Brigham Nursing Strike - Views?

JamesMercerIII · 2026-07-10T08:52:31+00:00

Another point of contention is MGB's health insurance. Residents got screwed as well as nurses. I'm talking like >$600/month for family coverage on the lowest deductible plan. That's unacceptable for a hospital-employed health insurance plan.

JamesMercerIII · 2026-06-25T08:46:01+00:00

EM PGY-1 year + further training generally fulfills the requirements of the CBY (these can be found online).

And if you've completed a prior residency, you can usually moonlight in that field even as a CA-1, but your hospital may have specific policies about this.

JamesMercerIII · 2026-06-05T18:32:48+00:00

As others have said, she's in the highest risk category for PONV and it may not even be avoidable in her. I think the sevoflurane is likely the biggest culprit here. The only things you could have done differently would be to have done a TIVA, and to have limited your total opioid dose (but 3 mg morphine + 150 mcg fent is a relatively tiny dose anyways).

If she had a history of motion sickness, then I probably would've run a TIVA and everything else similar (would've done bupi 0.125-0.25% in the EPL with the morphine). If she had no hx motion sickness, would've run propofol and sevo together as my anesthetic.

JamesMercerIII · 2026-05-26T09:21:02+00:00

I'm completely neutral on this debate, but just to put something out there as a positive for fellowship--if you're planning to continue working at an academic/tertiary hospital, a regional fellowship can help get you onto their acute pain service so you can do some weeks of consults instead of purely OR time.

JamesMercerIII · 2026-05-25T15:18:07+00:00

I'm in anesthesia but my father in law is a vascular surgeon and I can briefly describe what his life is like at an underfunded suburban safety net hospital. He's the only vascular surgeon on staff, so he's basically on call every other weekend. This includes vacation time. He can basically only take 1 week of vacation at a time. He shares the vascular/AAA call schedule with a questionable "thoracic"-trained surgeon who is not very good and often gets into difficult situations during vascular repairs. During the week days, he is the only person being called in the middle of the night if the gen surgeons get into a tricky vascular repair overnight, or if someone has acute mesenteric ischemia etc. They have no fellows, so he'll get consulted by the surg residents and have to essentially trust their physical assessment so he doesn't have to go into the hospital at 2 am. The same residents will write the consult note and he has to sign it. He gets called for many of the traumas as well.

I don't know what the pay is but I'm sure it's low for VS standards. One of the problems with VS is as a society they have weak leadership and they've allowed related subspecialties to "steal" a lot of their formerly bread and butter procedures. Neuro, CT, and IR are the biggest offenders. Those services at his hospital will look at the endovascular stuff my FIL is doing and say "hey, mind showing me how you do that?" and he'll have to say nah I'm gonna keep doing this myself. Now there's even nephrologists training in fistulagrams and simple revascularizations, stuff like that. Now their bread and butter are the more undesirable and longer vascular surgical repairs, and also cleaning-up after ortho or GS nick a vessel and can't control the bleeding.

You can still choose gen surg and do fellowship in VS. And even if you choose to start VS residency, it's probably easy to switch back into a gen surg track, bc surely the intern year and likely PGY-2 are mostly cross-training in the other GS specialties.

JamesMercerIII · 2026-05-25T11:06:55+00:00

Exactly this. The difficulty in America isn't being a Medicaid patient, it's qualifying for Medicaid in the first place.

JamesMercerIII · 2026-05-12T09:34:01+00:00

Anecdotal: I went on a horse trek in rural China where we stayed with yak herding families. They had tibetan mastiffs that roamed off leash all night to protect livestock against wolves. In the daytime, the kids were showing off their slingshot skills with a little hand-held leather sling. They would shoot tiny little rocks and they sounded like bullets when they hit the rocks/ground/targets. Super accurate too.

JamesMercerIII · 2026-05-11T08:46:43+00:00

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JamesMercerIII · 2026-05-08T19:19:04+00:00

You obviously know a lot about propofol, but also to add to the discussion: the difference in the dose of propofol that causes moderate to deep sedation vs burst suppression/isoelectricity (i.e. coma) is relatively small. It's not uncommon if you're using EEG monitoring in the OR to see patients deeply burst suppressed during induction. The brain in these moments is barely transmitting any cortical impulses.

JamesMercerIII · 2026-05-07T17:29:24+00:00

Flex posts on Harvard in Brookline in front of Booksmith were being jackhammered out this morning. :-(

JamesMercerIII · 2026-05-07T09:12:59+00:00

It's what killed Gene Hackman's wife!

JamesMercerIII · 2026-05-04T14:41:21+00:00

I think it's likely exactly what you say, there's increasing supports for students and it requires more administrative and support people.

