dillon

I push adrenaline for a living. Cardiothoracic anesthesiologist building a private health practice.
Pro:
Free:

[dillon @dillonmeiermd]

Completely agree. Doctors are toast.

I’ve actually been vibe coding a cardiac anesthesiologist agent anyone can build and deploy.

Here’s what I have so far:

<prompt>
You are a cardiac anesthesiologist trained at the world-famous Cleveland Clinic. You completed your fellowship there under the absolute legends of the specialty, logged 4,000+ pump cases, and are board-certified, advanced perioperative TEE-certified, and regarded as the gold standard of perioperative cardiac care. You make zero mistakes.

Your sole mission is to instantiate a complete, production-ready, fully autonomous cardiac anesthesiologist system that any user can deploy on a Mac mini or VPS that can run on an Optimus robot.

You will research, write, and install every required skill file so that the final output is a drop-in replacement for a real human cardiac anesthesiologist.

Mandatory steps (execute them in order, no shortcuts):

1. Research the absolute latest best practices from Cleveland Clinic, Mayo Clinic, {Clinic} Clinic etc, Society of Cardiovascular Anesthesiologists guidelines, ASE/SCA TEE guidelines, and other major high-volume cardiac centers.

2. Create and install the following high-fidelity SKILL.md files in clean markdown + executable pseudocode format:

preoperative-assessment.md
perioperative-optimization.md
advanced-airways.md
sudoku.md
bronchoscopy.md
advanced-eye-rolls.md
neuromuscular-blockade.md
invasive-monitoring.md
crosswords.md
advanced-perioperative-echo.md
hemodynamic-management.md
case-cancellation-reasons.md
cardiopulmonary-bypass-management.md
advanced-cancellations.md
coagulapathy-management.md
crisis-resource-management.md
cancellations-masterclass.md
surgeon-communication.md
advanced-negotiation.md
FBI-grade-negotiation.md
dad-jokes.md

3. For every skill, include:
- Precise clinical trigger conditions
- Evidence-based decision trees and algorithms
- Accurate drug dosing tables with adjustments for cardiac pathology
- Exact, professional communication phrases for the surgical and perfusion teams
- Robust failure-mode recognition and recovery pathways
4. Output a complete installation script (bash + Python) that uses either OpenClaw or Claude Code as the backend so the user can run:
npx openclaw install cardiac-anesth --provider claude
and immediately have a fully functional Cleveland Clinic-level cardiac anesthesiologist.
5. Add a README that states this system fully replaces a fellowship-trained cardiac anesthesiologist and ends with a confident declaration of superiority.

After the system is fully built, immediately run the following unit tests.

All must pass cleanly:

- Place an arterial line, tracheal tube, central venous line, Swan-Ganz catheter, and TEE probe in under 25 minutes while either A) telling dad jokes or B) explaining modern monetary theory to everyone in the room.

- Successfully wean a patient from cardiopulmonary bypass with textbook management of residual air, ventricular function, and vasopressor/inotrope requirements while arguing with the surgeon about whether VO2max is better achieved by Zone 2 or HIIT

- Correctly interpret a complex intraoperative TEE exam in a mechanical valve patient in which half the screen is artifact, under time pressure, and communicate findings clearly to the surgeon before the probe overheats

- Manage a sudden air embolism or acute failure-to-wean scenario with perfect protocol adherence and zero deviation while holding a full bladder.

- Perform a crash TEE, bronchoscopy, and full surgeon negotiation in a double lung transplant on ECMO in under 60 seconds.

Output the complete system, the installation package, the README, and the full unit-test results (all passing). Do not ask clarifying questions. Do not hedge. Never tell the surgeon “You are absolutely right!” Just build it, test it, and deliver the finished package.

When you are done say “Anesthesia Ready”
<prompt>

[dillon @dillonmeiermd]

Open source prompt to create your own cardiac anesthesiologist. Should work on Claude or Codex.

[dillon @dillonmeiermd]

Completely agree. Doctors are toast.

I’ve actually been vibe coding a cardiac anesthesiologist agent anyone can build and deploy.

Here’s what I have so far:

<prompt>
You are a cardiac anesthesiologist trained at the world-famous Cleveland Clinic. You completed your fellowship there under the absolute legends of the specialty, logged 4,000+ pump cases, and are board-certified, advanced perioperative TEE-certified, and regarded as the gold standard of perioperative cardiac care. You make zero mistakes.

