Noah Drake arrived at General Hospital and quickly developed a reputation of being a playboy doctor. Young, handsome, successful and charming were just a few of his attributes that attracted the women of Port Charles including nurse, Bobbie Spencer. Having just gotten over the death of her fiancé, Roy DiLucca, and frustrated by Noah's inability to tell her that he loved her, Bobbie took desperate measures to keep Noah. She faked blindness in an effort to gain his affection. Unfortunately, in the end, the lie spelled the end of their relationship. On the rebound from his failed relationship with Bobbie, Noah took an interest in sexy Tiffany Hill. When Bobbie returned to work, Tiffany was the only one not happy to see her back at General Hospital. She had good reason to worry about Bobbie. Bobbie and Noah briefly reconciled. After their relationship ended for a final time, Noah tried to seduce Tiffany. Tiffany and Noah started to make love but at the last moment, Tiffany pulled away.

Noah left town when he was offered a new surgical position in Atlanta, but years later, Robin Scorpio found him drunk in a bar not far from Port Charles. She convinced him to return to Port Charles to check out Jason Morgan's case. Noah realized he just wasn't up to operating on Jason, but he had an alternative -- his son, Dr. Patrick Drake. Noah and Patrick had been estranged since the death of Patrick's mother, which had sent Noah in a downward spiral into the bottle, and left him with a failing liver. After the operation, both Patrick and Noah chose to stick around Port Charles and try to patch up their broken relationship, but Noah's refusal to accept part of Patrick's liver to save his own life drove a wedge between the two men again.

Patrick and Noah struggled to build a relationship although Robin repeatedly tried to bring the men together. The father-son pair disagreed constantly in regards to patient care, including the course of treatment for the rock star Eli Love. Eli was in need of surgery although he was scheduled to perform at an AIDS charity concert. Robin's mother Anna had stopped by Port Charles to attend and was devastated to learn that Eli was unable to perform. She recognized the physical similarities between Eli and Noah and decided to pass Noah off as Eli so the benefit could go on as planned. Noah and Anna became close as they worked together but Robin and Patrick asked their parents not to become involved with one another and they agreed. Noah's stint as Eli included public appearances that required him to act the part of a rock star, which included being in close proximity to alcohol.

Noah turned to alcohol again and left town but he returned several months later. While he was gone, he spent time with Doctors without Borders and reclaimed his sobriety. He was surprised to learn that Robin was pregnant with Patrick's child. He and Robin's mother Anna bonded over the prospect of becoming grandparents but he and Anna disagreed about the role Patrick should play in the child's life. The pregnancy had been unplanned and Robin decided to raise the child without Patrick, although he wanted legal rights to his child. Noah supported Robin whereas Anna sided with Patrick. Noah admitted he had been a terrible parent and he believed that Patrick was too much like him to be a good father.

Things took an unexpected twist when a young doctor by the name of Matt Hunter joined the staff of General Hospital. Matt volunteered part-time at the Emily Quartermaine Free Clinic. He was there the night Jerry Jacks planted a device that would start a fire and burn the building to the ground. Luckily, Matt survived the fire but he sustained serious burns to his legs and his family needed to be notified. Noah reluctantly stepped forward and revealed to his son, Patrick, that Matt was his son. Noah confessed that he had had a short affair with Matt's mother but made it clear that he did not want to be a part of raising the child that they had conceived. Noah gave the woman financial support but never visited his young son Matt. As a result, Matt grew up to resent his father. Patrick, equally disgusted with Noah's behavior, turned his back on his father.