To The Great City!

Related: 0/4, 1/4, 2/4, 3/4

Last Friday I said goodbye to my patients, handed over my pager, and left Our Lady Of An Undisclosed Location for the last time.

I was hoping for a moment for quiet reflection, but I made it about halfway to the door before being accosted by an incoming intern who couldn’t figure out how to use the medical record system. I helped her, because I’d definitely been there before. I was looking back over my blog archives from four years ago, when I started all of this, and I’d written:

If you’re entering medical residency and want to prepare, practice this phrase: “I don’t know the answer to that question, but I’ll page my senior resident and he will get back to you.” I keep getting paged by nurses with questions like “Your patient in room 315 has critically low potassium, please advise.” And I went through medical school and I know stuff about low potassium and I have clever ideas for what to do and probably in over 80% of cases those ideas would not kill the patient. But “over 80%” isn’t enough, so each time I have to find my senior, who’s really busy and hates getting paged just like everyone else, and ask him a stupid question I already know the answer to.

And even though it seemed kind of unlikely at the time, that thing which happens to the people in all of those medical shows like Scrubs happened to me. I survived intern year. I developed some vague foggy idea what I was doing. At some point I crossed the border into competence. I started becoming one of the people who answers the clueless questions instead of one of the people who asks them.

I can’t say enough nice things about my hospital. They put up with me through all those years I didn’t really know what I was doing, invested thousands of hours into training me. They answered all my rookie questions, like “why can’t patients wear shoes with laces?” (answer: because you can tie shoelaces into a noose to hang yourself with) or “why do we have to learn this style of therapy when studies show it’s no more effective than empathetic listening?” (answer: because the government says so). Everyone knows the stereotypes about residency – you’re overworked, you’re abused, you’re treated like pond scum – and my hospital put the lie to every single one.

And I can’t say enough nice things about the other residents in my program. I’ve never been good at making friends, but being thrown into the lion pit together is a pretty powerful form of bonding, and after the existential terror of intern year where some twenty-something-year-olds who have been to medical school but are otherwise pretty normal people get shoved into a hopital and expected to treat patients together, I think we became pretty close. I never had to trust them with my life, but I trusted my patients’ lives to them every day. I’ve strategized first dates with them, been to their weddings, cooed over their newborn babies. Um. Had several-year-long arguments about consciousness with them. Met the gurus of their obscure religions. Good times.

But Kurt Vonnegut writes about the difference between two kinds of teams. A granfalloon is a team of people pushed together for some ordinary human purpose, like learning medicine or running a hospital psychiatry department. They may get to know each other well. They may like each other. But in the end, the purpose will be achieved, and they’ll go their separate ways.

A karass is a group of people brought together by God for some purpose of His own. No matter how little time they spend together, or how poorly organized they might be, they’ll always be on the same wavelength and have a special kinship with each other.

And all the wonderful and compassionate people I got to know during my four years in Michigan are my granfalloon. I’ve never stopped feeling like you guys – the rationalists, the effective altruists, the transhumanists, the AI scientists, the statisticians, and all the rest – are my karass. All these years I’ve had to spend away from you have felt a little bit like exile.

Back when I first left the Bay Area to take this position four years ago, I wrote myself a letter. I said that I know about value drift as well as anybody. People always say that they’re going to love their first girlfriend forever, and then it never happens. Or they say they’re going to keep in touch with their college friends, and then they forget. But – 2013-me wrote to 2017-me – if your values drift so far that you find yourself wanting to stay in Michigan, just…take a step back and think about it. Remember all the friends you have out west, and how exciting the intellectual climate is, and your feeling that it’s some kind of fulcrum for the forces that will produce the future, the sort of place that Athens must have felt like in 400 BC, or Florence in 1400. And before you end up marrying some Michigan girl and opening up a practice across the street from the hospital where you trained, just remember everything out here and how much you used to love it.

And even though I had a better time in Michigan than I could possibly have hoped – even though Detroit pizza is literally my favorite food ever and I’m kind of panicking at the idea of being somewhere you can’t get it delivered – despite all of that I didn’t even have to open the letter. I remember everything in it perfectly clearly. My values haven’t drifted at all. All of you are great.

