Two-fers And More

Anyone who has worked in an emergency department is well aware of the term "two-fer." It is a term that seems to be accompanied by dread and a discouraging shake of the head. Unfortunately, though, it is a reality that comes with our jobs. And as much as we'd like to run from a two-fer, we have all learned that it is better to just suck-it-up and deal with the situation.

Two-fer. See, just thinking about it, I can feel my heart rate picking up.

So, as the name implies, we are not dealing with a single patient. Nope. A two-fer typically means that there are at least two patients from one family that wish to be seen. For example, a mother with some URI symptoms may decide to be seen by a physician as long as she is checking-in her sick toddler, he with a fever and some ear tugging. Maybe it's the elderly couple who have both decided that their diarrhea is from eating out at a local buffet house. "I knew I shouldn't have eaten the rice, Edgar. It didn't look right." Maybe, even, it's twin pelvic exams for the college roommates who do everything together.

Surprisingly, though, I think patient number two does not typically plan on being seen but, instead, makes the split-decision to be treated once they arrive at the ER. And why not, really? They are already here. If their family or friend is going to be treated, they may as well get "checked-out, too."

If it were only two patients, maybe it still wouldn't be such a big deal. But guess what? Yep, you guessed it. Sometimes there is a "three-fer" signed in. Sometimes, even, a "four-fer" and a "five-fer." A general rule is that the more people that sign in from the same family, the less sick they really are. And because of that, they usually get sent to our express track. Don't you think, for one minute even, that I don't appreciate immensely that provider taking one for the team.

A few years back, one of my favorite physician assistants, a compassionate free-spirit named Patty (imagine Carole King dancing wildly at Woodstock), was assigned to my supervision. And it was during this shift that Patty set a new record. In my book, anyway.

Guess how many she saw from one family? Five? Nope. Six? Nope. Drum roll, please...Patty saw seven patients from the same family. Is "seven-fer" the right term here? I don't honestly know.

Can you even imagine walking into one treatment room and finding seven patients, though, waiting to be seen? I can't, although Patty seemed to take it all with a grain of salt. "I may as well just buckle-up and get this family taken care of, Jim," she replied when I called her to ask if she needed any help. And tell her that I thought she was a god. "They all seem to have the sniffles," she added, "I'll be okay."

It turns out that two adult-cousins, mothers in their twenties, each brought in two of their kids to be seen for cough and cold symptoms of a day's duration. While checking in their kids, the two adults decided that they, too, wanted to be "checked out." Heck yeah, why not? So let's count. One mommy plus two kids equals three. Plus, one mommy and two more kids. Three plus three equals six. Not seven.

Oh, but while this family was in triage, one of the young mother's decided to run back home and get her third child, an infant, who "was just starting to get a runny nose, too." So, while she was away, the other mother took charge of four unruly, poorly-behaved kids. We could hear them, three halls over in our acute ER, causing a ruckus. Wouldn't you think that if they were sick enough to come to the ER, they would be somewhat fatigued or a little wiped-out?

This, my friend, is how Patty ended up with seven patients in one room. While mom number two was away, mom number one was placed in one treatment room with the four waiting kids. The door was shut after a few minutes, by nursing, because of their disrupting behavior, until Patty went in to perform her exam. Pardon me, I mean exams.

Happily, Patty reported that there was no significant concerns or illnesses in the room. An ear infection here. A strep throat there. Otherwise, normal cough and cold symptoms presumed to be viral.

"Patty," I had to ask, "is this a record for you?"

She didn't even flinch. "Hell, yeah, Jim," she said, chuckling, "and I hope I never have to top it."

I was eager to see how she approached so many patients. Maybe she saw one or two patients at a time and then stepped out to fill out the medical charts. That's how I would do it, I think. To avoid all that confusion.

"Nope," Patty said, shaking her head and pulling out a ratty 8 1/2" x 11" paper, "all of my notes are right here." As the mothers had talked, she had taken notes on each patient and then immediately performed their exam. "If I had stepped out of that room, even one time," she added, "I don't think I would have ever gone back in." When she was done, she stepped out of the room and formally filled out each patient chart, their discharge instructions, and their prescriptions, if needed.

Time spent? One hour. Which, when you think about it, is a good average. Seven patients an hour. Us ER docs typically average two to three patients an hour, although our patients may be a bit sicker. Nonetheless, Patty kicked ass. And I told her so.

"Yeah, well thanks, I guess," Patty said, wondering if I was teasing her or being serious. Maybe a bit of both, actually.

News of Patty's heroics travelled fast through our ER and, for the next week, she was looked at with nothing less that pure adoration. Honestly, I think she soaked all the glory and attention right-up. Who wouldn't. Some even nicknamed her "Seven."

As much as a team player that I am, though, I was very glad that it was Patty who stepped up to the plate to see this family. And not me. I think Patty single-handedly saved me from becoming a befuddled bobble-head.

Suddenly, a two-fer doesn't sound all that bad anymore...

As always, big thanks for reading. I hope everyone is having a great week. See you Friday, June 18.