, these encounters accumulate and feel like an erasure of the self. Patients who are sicker than me – many who are much older, overweight and in need of mobility aids – should not have to deal with this. Late patients mean nurses have to stay later to finish treatment. The fact that a taxi is late weighs on a system that is already under too much pressure.

Why should patients and healthcare professionals put up with this?

The solution is to create a competitive agreement where more than one company is responsible for patient transport. For example, if a taxi company is unable to deliver patients to the hospital on time – due to 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 receive compensation. Make it a competitive contract. Prioritize mindfulness and compassion when picking up patients and wearing a mask.

After the crash I heard nothing from the taxi company. And even though I called in what happened, my remarkable team was still unaware a week later.

With the big taxi debacle, I wonder who has the duty of care to the patient and, when it comes down to it, if they really care.

#Orla #Tinsley #crash #taxi #duty #care #patients

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