We met in my first months of residency at Bellevue. We saw each other intermittently, sometimes not for months, sometimes three times a day. We would go through our usual routine; he would come in intoxicated when it got dark, when emergency medical services brought people in out of the cold. He would get his glucose checked, thiamine injection, and a quick once-over for trauma and then he would sleep. The only variable was his occasional set of labs or computed tomography (CT) scan of his head. In the morning, the social worker would bring clothes, the nurses would give him a sandwich, and I would discharge him at 6 am rounds in anticipation of sign-out. He was “one of the nice ones,” which for me meant that he would leave after his second sandwich and that I only rarely had to call security to escort him out. Our relationship continued for 4 years and he became one of my regulars. I am sure he had been many other residents’ regulars before me. I always wondered where patients like this went when they were not in my emergency department (ED); a few years later, I found out.

During my fourth year I began moonlighting at a smaller hospital in the city. It was close by, but it seemed like worlds away. I was by myself with no residents. I was the attending and people wanted me to make decisions. It was a surprise the first time I saw this patient I knew. I recognized his name on the triage list and I went to the waiting room to see if it was him. When I called his name, I was greeted with a friendly “What are you doing here, Doc?” I thought back to the medical school advisor who told me emergency medicine had no continuity of care.

After graduation, I took a job at a teaching hospital, near my resident moonlighting job. Several months after I started, the same patient came into that hospital. He was disheveled, and his mentation was altered from what I knew to be his baseline. It was a busy weekend overnight shift, and he did not have a scratch on him. Had I not seen him so many times before, I might have just left him alone until morning rounds.

The CT scan showed a large subdural hematoma necessitating an emergent trip to the operating room. The neurosurgeons said to me, “we can’t find any next of kin to sign the consent. Your residents told us you know him.” I said, “I’ve seen him more times than anyone else here if that’s what you mean, and I know him well enough to say you’re probably not going to be able to find anyone to sign.” He went to the operating room with my signature endorsing consent.

I worried about him for days. It made me think about the interesting relationships emergency physicians have. From the visiting tourist who sprains his or her ankle and never comes back, to the alcoholic that comes three times a day, these personal interactions only occur inside of the ED. These “regular” relationships are difficult to sort out. Anger may be a typical reaction to the patients we see over and over; however, we get to know them and secretly or not so secretly we worry about them.

To this day, I am not sure what my computer engineer husband thinks when my “regulars” say hello to me from the curb in the street. This patient reminded me that the easiest populations to overlook can actually be the most susceptible, and they need our attention and advocacy the most. The patient did well and was discharged the following week. I am sure I will see him again.