Guest post: Notes from a South Pole adventure
by Howard Rodenberg, MD, MPH, CCDS
A year ago, I was getting ready to attend the 2022 ACDIS National Conference in Orlando, and by all rights I should be doing the same this spring. I would be reviewing slides for the talks I might give; setting up lunches, drinks, and dinner with friends old and new; and looking through the program to see what sessions might be fun to attend and, more importantly, where I can sneak in a nap. Of course, astute attendees recognize that all ACDIS sessions have one or more of the following three underlying themes:
- It’s not about the money. (Which, in my opinion, it most often is.)
- Clinical validation is useful. (Which, in my opinion, it's most often not.)
- All doctors are jerks (Which, in my opinion, we are.)
Scratch the surface of any presentation and that’s what lies at the core. For example, let’s take a presentation about how good documentation supports the accurate reporting of quality measures. While quality care is a laudable goal, quality measures have financial impact (see theme #1 above). With better documentation, we can clinically validate the condition prior to the inevitable insurance denial (see theme #2 above). And we can educate physicians on specific terminology because doctors are jerks and they won’t write it down properly unless we tell them so (finally, see theme #3 above).
Given my skeptical eye towards much of what we do in CDI World, I especially value the national conference as a time to whine and complain with those few people in the Universe of Healthcare who understand my whines and complaints. If misery loves company, I always look forward to sharing my misery with only the best companions.
But instead of attending the conference, I’m wintering at the South Pole.
Yep, you read that right. I could be luxuriating in the mild breezes of Florida these next few months, sitting on the patio with an adult beverage in my hand and the dogs lazily draped at my feet, the endless summer interrupted only by a few fine days with my friends in the Windy City. But as the over-winter physician at the United States Antarctic Program Amundsen-Scott South Pole Station, I’ll be sitting in the dark of the polar night, locked in with nowhere to go and no way to get there between February and October while you, dear reader, are having fun.
How did I get here? Last summer my contract with Baptist Health came to an end. It was a fruitful five years that introduced me to the world of CDI, and I think I was able to make a positive impact upon our system. I was also fortunate to work nationally with ACDIS as chair of the Regulatory Committee, and to participate in the physician advisor leadership roundtable meetings over the past two years. I had the opportunity to write for the ACDIS Blog and the CDI Journal, as well as get a few papers published in the academic health information management and the public health press. So, overall, not a bad track record, but one that doesn’t readily lend itself to resolving the latest in a series of slightly post-midlife crises.
However, one doesn’t simply run off to the South Pole instead of buying a power boat or red corvette. Before I made my grand plans, I had a chat with the Best Girl Friend Ever since I simply adore her and I believe in shared decision-making within a relationship. Here’s a brief synopsis of the negotiation, conducted while flipping channels one fall evening:
“So, you know I’m looking for something different to do.”
“Um-hmm,” she said, finding Seinfeld on Netflix.
“I kind of feel like I’ve never really had an adventure.”
Still working the remote. “Did you forget about your ex-wives?”
I doubled down. “No, a real adventure. I never did the military, was never part of a heroic crowd like police or firefighters, never really part of team like athletes. I just don’t feel like I’ve ever put myself out there and really lived.”
“Mmmmm.”
“What would you think if I went to Antarctica for a year?”
Having started an episode of The Show About Nothing, she put down the controller and looked at me with a pitying sapphire-eyed gaze.
“Well, that’s stupid.”
And of course it is. But I argued my case, describing all the wonders of the opportunity and pleading for understanding until she finally came to a decision.
“I don’t like it, but if you don’t do this, I’m going to hear you whine about it for the next 30 years. So, get it out of your system, but know that I’m going to be mad at you for a long time and you’re never doing this again.”
Three months later, I’m on the ice. And after nearly three months here, she’s still mad, and I’m never doing this again.
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What can I tell you about living in Antarctica that has relevance to CDI? First, I would note that the ICD-10-CM is woefully deficient in diagnostic terminology for cold. The only code I can find is X31, “Exposure to excessive natural cold,” which isn’t nearly specific enough. I’m certain I could write a compliant query asking the respondent to specify just how cold they are at any given time, with a range of most likely answers from ”nippy” to “colder than a witches [REDACTED]” or “cold enough to freeze a monkey’s [REDACTED].” You get the picture. The South Pole is nothing if not a place packed full of literary metaphors.
There is a code sequence for “Blizzard (snow)(ice):
X37.2 Blizzard (snow)(ice)
X37.2XXA Initial encounter
X37.2XXD Subsequent encounter
X37.2XXS Sequela
(This is in the X37 code series for “Cataclysmic Storms,” which includes hurricanes tornados, blizzards, dust storms, tidal waves, and other unspecified cataclysmic storms, which I think includes the wrath of the Best Girl Friend Ever when she figures out you’re actually serious about going to Antarctica.)
The Y93 series is also helpful:
Y93.2 “Activities involving ice and snow.”
Type 1 excludes Y93.H1, “Activity, digging, shoveling, or raking.”
Instead of writing in a diary, each day I could simply record “X31, Y93.2” and have it be a pretty accurate recollection. However, should one get frostbite or hypothermia, there are a plethora of codes for that. So perhaps it’s best if I wait for appendages to fall off before documenting.
Yes/no queries about the presence of cold, ice, or snow are redundant because the answer is always yes. Quality measures are limited to frozen or not frozen. Thirty-day readmissions are not an issue, because there’s 44 of us locked down here until November, and there’s no place for someone to be discharged. (There are no Skilled Nursing Igloos.) There’s also no utilization management work, for in a very real sense we’re all long-term inpatients.
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I hope you enjoy the ACDIS conference, and please be sure to share in the special remembrance for our friend Melissa Varnavas. I’ll miss being there to honor her, and to see all of you. One of the great unknowns of spending a year at the Pole is that I don’t have an agenda for what I’m going to do when I get back. I plan to be open to any and all opportunities and hope to stay active in the CDI World. If you’d like, you can follow my current excursion at AntarcticAnecdotes.Blogspot.Com. It would be great to stay in touch with the other side of the world.
I may not know much about what will happen when I return in November, but I do know where ACDIS can get a keynote speaker in 2024 to talk about what he’s learned over a year at the other end of the earth. And I’m pretty sure he’d do it real cheap.
Editor’s note: Dr. Howard Rodenberg was the adult physician advisor for CDI at Baptist Health in Jacksonville, Florida. He is now the over-winter physician at the United States Antarctic Program Amundsen Scott South Pole Station. Contact him at hdrdab@aol.com.