So I’m happy to be able to announce that I’ve just accepted a psychiatrist position in the San Francisco metropolitan area – the greatest metropolitan area in the world! I’ve cancelled my lease, loaded everything I own into the trusty little Subaru I got before I realized that driving a Subaru in Detroit would earn you constant dirty looks, and am very gradually moving west.

Thanks to all of you for keeping in touch and helping me stay sane these past four years. I’ll be seeing you very soon.

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96 Responses to To The Great City!

  1. jprester says:

    Awesome to hear. I always felt the same about Bay Area as being the fulcrum of the future. Would love to be there myself, but at least I managed to move to the place that might be one of the contenders (Shenzhen/HK area) which is a reasonable consolation prize. Wish you all the best and hope you continue to find time for brilliant essays.

  2. eqdw says:


    I’m currently shopping for a more conveniently-located psychiatrist, and if it’s not too soon to ask, would you like a patient? I’ve often struggled with getting value out of psychiatrists. Typically the inferential gap between us is too large for me to find them very useful, and they try to treat me too much with kid gloves for me to feel comfortable really making any serious progress. As it is, I essentially treat them as a scrip-signing robot, but I think this is not a terribly healthy attitude to have.

    If you’ve taken a job at a clinic that’s a reasonable distance from Mountain View, or your practice does online video consults, I would like to repeatedly throw my insurance card in your general direction.

    And on a more personal note, congratulations. I’ve been reading your blog for several years now and it’s been a significant force for good in my life. Here’s to you being a force for good in the lives of many more.

    • Scott Alexander says:

      It’s generally considered dangerous / conflict of interest – ish to have patients who you know personally. Even though I don’t really know you personally, I’m going to err on the side of caution for now and say no. Happy to talk to you briefly by email if you have specific questions I can help point you in the right direction for. I might change my mind about this kind of thing once I know more and am more comfortable practicing. And thanks for the kind words.

  3. Tracy W says:

    Congratulations! And best wishes for the move.

  4. I do have to say… The thing that makes me most question my association with the lw-diasporasic karass is the obsession with San Francisco. It is one of the worst places I know in America.

    (Evidence: see most posts on Zvis blog, or hang out around all the terrible people there for two years, while paying a fortune to live in a hovel two hours from work in a terrible concrete desert; meanwhile every flat surface is covered in hobo piss. Every normie within fifty miles either despises you and applauds rioters who throw bricks at your friends, or holds you in contempt as a pitiful loser who deserves no human treatment. Great restaurants though.)

    • jprester says:

      i dont think there is obsession with San Francisco in R-community because of some intrinsic property of the city. Its just that there is high concentration of interesting people for various historical reasons.

    • Scott Alexander says:

      I hate the city of San Francisco itself and am trying to stay out of it. I like parts of the metropolitan area. But mostly I just like the people there.

      • WRD says:

        That’s really interesting to me. I’ve spent lots of time in LA but never been to San Francisco. I’d love to hear a bit about why the city is bad but the region is good.

        • watsonbladd says:

          The city is bad because it pretends to be a small town and is filled with lotus-eaters who tolerate a level of anti-social behavior most places would be recalling mayors over. It doesn’t have nearly as much cultural opportunities as the actual city in the US. There is a deep antipathy towards more transit investments, and the older residents hate the techies with a passion.

      • outis says:

        I have to ask… where are all these interesting people and things in the Bay Area? I have lived there for a couple of years, and I have no local friends, I know no interesting people, I definitely don’t have anyone with whom to have the conversations that one can have on this blog. Nor have I found or heard of any interesting events or places.

        It feels like moving here has been a complete waste (apart from the salary, I mean). But my experience has been so different from yours (and that of so many others) that I feel I must be missing something. What does one do to get in touch with the interesting Bay Area?

        • MugaSofer says:

          I imagine attending LW meetups would lead to encountering some of the people Scott is friends with, and/or people a lot like them.

        • raemon777 says:

          One important bit is that it’s *not* San Francisco you’re supposed to move to, it’s middle-Berkeley (apparently Ward Street according to the most recent Open Thread)

          • poipoipoi says:

            Which is annoying because there’s no sane way to get to the jobs in Silicon Valley from there.

            /One of many reasons I left the Bay Area proper last month.

          • Reasoner says:

            Which is annoying because there’s no sane way to get to the jobs in Silicon Valley from there.

            The hottest tech jobs are in San Francisco, which is a manageable BART ride away.