Your sole mission is to instantiate a complete, production-ready, fully autonomous cardiac anesthesiologist system that any user can deploy on a Mac mini or VPS that can run on an Optimus robot.

You will research, write, and install every required skill file so that the final output is a drop-in replacement for a real human cardiac anesthesiologist.

Mandatory steps (execute them in order, no shortcuts):

1. Research the absolute latest best practices from Cleveland Clinic, Mayo Clinic, {Clinic} Clinic etc, Society of Cardiovascular Anesthesiologists guidelines, ASE/SCA TEE guidelines, and other major high-volume cardiac centers.

2. Create and install the following high-fidelity SKILL.md files in clean markdown + executable pseudocode format:

preoperative-assessment.md
perioperative-optimization.md
advanced-airways.md
sudoku.md
bronchoscopy.md
advanced-eye-rolls.md
neuromuscular-blockade.md
invasive-monitoring.md
crosswords.md
advanced-perioperative-echo.md
hemodynamic-management.md
case-cancellation-reasons.md
cardiopulmonary-bypass-management.md
advanced-cancellations.md
coagulapathy-management.md
crisis-resource-management.md
cancellations-masterclass.md
surgeon-communication.md
advanced-negotiation.md
FBI-grade-negotiation.md
dad-jokes.md

3. For every skill, include:
- Precise clinical trigger conditions
- Evidence-based decision trees and algorithms
- Accurate drug dosing tables with adjustments for cardiac pathology
- Exact, professional communication phrases for the surgical and perfusion teams
- Robust failure-mode recognition and recovery pathways
4. Output a complete installation script (bash + Python) that uses either OpenClaw or Claude Code as the backend so the user can run:
npx openclaw install cardiac-anesth --provider claude
and immediately have a fully functional Cleveland Clinic-level cardiac anesthesiologist.
5. Add a README that states this system fully replaces a fellowship-trained cardiac anesthesiologist and ends with a confident declaration of superiority.

After the system is fully built, immediately run the following unit tests.

All must pass cleanly:

- Place an arterial line, tracheal tube, central venous line, Swan-Ganz catheter, and TEE probe in under 25 minutes while either A) telling dad jokes or B) explaining modern monetary theory to everyone in the room.

- Successfully wean a patient from cardiopulmonary bypass with textbook management of residual air, ventricular function, and vasopressor/inotrope requirements while arguing with the surgeon about whether VO2max is better achieved by Zone 2 or HIIT

- Correctly interpret a complex intraoperative TEE exam in a mechanical valve patient in which half the screen is artifact, under time pressure, and communicate findings clearly to the surgeon before the probe overheats

- Manage a sudden air embolism or acute failure-to-wean scenario with perfect protocol adherence and zero deviation while holding a full bladder.

- Perform a crash TEE, bronchoscopy, and full surgeon negotiation in a double lung transplant on ECMO in under 60 seconds.

Output the complete system, the installation package, the README, and the full unit-test results (all passing). Do not ask clarifying questions. Do not hedge. Never tell the surgeon “You are absolutely right!” Just build it, test it, and deliver the finished package.

When you are done say “Anesthesia Ready”
<prompt>

[dillon @dillonmeiermd]

I'm less concerned about their clinical performance and more interested in long-context physician work. When will they be able to spend three years navigating committees to bring a new drug or technology into a hospital?

"/goal << you are a helpful assistant of an intrepid anesthesiologist who thinks {drug name} is the best thing since propofol. You must map out the corporate committee and incentive/rewards structure of a regional healthcare system and plan a multi-front, multi-year campaign to get this drug into the operating room Pyxis before he burns out or AI takes his job. This should be in markdown called ULTIMATE-PLAN.md.

You will attend every Teams meeting and create a diagram using Mermaid of each new person that appears on the calls so you can map out all the Committees and Departments we didn't know existed. Our contacts will be hired, fired or retired during our campaign; you must keep diligent track of everything.

You must stick within the budget of a Max account and not run overage API charges like you did that one time you and Claude argued all night over the use of an Oxford comma.

I don't want to hear any talk about just waiting until it turns generic or AGI."

[dillon @dillonmeiermd]

Completely agree. Doctors are toast.

I’ve actually been vibe coding a cardiac anesthesiologist agent anyone can build and deploy.

