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out in Californiaのout

She even told me a story about a patient of her colleague, out in California, who had cancer but who wasn’t a candidate for surgery. out in Californiaのoutはなくても良いと思うのですが、あるとどう違うのでしょうか?よろしくお願いします

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 out in Californiaのoutはなくても良いと思うのですが、あるとどう違うのでしょうか?  「人里離れた」「鳥も通わぬ」、あの遠い、文化の中心から遠く離れた、と言う距離感を出していると思います。

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