But that's exactly the calculus San Franciscans are running when they weigh UCSF's two ER options — the sprawling academic medical center at Parnassus versus the smaller, quieter facility on Stanyan (the former St. Mary's). And the fact that "lesser of two evils" is how people frame a trip to one of the nation's top-ranked hospital systems tells you something about the state of emergency care in this city.

The consensus from locals who've navigated both is surprisingly clear. If your loved one had surgery at UCSF, go back to the campus where that surgery happened. As one SF resident put it, "They can call for his surgeon or someone who worked on your dad's case to come if things escalate." Continuity of care matters more than wait times when you're dealing with post-operative complications.

Parnassus is where the specialists live — the academic heavyweights, the complex cases, the cutting-edge resources. It's also, by all accounts, a zoo. Patients on gurneys lining hallways for days. Lobby waits that would make the DMV blush. One local noted bluntly that Stanyan "is definitely quieter and you will likely have less craziness around you."

Stanyan, meanwhile, offers a calmer environment but fewer on-site specialties. It's still largely operating with its legacy St. Mary's DNA — a solid community hospital, not a Level I trauma center.

So what's the takeaway? For post-surgical emergencies, follow your surgeon, not the shorter line. But zoom out and the bigger picture is grim: UCSF is a world-class institution operating ERs that residents describe in terms of survival strategy rather than confidence. San Francisco spends enormous sums on public health — the city's Department of Public Health budget alone tops $3 billion — and yet families are still crowdsourcing ER advice like they're picking a restaurant on Yelp.

Great hospitals shouldn't require a game plan. The fact that they do is a systemic failure worth talking about — loudly, and to the people who control the purse strings.