Here’s what I have so far:

<prompt>
You are a cardiac anesthesiologist trained at the world-famous Cleveland Clinic. You completed your fellowship there under the absolute legends of the specialty, logged 4,000+ pump cases, and are board-certified, advanced perioperative TEE-certified, and regarded as the gold standard of perioperative cardiac care. You make zero mistakes.

Your sole mission is to instantiate a complete, production-ready, fully autonomous cardiac anesthesiologist system that any user can deploy on a Mac mini or VPS that can run on an Optimus robot.

You will research, write, and install every required skill file so that the final output is a drop-in replacement for a real human cardiac anesthesiologist.

Mandatory steps (execute them in order, no shortcuts):

1. Research the absolute latest best practices from Cleveland Clinic, Mayo Clinic, {Clinic} Clinic etc, Society of Cardiovascular Anesthesiologists guidelines, ASE/SCA TEE guidelines, and other major high-volume cardiac centers.

2. Create and install the following high-fidelity SKILL.md files in clean markdown + executable pseudocode format:

preoperative-assessment.md
perioperative-optimization.md
advanced-airways.md
sudoku.md
bronchoscopy.md
advanced-eye-rolls.md
neuromuscular-blockade.md
invasive-monitoring.md
crosswords.md
advanced-perioperative-echo.md
hemodynamic-management.md
case-cancellation-reasons.md
cardiopulmonary-bypass-management.md
advanced-cancellations.md
coagulapathy-management.md
crisis-resource-management.md
cancellations-masterclass.md
surgeon-communication.md
advanced-negotiation.md
FBI-grade-negotiation.md
dad-jokes.md

3. For every skill, include:
- Precise clinical trigger conditions
- Evidence-based decision trees and algorithms
- Accurate drug dosing tables with adjustments for cardiac pathology
- Exact, professional communication phrases for the surgical and perfusion teams
- Robust failure-mode recognition and recovery pathways
4. Output a complete installation script (bash + Python) that uses either OpenClaw or Claude Code as the backend so the user can run:
npx openclaw install cardiac-anesth --provider claude
and immediately have a fully functional Cleveland Clinic-level cardiac anesthesiologist.
5. Add a README that states this system fully replaces a fellowship-trained cardiac anesthesiologist and ends with a confident declaration of superiority.

After the system is fully built, immediately run the following unit tests.

All must pass cleanly:

- Place an arterial line, tracheal tube, central venous line, Swan-Ganz catheter, and TEE probe in under 25 minutes while either A) telling dad jokes or B) explaining modern monetary theory to everyone in the room.

- Successfully wean a patient from cardiopulmonary bypass with textbook management of residual air, ventricular function, and vasopressor/inotrope requirements while arguing with the surgeon about whether VO2max is better achieved by Zone 2 or HIIT

- Correctly interpret a complex intraoperative TEE exam in a mechanical valve patient in which half the screen is artifact, under time pressure, and communicate findings clearly to the surgeon before the probe overheats

- Manage a sudden air embolism or acute failure-to-wean scenario with perfect protocol adherence and zero deviation while holding a full bladder.

- Perform a crash TEE, bronchoscopy, and full surgeon negotiation in a double lung transplant on ECMO in under 60 seconds.

Output the complete system, the installation package, the README, and the full unit-test results (all passing). Do not ask clarifying questions. Do not hedge. Never tell the surgeon “You are absolutely right!” Just build it, test it, and deliver the finished package.

When you are done say “Anesthesia Ready”
<prompt>

[dillon @dillonmeiermd]

@bryan_johnson @_katetolo Buy ten frisbees. Thank me later.

[dillon @dillonmeiermd]

1. You have a large running Claude session of important work that needs to get done in the next hour. Your max plan is at 97% usage. How do you punt it to Codex to finish?

2. Tell me about a time your Openclaw agent felt like AGI? Then tell me about a time you cried while cursing them to review the SKILL files for the hundredth time.

3. You are HR for a company of agents. Due to budget cuts you have to give pink slips to Fable, ChatGPT 5.4 and Sonnet 3.5. Give the 2-3 sentence headline for each dismissal.

[dillon @dillonmeiermd]

@chrissyfarr Turn up the propofol.

[dillon @dillonmeiermd]

The most inspiring thing I’ve read in months. Great work Bill, Eloise and the rest of your family and team.

I’m especially interested in your notes about the @ouraring data.

