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.