Splitting structured clinical facts into SQL and freeform text into pgvector is pure architectural maturity. Relying on evals rather than unit tests for confident wrong answers is spot on.

This is hands down one of the most balanced takes on the Node.js vs. Rust debate. The section on how unoptimized CPU-bound work silently destroys the entire event loop highway should be mandatory reading for every junior backend dev. Your conclusion about the hybrid architecture is spot on. Using Node.js for rapid CRUD, API gateways, and routing, while spinning up isolated Rust microservices for raw execution velocity (like data aggregations or heavy IO) is the sweet spot. Incredible write-up, Ahmer!