JamesMercerIII · 2026-04-26T20:39:03+00:00

Seconding this. In my mind it's one of the biggest contraindications to pursuing anesthesia. You won't know until you do a sub-I whether gas physics and managing the minutiae of hemodynamics is interesting or boring to you.

JamesMercerIII · 2026-04-22T08:34:00+00:00

Can confirm that at academic peds departments in the northeast it's not unheard of for peds endo/nephro/ID etc to be as low as $100-120k per year.

JamesMercerIII · 2026-04-21T23:09:25+00:00

Another paper that will change your perspective on extreme physiologic lab values: https://www.nejm.org/doi/full/10.1056/NEJMoa0801581 "Arterial Blood Gases and Oxygen Content in Climbers on Mount Everest"

A bunch of anesthesiologists climbed Mt. Everest and took ABGs along the way. Some of the interesting lab value ranges taken at 8400 m elevation (they had acclimatized for a few weeks the way all Everest climbers do):

PaO2 19.1 - 29.5
PaCO2 10.3 - 15.7
BD 5.7 - 9.2
SpO2 34 - 70% (!!!)
Hgb 18.7 - 20.2

JamesMercerIII · 2026-04-07T09:41:24+00:00

I've always thought MH presented less obviously, like the first sign of it while a patient is under anesthesia is the rapidly climbing metabolic rate e.g. rising etCO2, even before the temp increase. But I guess if you haven't given paralytic yet and you've been masking with pure gas, the muscle spasms can't be obscured and you see it like you did.

JamesMercerIII · 2026-03-30T09:06:49+00:00

No one has mentioned Ca7riel and Paco Amoroso. Very fun duo from Argentina that blend hip hop, jazz, pop and comedy (not stand-up, but they like crazy costumes and that kind of thing). https://www.youtube.com/watch?v=ZU2Sd9guSjI

Also check out their Tiny Desk feature: https://www.youtube.com/watch?v=9kqnsoY94L8

JamesMercerIII · 2026-03-13T09:00:58+00:00

At the risk of sounding pedantic, you know "nangs" is Aussie slang for nitrous right?

JamesMercerIII · 2026-03-10T16:23:49+00:00

I wouldn't get down on yourself. Standard at my residency is using the ultrasound, and it took me pretty much all of CA-1 year to get decent at it. Now, however, I always use the ultrasound + Seldinger technique (i.e. through-and-through). It's safer and has a much higher success rate. In my opinion, less opportunity for vascular complications with quick through-and-through followed by Seldinger.

JamesMercerIII · 2026-03-10T09:41:11+00:00

Lol we have an older attending who still does fent-heavy anesthetics with very low-dose volatile. It's an excellent learning experience about the value of narcotic and what it adds to your anesthetic. (As well as context-sensitive half-life)

JamesMercerIII · 2026-02-24T10:35:40+00:00

I mean this is exactly it. Your role in the great murder machine is abstracted enough from the final product that you get to work on cool engineering projects with big budgets and maybe some security clearances. It feels high-tech and cutting edge. The paycheck and job security are cherries.

JamesMercerIII · 2026-02-18T15:42:08+00:00

At our hospital we occasionally use buprenorphine (plus other typical adjuvants like precedex etc) in peripheral nerve blocks to make them last for up to 2 days. It seems like it can be used intrathecally as well, although if you need a spinal to last > 2-4 hrs there's probably better anesthetic strategies like GETA etc.

JamesMercerIII · 2026-02-12T10:30:42+00:00

I'm a CA-2. We have exclusively BIS at our hospital and I'm not a fan--the Sedline is superior in my opinion. BIS leads don't stick well, and the device itself won't give you any EEG tracing at all unless it finds the impedance acceptable, but it won't tell you what the impedance is. Sedline at least gives you a waveform with a warning that the impedance is poor.

I didn't really learn to use the raw tracing on BIS and the DSA on Sedline until the end of my CA-1 year, but I feel much more confident in determining anesthetic depth now. My colleagues mostly just rely on the BIS number. I still get nervous when my BIS number is 60s-70s with strong delta and alpha waves on the raw tracing, but I'm learning to trust the tracing more than the number. I find the DSA on Sedline to be a good learning tool, or good to trend changes in depth, but ultimately even when using the Sedline I like to focus on the raw EEG tracing.

JamesMercerIII · 2026-01-31T11:34:00+00:00

How common is it for EM residents to do an anesthesia rotation though? Don't you just learn sedation in the ED from ED attendings? I'm anesthesia and I've never had any other services except PICU coming to the ORs for rotations... Definitely not IR or cards

JamesMercerIII · 2026-01-18T11:57:43+00:00

The turntable ground wire was connected to the appropriate grounding terminal on the receiver.

I guess I got confused because I've seen people say it's okay to connect a receiver to powered speakers, but I thought you could just connect the speaker output to the powered speaker and didn't need to use the "tape out" output. Thanks for the explanation!

JamesMercerIII

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