        • We’ve had several SSC meetups at my place in San Jose.

          • raemon777 says:

            Not saying there’s literally nothing in San Francisco, but mid-town Berkeley is where I reliably walk down the street and will see a person I don’t even know where a CFAR or Effective Altruism t-shirt.

    • Wrong Species says:

      Are there any places outside San Francisco that have a strong rationalist community?

      • Nornagest says:

        Boston. There used to be a strong New York rationalist scene too, but I don’t know if it still exists.

        Not that I’d want to live in New York any more than I want to live in the Bay.

        • Quixote says:

          NY is nothing like SF. For one, NYC is actually a real city (ala London, Paris, Tokyo, etc). It has a daytime population in the 10s of millions, not hundreds of thousands. SF really is just a very large town. The dynamism and diversity that you get from a large population really isn’t replicable in small places. Also NY is, like other real cities, transit based. People walk or take the subway; car ownership isn’t required, or even that useful. The experience of being able to causally walk to almost anything you could want or require is so convenient that its difficult to describe how much it boosts your quality of life.

          • It has a daytime population in the 10s of millions


            I don’t think that is close to correct. Judging by a little googling, Manhattan roughly doubles from two million to four million (1.5 to 3 in another source) on a weekday. Every other borough loses population on a weekday. Total population of the city is about eight and a half million, so the total weekday population is around ten million.

            Do you have a source to support your claim?

          • Quixote says:

            @David, good catch. I had read that NYC’s population doubled during the daytime due to commuters, but on further googleing, I think my original source was using sloppy language and that Manhattan’s population doubles during the daytime. Some of that doubling comes from commuters in Jersey, CT, long island etc, but some will come form Brooklyn and the other boroughs. So probably does go over 10million during the day, but nowhere near 20.

            So by the narrowest possible technical reading, I wind up being technically correct by dumb luck, but my sourcing was off and I’m certainly connotatively wrong.

            That aside though, its still larger than SF by an order of magnitude, (three orders of magnitude if we are talking base 2). That makes a big difference.

          • San Jose is bigger than SF too, but considerably less important as a cultural center.

            I’m not convinced by your “The dynamism and diversity that you get from a large population really isn’t replicable in small places” in this context. Periclean Athens had a population of about 300,000, slaves included. Elizabethan London about 200,000.

            A million is a lot of people.

      • Tedd says:

        Berkeley, which is where Scott is going, is outside of SF proper, and is much more pleasant. More college kids, fewer homeless people.

        • crilk says:

          fewer homeless people

          Have you ever been to Berkeley?

          • SolveIt says:

            No no, those are Berkeley professors.

          • basenjibrian says:

            The homeless problem is actually terrible in Berkeley and Oakland right now. There is a (politicized) encampment on the main central median of Adeline Street leading right into Downtown. Oakland is worse.

            I can’t afford to live in the central Bay Area. I always say I should become a heroin addict, move to the Van Ness median island, and wait for the subsidies. But then, I realize how nasty that opinion is and I return to ineffectual “how do we solve this” musings. 🙁

            Parts of SF are just appalling right now, though. Especially the Mission District, SOMA, and Portrero Hill. While a block away you see shiny glass towers worthy of Blade Runner.

          • Anthony says:

            So does anyone know why the homeless encampment population exploded over the past few years? I work in SF and live in Alameda, and take 5th Street in Oakland from the freeway to get home. A few years ago, there were a couple of tents, and a couple of people hanging out who were obviously homeless but not sleeping there. These days, there are literally several blocks *crowded* with occupied tents. Probably several hundred people just in that area, and there are encampments like this many other places in SF, Oakland, Berkeley, etc.

            What changed?

          • Anthony says:

            @basenjibrian – now is *really* not the time to go live in the Van Ness median. They’re tearing it up for “Bus Rapid Transit”. Come back in a few years.

            Or try U.N. Plaza.

    • Aylok says:

      Is there anywhere else that remotely competes to be the Athens/Florence of the 21st century? Boston? London? Not yet anywhere in China, maybe in a few decades.

      • Yair says:

        Tel Aviv maybe? Or is it over-rated?

      • Reasoner says:

        Cambridge has both MIT and Harvard.

        • Creutzer says:

          Cambridge is MIT and Harvard. And as such produces some intellectual and no cultural output, which puts it out of the Athens/Florence league.