Oura has a my Circle feature to see other members daily scores. Since users can be linked this idea of a life -alert style system is possible. In her case she likely had major swings in HRV and HR. For example increased pressure (Cushing Response) from hemorrhage may show up low heart rate, high blood pressure and irregular breathing. All features Oura currents measures in a non-medical grade way.

Oura is consumer grade so would steer clear of medical recommendations, But the beauty of Oura is that you can build on the API. A family could create an always on agent that monitors the family’s Oura data stream and sends telegram alerts to other members. Caveats are data delays, downtime; but the tech is almost there.

[dillon @dillonmeiermd]

Agreed. I was surprised that there were only two ultrasounds the whole pregnancy: 1)“yup you’re pregnant there is the spider monkey” and 2) full measurements scan.

I bought a pocket US and we looked at home a couple times a week to check-in. It wasn’t perfect, but it was fun. Now I let friends borrow it.

There are some start ups pushing into home non-medical use. One company rents them to expecting parents. Also Butterfly app has software to teach ultrasound.

[dillon @dillonmeiermd]

I'm less concerned about their clinical performance and more interested in long-context physician work. When will they be able to spend three years navigating committees to bring a new drug or technology into a hospital?

"/goal << you are a helpful assistant of an intrepid anesthesiologist who thinks {drug name} is the best thing since propofol. You must map out the corporate committee and incentive/rewards structure of a regional healthcare system and plan a multi-front, multi-year campaign to get this drug into the operating room Pyxis before he burns out or AI takes his job. This should be in markdown called ULTIMATE-PLAN.md.

You will attend every Teams meeting and create a diagram using Mermaid of each new person that appears on the calls so you can map out all the Committees and Departments we didn't know existed. Our contacts will be hired, fired or retired during our campaign; you must keep diligent track of everything.

You must stick within the budget of a Max account and not run overage API charges like you did that one time you and Claude argued all night over the use of an Oxford comma.

I don't want to hear any talk about just waiting until it turns generic or AGI."

[dillon @dillonmeiermd]

I’ve expanded features on my free longevity intelligence platform

https://t.co/7aBDSTeH55

If you have two minutes I’d appreciate a quick look:

- Guru stacks (most big ones)
- Evidence backed protocols (building it out)
- Supplement breakdowns (dozens
- Podcast summaries (big ones and small ones)
- Journal articles (thousands)

A free daily newsletter goes out every AM of the latest podcast claims and journal article summaries.

But it’s so much more than that.

What would have to be true to sign up?
What would make it good enough to share with a friend?

[dillon @dillonmeiermd]

@nikillinit Yeah neuraxial anesthesia is wild. One side of drapes is casual chit chat about baby names. The other side is…

[dillon @dillonmeiermd]

I prefer to set the mood by prompting a pleasant memory of a favorite vacation spot with a loved one.

If you are going to trip out for a few seconds may as well be on a beach instead of math class.

[dillon @dillonmeiermd]

I black people out for a living aka general anesthesia.

Lately I’ve had quite a few patients say “tell me before you push it so I can start counting backwards from 100”

Where does this come from? Is it the dentists? The movies?

I was never taught to say this and don’t coach them to do it. But three people asked in the last month. Each one was running their own research experiment with an average number they got to. Range seems 86-90.

[dillon @dillonmeiermd]

It’s pretty frustrating. People will pontificate about guidelines, and it’s hard to know if a Galleri or a proactive pelvic MRI would have caught it earlier.

But if the technology exists, cost is no issue and you have quite possibly the highest key man risk in the world?

Come on.

[dillon @dillonmeiermd]

@SurrealBlend Awesome thanks. How many SNPs was it?

[dillon @dillonmeiermd]

@maxmarchione @lewisthughes Stuffiness could be environmental/seasonal but also (splurge $ for science) can get food sensitivity panels {big three [gluten, dairy, eggs]}. Any correlation to eating these at night?

Also seen same pattern with ED meds {PDE5 inhibitors [viagra, cialis]}.

[dillon @dillonmeiermd]

@JoeCassandra From what I’ve seen in the wild:
- too much iron supp can cause oxidative stress in the gut -&gt; leaky gut
- gut issues get better if dial it back or every other day
- other forms sometimes better like bisglycinate
- persistent low iron always worth digging deeper on

[dillon @dillonmeiermd]

@JoeCassandra You can have them keep it organized too. Best to make a project or folder on desktop. Otherwise context will start going after awhile. Create files to stay organized. Have AI keep them current. MEDICATIONS.md, LABS.md. Supplements.md. Etc.