We tend to organize our relationships into familiar categories: family, close friends, colleagues, acquaintances, strangers. Yet much of social life occupies the territory between these categories. There are people we encounter repeatedly without becoming friends: the neighbour we greet, the colleague with whom we exchange a few words, the person whose face becomes familiar through years of routine encounters.

These relationships may seem peripheral. Yet their psychological significance often becomes apparent only when they are interrupted or lost.

This is particularly relevant for people dealing with  chronic illness. Illness can progressively contract a person’s social world. Employment becomes difficult, activities are relinquished, travel becomes less feasible, and friendships may change. At the same time, the patient may lose the innumerable minor encounters that once gave texture and continuity to everyday life, beyond what we may even notice.

Dialysis offers a particularly vivid example.

Patients may spend several hours, several times a week, beside the same people for years. They become familiar with one another’s routines and histories. They notice when someone has been hospitalized, when a family member is unwell, or when a usually talkative person is unusually quiet. There may be conversation, humour, irritation, shared meals, or simply help with maneuvering a wheelchair.

These people may not be friends in the conventional sense. Yet they experience a form of social attachment created through repetition and shared circumstance.

The Korean concept of jeong captures something of this process. It refers to an attachment or affection that develops gradually through shared time, familiarity and repeated encounters. It does not require intimacy or even a conventional friendship. The relationship acquires emotional significance because two lives have become woven together through repeated ordinary experiences.

Dialysis can create precisely this kind of bond.a

Consider two patients who have dialyzed beside one another for years. One is suddenly called for a kidney transplant. The event is, unequivocally, positive news. Yet the patient’s departure alters the emotional landscape for everyone who remains.

For the patient staying on dialysis, the response may be ambivalent. There may be genuine happiness for the other person alongside envy, disappointment, sadness, or a renewed awareness of one’s own continuing dependence on treatment. Such feelings can be difficult to acknowledge because they arise in response to another person’s good fortune. But ambivalence is not necessarily emblematic of malice; it is often evidence of attachment.

The person receiving the transplant may experience a parallel complexity. Leaving dialysis means leaving behind a community that has accompanied them through an important period of life. There can be relief and anticipation, but also loss, and sometimes guilt about moving into a future that others are still waiting for.

The transplant therefore contains two psychologically distinct events: an escape from a burdensome treatment and a separation from a familiar social world.

A similar dynamic appears when a young person with kidney disease reaches adulthood and is transferred from a pediatric to an adult dialysis or transplant program.

From a medical perspective, the transition is appropriate. From a psychological perspective, it can represent a significant rupture in continuity. The pediatric team may have known the patient for much of their life. Nurses and physicians may have been present through childhood, hospitalizations, developmental milestones, family difficulties, and the evolving emergence of autonomy. Other young patients may have provided a sense of being understood by people who shared an experience that few outside the medical setting could fully appreciate.

Then, often quite abruptly, that world ends.

The adult program may offer excellent care, but it is unfamiliar. The clinicians do not yet know the patient’s history through years of accumulated contact. The other patients are different. Expectations concerning autonomy may change. At an age when the young person is already negotiating separation from parents, school, childhood identities and familiar institutions, another significant separation occurs.

The transition can therefore carry an emotional meaning that is easily obscured by its administrative description: transfer of care.

This is why transitions in chronic illness warrant attention not only to practical competence but also to attachment and loss. We routinely ask whether a patient understands the new treatment regimen, can manage appointments, and knows whom to contact. We should also consider what relationships and sources of continuity are being relinquished.

Some of these relationships will never have been formally recognized.

Psychologists sometimes describe them as weak or peripheral ties. They are not intimate attachments, but they connect an individual to a larger social world. Their importance lies partly in their ordinariness. They require little effort to maintain because they are embedded in routines: the same chair, the same treatment schedule, the same hallway, the same transportation service home.

For patients with chronic illness, such relationships may acquire particular importance because illness itself can narrow opportunities for spontaneous social contact. The dialysis unit or pediatric clinic can become more than a site of medical treatment. It can become part of the patient’s social environment and, over time, part of their sense of continuity.

Clinicians who participate in this environment may also be impacted. The dialysis unit creates repetitive encounters over prolonged periods of time.  The physician or nurse is not a friend, and professional boundaries remain essential. Yet longitudinal care inevitably produces familiarity. Remembering a patient’s family, noticing a change in affect, or recalling a conversation from months earlier conveys something psychologically important: this person is not anonymous. The loss of these connections is difficult to quantify yet it is mourned by all those connected.

Some of the most consequential relationships in chronic illness may be those that never quite became friendships. Their importance is revealed not by their intensity, but by the sense of absence they leave when they are gone.