I pitched YC, was rejected, just closed a multi-million dollar round.

They're rejecting the team, which could mean two good people who don't fit well together.

If you think of it like this, you'll poison yourself. Maybe reframe it as "Declined the opportunity to invest in this team at this time."

(See also: college, job offers, consulting engagements, and -- took me decades to learn this -- dating.)

While this is strictly true, this guy already beat out 90+% of applicants just to get to the interview phase. While it's disappointing not to go all the way, reaching that far is a meaningful accomplishment.

This doesn't explain how some people get rejected for one idea and get accepted with another one.

You're right. I should have said "a todo app" or something similar - Rails was what came to mind first because of 37 Signals et al who make a lot of that kind of stuff.

Aside from that, I'm a huge fan of abstracting commonly made and agreed upon technical decisions further down the stack, making higher level development much simpler and less technically challenging - which is from my understanding what RoR was/is largely about. That's not to say that RoR as a framework isn't in and of itself a technical achievement though.

Good to know.

Again, well done on your recent success. Now the real work (and fun) begins :-)

Fair questions. A bit of a background first. My co-founders were: an MBA student with a healthcare concentration (Wharton), an MD/PhD student (Columbia), and me, the techie (grad student Columbia). Unfortunately for the start-up (and fortunately for my co-founders), they graduated and moved to Denver (to work at a healthcare company) and San-Francisco (residency), respectively. Although I wanted to continue working on things, with 66% of the founding team away and unwilling to commit to putting in the time, the project is bound to fail. Now, one may argue that I should have continued on my own, which is a fair point to make. However, what I've learned about healthcare is that it's a VERY tough market. It is not because of there exists some crazy technological challenge that the tech world has never seen before, rather because of the people in the industry and the industry's regulations. Physicians and institutions are VERY suspicious of anyone even remotely trying to enter their "domain," and they would thwart any attempt. Our intention was to help them with their workflow, so they could see more patients and thus make more money. When you approach MDs, for the most part, they fear that you may try to replace them (although that was not our intention). It follows with immediate resistance. Also, if you were to get into this domain, you should know that you can't just put up a website in 4 hours and start testing (Snowcolypse!! :-) ). Medicine is so "academic" that people want to run clinical trials, etc. In short, there's a lot of bureaucracy. Interestingly, I now lead the implementation of the clinical data warehouse at a major medical institution in the US (though I was always a programmer, not a DB or BI guy. Sortta fell into this position). The other week I spoke to the director of the stroke center at a medical institute in Brooklyn NY. A 50-something year old guy, one of the only 1200 stroke experts in the US. Super nice guy, super smart (taught himself python and Fortran to have a common language with the technies and to know when they're trying to pull his leg). He's very much into technology and its applications within medicine (he's trying to push telemedicine to strokes, because every second counts). As he put it, "the problem with healthcare is that the stakeholders think that this is the most complicated domain in the world. People are so arrogant to think nobody has tackled these technological problems before." They, therefore, push off any suggestion for improvement (what worked for Pfizer, BMW, or Goldman Sachs, who have millions of transactions a second, will not work for us!) Same sentiment exists at my current employer.