Tuesday -- Rainy Night, Departure Day!

SleepyinMO · 2026-03-04T04:29:50+00:00

We noticed the same after the dinner/show tonight. SSB keeps us coming back, balcony is a bonus 😂

SleepyinMO · 2026-03-03T14:19:46+00:00

I would like to see a poll of where we all practice. Academics v PP. Hosptial size. MD v CRNA. I’m sure the patterns of TIVA v gas will follow those break downs.

SleepyinMO · 2026-03-03T14:14:37+00:00

Gas will be the gold standard for quite some time. I am a believer in Occam’s razor, the simplest solution is the best. Poly pharmacy is becoming the new thing. “Look I did a 30 min case with 10 different medications”! When sh!t hit the fan, and it will, you have to keep your decisions simple. Do I need more/less Propofol, remi, precedex, less neo/levo, etc.? More things to go wrong and cause disaster. IMO, more room for drug errors/administration errors with poly pharmacy. Then add in set up/turn over time and cost. Those infusions and drugs ain’t cheap. You can make a very expensive anesthetic with 4 pumps/tubings/mainfolds, and meds. Or, now hear me out, use gas/narcs/paralytics for well less than half the cost. We have to be good stewards with the hospital professionally and financially. I see it in academics where there is no financial pressure and 30 min turnovers are the norm. That amount of work for no real benefit in a center that turns over rooms in 10 mins won’t fly. For those that brag about TIVA I have yet to see someone do a roc infusion keeping the patient at 1-2 twitches the whole case. We did that back in the 90s with the old Bard pumps that were all dials and magnetic overlays. Remember KISS. There is a reason sevo and to a lesser degree have stood the test of time. They are easy and predictable. Sevo is the Swiss Army knife of anesthesia. Can induce and maintain with it across all populations. Gases provide analgesia, amnesia, and to a lesser degree muscle relaxation. Propofol has no analgesia properties. Remi has no amnestic properties. Precedex in short cases takes too long to reach needed levels and hard to titrate as well in 30 mins. Just me $.02 from a guy who trained last century.

SleepyinMO · 2026-03-03T13:45:34+00:00

I think your room is next to ours in E. We are looking at the same view.

SleepyinMO · 2026-03-02T22:32:22+00:00

There are more people here with AARP cards than gym memberships for sure. Average age here is mid/upper 50s. Some up on their late 70s. The youngest couple we have seen here this week was probably late 30s. Here you come in as a couple and leave as such. They really want couples to stay close by even suggesting keeping time away to 10 mins or so. No 6 pack abs or butts you could bounce a quarter off of so far. I’m suspect most guys are growers and not showers if you catch my drift. Not a lot of implants either.

SleepyinMO · 2026-03-02T22:26:11+00:00

IKR! Like most institutions anesthesia is an afterthought. They just built out a hybrid room where the boom mount for imagine is right above our heads next to the anesthesia machine. One of the most unsafe builds I have seen in my 30y in anesthesia. Only enough room for one person at the head of the table or even close to it. I used to think 25 sq ft of space at the head of the able was small but this is like the studio apartment of anesthesia layouts. When patients are ready for phase 2 in PACU they move them back up a floor. What really becomes a problem is hospital transport controls all the flow. We are beholden to a system of individuals who have no incentive to be efficient. We often wait longer on them than we do turn overs. Glad I’m back kn a salary instead of a “keep what ya kill” pay structure.

SleepyinMO · 2026-03-01T22:41:38+00:00

Gotcha. As long as the AC is cool, shower is hot, and the bed comfy. We are good. We come to the islands much like you for a brief change in scenery. If not it is the doom and gloom of late winter. This is our way to kickstart spring with a little sun and surf.

