We didn’t send Christmas cards this year. This was mostly because our son was not home from college soon enough to take a picture with our daughter. Thus, we sent New Year’s cards. I needed stamps so I went to Costco. I love Costco. It’s 5 minutes from my house, so I am a regular visitor. I get fuel and electronics and groceries and even stamps.

I went right to the checkout area and reached the shortest line simultaneously with a guy pushing a cart full of salt. I waved him ahead as he struck up a conversation with me. This is not an unusual event at Costco. It is uncommon at places like the bank, the post office, or Home Depot, but not at Costco. People seem to be happy at Costco, but I suspect there is more to it than that.

He noticed that I had no cart and nothing in my hands.

“You’re not buying anything?” he said.

“Just stamps.”

He nodded. Now it made sense. I asked if he knew something that I did not know. There was a long pause. He did not catch on to my inference that he must be expecting a snowstorm of which I was not aware.

“I noticed my salt container was half full,” he said.

Now I realized that he was not planning on spreading it on his driveway. Water softener. We continued the small talk until he completed his purchase.

I’m not one for chatting people up in line, but I’m happy to participate if someone else initiates it. On the way home I wondered why people were chatty at Costco and not at Kroger. It’s essentially a similar experience. One needs milk or meat or an eight-horsepower pressure washer, one picks it out and then proceeds to the checkout area. I realized what is different at Costco is that everyone is a member.

There’s really nothing special or exclusive about it. They don’t ask for a reference or check to see if you have blue blood when you join. Fifty bucks and you’re in. Just the same, there is a kinship when you hold that ID card.

We have our own little club in the ED. It’s not as profitable as Costco – everyone has to pay there. Nevertheless, we are still a club. The clerks, nurses, techs, security guards, registration folks, and doctors are all in it. There is no entry fee, no membership card, and no initiation. Anybody crazy enough to want to work in the ED is in.

We have this kinship that the rest of the hospital does not understand. I don’t think we are cliquish about it, but others definitely feel like outsiders when they come through the double doors. They are strangers in a strange land. They wonder how we put up with the noise, the chaos, the smells, and the odd personalities we encounter. They come down and take care of their business and then scoot. No conversation about salt spreading or New Year’s cards. It’s like they are in a foreign country and don’t speak our language.

Occasionally some of the older members of the medical staff will hang around to chat. They remember the bad old days of rotating call for the ED and the hit-or-miss quality associated with that system. They’re in the club because they understand what we are about.

So maybe this is why some doctors are so surly when they come to the ED. They feel left out. Of course, getting called at 2 a.m. to admit some drunken guy will put anyone in a bad mood. Some docs, however, always seem to be in a bad mood when they come to see us. It’s like they waited in line for gas at Costco and realized that a membership card is needed to make the pump go. They feel like outsiders and therefore sense a need to express their superior status.

The need to belong is basic. I think that quietly they envy the kinship we share in the ED. Our full team camaraderie and closeness is unmatched in the hospital, and I can understand why others find it desirable.

When these folks come to the ED, they are the odd man out. Fifth wheel. Three’s a crowd. Possibly if we let the people we regularly encounter know that they are “in the club,” they would be nicer to us. Just telling them or giving them some dopey card won’t do it. This requires time and multiple positive interactions before they will come to this realization. Until then two personality traits, which we have in abundance, will be needed: patience and perseverance. Eventually they will come around and join the club.

Be happy.

Dr. Baehren lives in Ottawa Hills, Ohio. He practices emergency medicine and is an assistant professor at the University of Toledo (Ohio) Medical Center. Your feedback is welcome at David.Baehren@utoledo.edu.