          Come to think of it: what is Harvard actually really good at apart from looking prestigious? I mean, in which field of intellectual inquiry (to avoid the word “science”, which one might interpret overly narrowly) are their researchers actually up there at the very top? Psychology maybe? What else?

    • Eli says:

      By default, I’d say, “lovely weather, lovely landscape, godawful legal/economic environment, godawfully smug population.”

      My second thought is, “Oh of course you’d say that. You’ve absorbed Bay Area hate from your MIT people. You disagree with them on science and technology, and then just don’t like the housing prices and suburban sprawl.”

      Is there anywhere else that remotely competes to be the Athens/Florence of the 21st century? Boston? London?

      Most other major metros on the planet with high intellectual concentration? So, like, London, Boston-Cambridge, New York, France and Germany but kinda spread out, and maybe a few more.

      • Nornagest says:

        No, you’re right. Your MIT friends might hate the Bay for bad reasons, but that doesn’t make them wrong.

      • Virbie says:

        > Most other major metros on the planet with high intellectual concentration?

        I don’t think it’s reasonable to interpret “Athens/Florence” as meaning somehow comparable (or better) _absolute_ levels of output, but instead _relative_ to their contemporaries. Athens and Florence weren’t just another place among contemporaries experiencing similar levels of intellectual flowering, they’re generally (at least colloquially) considered to have been something fairly unique among their respective contemporaries.

        This by definition excludes the answer “most other XYZ” since the question implies “one (or perhaps two) place that had a claim to exclusively holding that title”.

        • Creutzer says:

          If you’re going for relative prominence, it would be very surprising for the 21st century to have an Athens/Florence.

    • neciampater says:

      I recently drove the entire Pacific Coast Highway, and San Francisco was, by far, the worst stop.

      Being a east coast southerner, I rather expected much more from the place.

      Having been to San Francisco, I can now say I’ve seen a homeless woman piss in the street at 10pm.

      • Anthony says:

        I saw a rather well-fed woman, pants down, wiping her ass on a street corner in SF at about 10am. I’m glad that people who live near my office walk large dogs, because then I can pretend that the large turds on the street are dogshit.

  5. Reasoner says:

    The rationalist community in the Bay Area is a little overrated, in my experience.

    The theme of the Bay Solstice turned out to be “Hey guys, so people keep coming to the Bay, running on a dream and a promise of community, but that community is not actually there, there’s a tiny number of well-connected people who everyone is trying to get time with, and everyone seems lonely and sad. And we don’t even know what to do about this.”

    In 2015, that theme in the Berkeley Solstice was revisited.


    • Jugemu says:

      Scott is one of those people everyone is going to want to get time with, so not a problem for him.

      • Reasoner says:


        You know, I’m not sure Raemon’s description is quite accurate. Highly speculative: I think maybe what’s going on is that in the absence of concrete status metrics, the Bay Area community has a culture of signaling status by making oneself inaccessible. No one knows quite what high status people like Eliezer and Anna Salamon are working on, but they are certainly too cool to appear at your average publicly advertised rationalist event. This explains why LW community organizers from other parts of the world come to the Bay Area and then stop organizing things: They pick up on the fact that doing this does not signal coolness.

        If this hypothesis is true, Scott might have the opportunity to disrupt things by countersignalling and making himself accessible. I don’t think it would require a large time investment. I would be very curious to see how the composition of the Berkeley LW meetup changed if it became known that Scott was showing up every Friday evening. (Also, speaking of attracting cool people, it’s possible that Friday evenings are not the best time of week if one wants to do this.)

        • raemon777 says:

          I think it’s less accurate than it used to be (people didn’t just sit on their laurels for the past few years), but some of the key dynamics are still there. However, I don’t think this is the fault of the high-status-people-everyone-wants-time with. It’s the fault of, well, everyone else + game theory.

          Maia’s post touches upon the details of the problem and potential solutions (I’d quote a snippet but the whole thing is pretty relevant)

          The issue is not that high status people are deliberately doing weird signaling stuff – it’s just that their social lives are full. You can only have 4-7 close friends and 12-30 people you are reasonably well acquainted with before you run out of time and energy. (And remember, these are all introverts).

          • Reasoner says:

            I didn’t mean to say that the high status people were blameworthy, just hypothesize about a signaling game that might be getting played.