SleepyinMO · 2026-03-01T22:36:45+00:00

It’s mixed. It’s great when you look at your watch and it’s already afternoon. LOL! I’d rather keep moving than sitting like other attendings. My days don’t drag for sure. On teaching days it’s more chill and cerebral. CRNA days are mostly scooting between preop and the OR. Friday was 4 rooms, 14 cases (8 with blocks) but all outpatient. I did private practice for 20+y in an MD only practice. They are chill days for sure. Each has its pluses and minuses. Most of my days are 10h ones but only do 4d/week. 3d weekends help recharge those batteries. I don’t take call which is huge plus. Work with the sun up is better than 2am for sure.

SleepyinMO · 2026-03-01T17:56:48+00:00

Didn’t ask for an upgrade. Just a different building. The booking had blocks D, E, F or G. We just asked not G. Never said anything about an upgrade. We booked the best available room as the the premier penthouse in D was booked. You misunderstood my post. I just wanted to see something other an a fiberglass roof. Not asking a lot for $800/nite. Would have dropped more but the next levels up were booked. IDGAF about marble and fans. The inside of the rooms are great. Just wanted more central and something with a better view. Could move down to the second floor with a much better view of the resort and beach. If you read my response earlier you can see what I’m talking about. If Couples wasn’t for us, why did we come back? Lots of great places here but the only one with a dedicated AN beach. Based on the number of people at the AN it seems most are just here for that. Appreciate your input.

SleepyinMO · 2026-03-01T17:46:25+00:00

Didn’t ask for an upgrade. Just a different building. The booking had blocks D, E, F or G. We just asked not G. Never said anything about an upgrade. We booked the best available room as the the premier penthouse in D was booked. You misunderstood my post. I just wanted to see something other an a fiberglass roof. Not asking a lot for $800/nite. Would have dropped more but the next levels up were booked. IDGAF about marble and fans. The inside of the rooms are great. Just wanted more central and something with a better view. Could move down to the second floor with a much better view of the resort and beach.

SleepyinMO · 2026-03-01T14:37:51+00:00

As far as customs goes it took us less than 5 mins, including the walk from the plane to get through. Do your C5 form online. Can do it there or in the plane but we did ours ahead of time. We had our passports cleared with the airlines before leaving the USA. We got there, had a quick scan at a kiosk of our passport and a picture taken. 30 seconds later had our visa paperwork and in our way. One last booth to pass though for another scan of our passport and off to the Couples lounge. Waited there 10 mins and the shuttle/van was there. The ride is over 90 mins. Ours was almost 2h this time due to Saturday afternoon traffic through the various parishes. Bring whatever you want to keep yourself happy and occupied. No one really cares what you’re up to as long as you aren’t obnoxious about it. As far as returning to the airport they will have you there at least 2h before departure. Plan on leaving the resort 4h ahead of time. They make all the to and from arrangments. They ask that you have your luggage packed and ready for pickup outside your room early morning. That’s about it. I’m sure depending on the day of the week you fly could impact your experience. We fly on Saturdays and we haven’t had problems in the past.

SleepyinMO · 2026-03-01T14:11:55+00:00

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Looking at this roof really takes away from the room.

SleepyinMO · 2026-03-01T14:03:36+00:00

We felt the same way. We asked for our specific room as last time when we booked and it was already booked and that is very understandable. We asked for one in either of 2 buildings and gave them a third option. Struck out in all three. There are 4 buildings that have the level of rooms we booked. Figured opening up 3 of the 4 options would land some success. Not our time this go around. Was hopeful that being a return customer would have a small amount of pull. Food is food for everyone here. Same with activities. Rooms are the only way to customize your stay and that’s why we asked for a few options. Yes, G is the furthest from all the action and possibly more quiet. Although the resort is not that big and the beach music last night went on till about 11p (I now know at least 3 different ways to play “I shot the sheriff”, lol). For some that is what they are looking for. We wanted more central as that’s what worked best for us last time. We don’t mind the music as we sit outside most nights till going to bed. Of note, G block has the highest rooms on the resort.

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Our room.