          • Reasoner says:

            It seems like most big groups of people make use of “headliners”–high status people who act as a Schelling point for others to gather. Think of events like TED. People are still excited to go to TED even if they know they’ll never get a chance to speak one-on-one with Al Gore. So I don’t think number of strong ties, or even number of weak ties, is the bottleneck for large group formation.

            I can’t think of any big, successful communities who function without prominent leaders who are physically present with their followers on the regular.

            Maybe part of the the issue is that the LW community formed through the internet, and internet communities select for introverts. (Extraverted intellectuals are busy being professors at prestigious universities, working as the CEOs of tech companies, etc.)

    • callmebrotherg says:

      It probably varies on what you’re used to or what sort of situation you’re coming out of. My experience with a rationalist meet-up was wonderful and refreshing and filled a need that I didn’t realize was there, even though I didn’t interact with anyone whose names I knew prior to that meet-up.

  6. meltedcheesefondue says:

    >I’ve never stopped feeling like you guys – the rationalists, the effective altruists, the transhumanists, the AI scientists, the statisticians, and all the rest – are my karass.

    Welcome home 🙂

  7. Ally says:

    Congratulations. And best wishes for the move.

    I was reading this and thinking: why would driving a Subaru in Detroit earn you constant dirty looks? Then I realised – Oh yeah! – That’s why!

    • tcheasdfjkl says:

      I’m still confused. Explain?

      • sohois says:

        Detroit is the historic centre of the major American car manufacturers. Subaru is a Japanese car and thus a marker of the economic decline of the city, since it was largely Japanese competition which caused American car manufacturing to plummet.

        • Slocum says:

          Kinda. Except Subarus and other foreign makes are thick on the ground in Ann Arbor (which isn’t exactly Detroit, but still). And foreign automakers and suppliers now have a big R&D presence in the area as well (especially near Ann Arbor, with Toyota and Hyundai/Kia tech centers). There’s no foreign manufacturing in Michigan though — they’re avoiding the UAW. So at this point you might still get the stink-eye from a UAW member, but nobody else really.

          And the decline of Detroit (the city) really isn’t about the auto industry (which, after all, is still around) — it’s much more about white flight. Starting in 1950, the city lost 2/3rds of its population (and an astounding 95% of its white population) while the overall metro area grew. The city’s decline continued over decades that included some of the U.S. auto makers’ most prosperous. Detroit proper actually hasn’t had much auto manufacturing for quite a long time. Ford hasn’t had a plant in the city for 100 years, and others moved out in the mid 20th century as they switched from multistory urban plants (like the famous derelict Packard Plant) to new single-story plants built on greenfield sites.

          • BBA says:

            I wonder if a Tesla (American, but from outside Detroit) also gets the stink-eye. Also, with NAFTA the Big Three have moved some production to Mexico, and Chrysler has been under foreign ownership for most of the last 20 years (Daimler from 1998-2007, Fiat since 2014) making “buy American” a much more ambiguous thing.

      • SEE says:

        sohois gives the short explanation. Let me give the long, as someone who grew up in suburban Detroit.

        Detroit calls itself “the Motor City”. A twenty-mile-radius circle around the house I grew up in encompassed the world headquarters of GM, Ford, and Chrysler. The tallest building in Detroit, and indeed the state, was built by Henry Ford II, and is currently the world headquarters of GM. The local custom of naming freeways after people results in names like “The Chrysler Freeway” (I-75), “The (Edsel) Ford Freeway” (I-94), and “The Reuther Freeway” (I-696, after United Auto Wokers union organizer Walter P. Reuther). When you take the Ford Freeway from Detroit proper to the airport, you will pass by a eighty-foot-or-so tall automobile tire, known as the Uniroyal Giant Tire. One of the major school field trip destinations was the Henry Ford Museum. One of the major hospitals is the Henry Ford Hospital, part of the Henry Ford Health System and staffed by the Henry Ford Medical Group. The professional football team (now) plays at Ford Field and is owned by Martha Firestone Ford (widow of since-1963 owner William Clay Ford, Sr., of those Fords).

        My family was deeply entwined with the auto industry. My mother is a graduate of the General Motors Institute (now Kettering University, in Flint, Michigan), got a job at General Motors, took time off to have kids, went back to part-time work at General Motors. My father is a graduate of the General Motors Institute, got a job at GM, got laid off, got another job at GM, got spun off and laid off, got a job at GM, got spun off, and got spun off from the spinoff. (He just retired this year.) My uncle is a graduate of the General Motors Institute, and got a job at General Motors. His wife worked for EDS when it was part of General Motors. My maternal grandfather worked for GM’s Allison division, back when GM had such a division. Except for the fact that my family was heavily white-collar, this was not a particularly unusual level of family employment by the auto industry.

        Accordingly, Japanese automakers, when I grew up in Detroit, were as popular as, say, Margaret Thatcher in English coal mining towns at the same time. I assume it’s toned down some, but, still.

    • Pete says:

      Additional things that may have marginally contributed to the already explained base layer of contempt: with regard to the Subaru in particular, American car guys often consider the higher price exacted for only slightly better safety basically a marketing scam aimed at blue tribe helicopter parents. And of course there’s the longstanding perceived association with lesbianism. So the Subaru’s about as blue-tribey a car as you can buy. (That being said, driving a macho Japanese supertruck around Detroit might be more directly offensive for both cultural and straightforward economic reasons.)

      • MostlyCredibleHulk says:

        Subaru is associated with lesbianism? That’s the first time I hear this one. You learn something new every day.

        Also, isn’t Detroit very “blue” city? Last time Detroit mayor was a Republican was in the 60s, the county (didn’t find city-only results) voted 73% Obama and 66% Clinton.

        • BBA says:

          Democratic != blue tribe. The core of the Democratic party, especially in Michigan, used to be “hardhats” – socially conservative union members. They’re basically gone, replaced by minority voters (who themselves aren’t really “blue tribe” but I digress).

          To the extent they’re a real phenomenon and not a gross flattening of complex socio-political forces, the “tribes” only really apply to middle-class-and-above white people. The working class has a different dynamic, and nonwhites are even further from it.

        • SEE says:

          Note that in local parlance (and the sense Scott seems to be using it), “Detroit” very often doesn’t mean the city proper, but what the Census calls the “Detroit Urban Area”, or the the local media the “tri-county area”. That is, the circa 3.8 million-person urbanized zone spread across Wayne County (1.8 million people, including the City of Detroit), Oakland County, (1.2 million people), and Macomb County (0.8 million people).

          Analyzing statements about “Detroit” as just the city of 0.7 million people accordingly is very often misleading — and treating Wayne County as a proxy for Detroit in either the narrow (city) or broad (urban area) definitions will garble everything to hell (since over half of Wayne County’s population isn’t in the city proper, but it’s less than half the population of any broad definition).

    • S_J says:

      One small thing…

      I drive a Subaru in the Detroit Metro area, and work for a company in supply chain of the automotive business.

      The Subaru doesn’t get me dirty looks, that I’m aware of.

      But I’m driving the sporty hatchback with a manual transmission, which gets me some respect with people who like fast cars…and I work at an Automotive Parts company that has a foreign name.

      Which probably means I don’t mingle much with the social class of UAW-friendly workers.

  8. sohois says:

    I’m just gonna leave this here:

    I’ve made it before and can vouch for the taste and ease of preparation, though I have not actually had the real thing and don’t know if it really compares

    • vaniver says:

      I’ve had the real thing and made some using that guide. I think the volume of dough they recommend is a bit too low, but it’s otherwise good.

  9. Sniffnoy says:

    Michigan will miss you, Scott!

  10. Jack V says:


  11. TheZvi says:

    Congrats, Scott. Even I am happy to see you head to San Francisco (although, if you ever want to sign with New York, which I knew never had a chance, I would work quite hard to make that happen).

    My worry is that being in Michigan gave you valuable perspective and outside view, so you could embody the best of the karass while pointing out some of the problems that others are too close to and can’t see. Remember to hold on to that!

  12. joshuatfox says:

    Did the management of your hospital ever object to your blogging? You took care for some anonymity for you, the hospital, and of course the patients, but it’s impossible to keep at least the first two secret and some of your blogs could be considered to reflect negatively on the hospital.

    • Scott Alexander says:

      The only person who knew quit a few months into my residency, and after that I didn’t tell anyone and they didn’t find out.

      • Winter Shaker says:

        I was going to say: how disappointing that there were zero people at the hospital who read SSC and were able to figure out that its author walked among them. But then I thought, if I were your colleague, and had figured it out, knowing how much you value your pseudonymity, would I make you aware that I knew? Maybe not.