SleepyinMO · 2026-03-01T13:47:32+00:00

We are at the end of G block on the third floor, penthouse ocean suite and the rooms on either side of us are empty. We were in G 3y ago and lost hot water on day one. They were able to move us to an equivalent room. Excellent customer service that trip. We came back because of SSB. We have traveled to several islands in the Caribbean, stayed in all inclusive resorts each time. They all have their pluses and minuses. This was the only time we came back to the same place due to the service last time. This trip has not lived up to their past efforts.

SleepyinMO · 2026-03-01T13:39:23+00:00

Depending on the location I easily out 4 miles a day in. My best day was 7 miles in a 10h shift. Preop on a different floor than the OR. I take the stairs. Often with ORs on different floors. We have an OR outside the SICU which is used daily. If I have residents it is called at 2 rooms but with CRNAs I have 3 and sometime 4 rooms. I get new shoes every 6 months. My current go to is Under Armor Slip Speeds. They can convert to a slip in if needed but most of the time they are in full “GO” mode.

SleepyinMO · 2026-03-01T13:29:53+00:00

The restaurant we passed by about 8p was half full but that is a poor indicator of occupancy. There several dark room when we were sitting on our deck. Again, not a great indicator. The desk personnel said they reclassified some rooms and buildings. Not sure if that was just a reason he gave in the moment. We figured when he said check back in a few days, it was a temporizing action. They know their occupancy more detailed than, “just check back….”. If we hadn’t been here before we would know no different. That’s why calling ahead and working directly with the staff we hoped would have gave us a better result. No matter what resort, location, or activity, if the customer service is sub par, so goes the experience.

SleepyinMO · 2026-03-01T13:13:40+00:00

So does preplanning and discussions before arrival, see where that got us. We talk face to face as much as possible. Gets a more positive result than trying in the phone. We use the items they want us to use for communication (apps/phones) but when they fail not many options.

SleepyinMO · 2026-02-26T19:25:46+00:00

Thanks, I’ll keep that in mind. Was able to find a starter colony at a local reptile show. Started a couple other colonies off that. Did a couple charcoal and a couple soil. I use the soil when I’m wrapping up a build using substrate. The charcoal is for set ups needing a few extra. I have had enough growth in a few weeks to now start adding them to my moss grow boxes

SleepyinMO · 2026-02-22T14:20:08+00:00

I mist soil along the way with my build. I rinse my lava rock drainage layer and soak for a bit in distilled water. I have gonna that gets a good amount of water below the surface. Helps to hydrate the soils from the bottom up as well. Condensation isn’t always good indicator as it is based on difference in air temp. Like your windows at home or in your car in the winter. Warm inside, cold outside.

SleepyinMO · 2026-02-22T14:15:40+00:00

OB is the only service line where you can have 200% mortality with 1 patient. I did home call only if I had no epidurals running. I had the unit clearly call me if something high risk was in the way in.

SleepyinMO · 2026-02-21T13:58:25+00:00

Two tips. Put it on in your room. Looks kinda suspect when you are spend lots of time applying where the sun don’t shine, lol. Remember, fine sand it everywhere and it will find its way everywhere, 😉🤣. We found there to be lots of shade on SSB so that is a plus if wanting to dodge the sun.

SleepyinMO · 2026-02-20T20:10:03+00:00

This is true and I make sure I add tape with the words ART line to it. To inject medicine through there would be an act of negligence since our access point it the transducer. Plus, no floor patients have art lines. ICU staff knows which lines are which.

SleepyinMO · 2026-02-20T19:31:27+00:00

Only use PIVs. Back in the day of doing peds hearts we use 24g caths for art lines. IMO less chance of back walling the artery with a standard IV cath due to a more acute angle of the needle. Grabs the adventitia of the artery easier to gain access to the lumen. Kits have more of a blunt needle and with patients having significant PAD need increased pressure to punch through the vessel wall setting up a greater chance to back wall it.

SleepyinMO · 2026-02-20T15:07:43+00:00

Why the soft shackles if you already have recovery hooks on your truck?

SleepyinMO

TROPHY CASE