  13. kipling_sapling says:

    Which style (or styles) of therapy is referenced in the post as being no more effective than empathetic listening?

    • eelcohoogendoorn says:

      My guess is that you could substitute any in that blank; hence the blank.

    • chernavsky says:

      Perhaps none of them are any more effective than empathetic listening. See the Dodo bird verdict:

      The Dodo bird verdict (or Dodo bird conjecture) is a controversial topic in psychotherapy,[1] referring to the claim that all psychotherapies, regardless of their specific components, produce equivalent outcomes.

  14. chariava says:

    Congratulations on completing your residency! It’s awesome that you’ll be coming back out to the Bay Area!

  15. Paul Crowley says:

    We are so looking forward to having you 🙂

  16. bean says:


  17. mrshankly01 says:

    Congratulations. My wife is a rising third year med student. I share your residency posts with here. Thank you.

    Good luck with the move. Try “Pizza my Heart.” Good pizza. There is one in Burlingame, CA and another in San Mateo. Thin slices though, not the Chicago slabs.

  18. andrewflicker says:

    Have fun in the Bay! Maybe someday (after my wife’s grad school) I’ll make it back to California too- I can trade my actual desert for a concrete one.

  19. Well... says:

    Electronic medical records systems seem to be a…polarizing thing.

    Tangent: I love happening across two public figures who look very much alike, and I keep wanting to show people how much the founder of EPIC resembles Adam Sandler in drag, but it wouldn’t be very nice. But it is uncanny anyway.

  20. andymatuschak says:

    Regarding Detroit-style pizza, Tony’s Pizza Napoletana in North Beach actually makes it! And it’s really great! I’d be very happy to treat you to a pie anytime. Congratulations and welcome back.

  21. hlynkacg says:

    Congrats! But whatever you do, don’t drink the water.

    • mupetblast says:

      Really? I drink my Oakland water straight from the tap, in a building with old plumbing no less. Here’s to my health!

    • basenjibrian says:

      If he is lucky enough to be on SF water (City and parts of the Penninsula) the water is first rate Hetch Hetchy stuff.

  22. vaniver says:

    And even though I had a better time in Michigan than I could possibly have hoped – even though Detroit pizza is literally my favorite food ever and I’m kind of panicking at the idea of being somewhere you can’t get it delivered

    I know, right?!?

    You’re covered. I have the cheese and the pan. Come to Event Horizon and I’ll make you some.

    (Or, in theory, I could deliver it. Which house are you going to be at?)

  23. caethan says:

    Welcome! If you ever need to refer to an endocrinologist up here, my wife is great!

  24. Corundum says:

    Hi, I’ve been lurking around here for a while but this is my first time commenting.

    A few weeks ago I decided to read All your posts, From the beginning, Until the present. The last post I read before go to sleep last night “Going From California, With an Aching in My Heart” from 2013, in which you say goodbye and thank all your Bay Area friends. And then today I opened SSC to see this. It was incredibly touching. I am so happy for you, and thank you for bolstering the hope of one day finding my own karass.

  25. LRS says:

    Congratulations, and best wishes for the future.

  26. Jaskologist says:

    Congrats, and good luck.

  27. cvxxcvcxbxvcbx says:

    Don’t forget to give Japantown a whirl while you’re in SF. The Playland arcade has a copy of this ordinarily Japan-exclusive novelty arcade game. See for yourself. Or not, just an example.

  28. gbdub says:


    Though as a person originally from Michigan, who rather likes Ann Arbor, I can’t help but feel a little insulted. I might order some Jet’s (which exists in AZ now, but not CA) tonight just to spite you 😛

  29. John D. Bell says:

    Scott –

    As one who just recently met you F2F (Penguicon 2017), has only been following your blog for a scant year, and hasn’t had nearly enough time to get to know you as well as I would like (hoping that you would feel the same way reciprocally), I must confess that I’m saddened by seeing you leave this area, and immensely heartened by seeing you get back to your karass.

    Congratulations and safe journeys! If you ever get back to SE Michigan again at the end of an April, please join us again at Penguicon!

  30. Sonata Green says:

    You should make sure to read the letter anyway, just in case.

  31. kynanggame says:

    Congratulations! That’s really interesting to me.