Riley: An Excerpt from Patient Care

Dr. Paul Seward

He had a first name, but for the entire time I knew him, I called him Mr. Riley and he called me Dr. Seward. Most of our conversations were on the phone in the context of prescriptions for ER patients. And in the ER, when we talked about him among ourselves, he was just “Riley.”

Riley was the owner and principal pharmacist of Riley’s Drugs, a pharmacy a few blocks from the hospital. This was the late eighties, and the large pharmacy chains were starting to come to town to compete with the mom-and-pop pharmacies that had been there for years. Despite the competition, Riley was a favored vendor both for people in the neighborhood and for the local emergency departments in that part of town.He had a first name, but for the entire time I knew him, I called him Mr. Riley and he called me Dr. Seward. Most of our conversations were on the phone and in the context of prescriptions for ER patients. And in the ER, when we talked about him among ourselves, he was just “Riley.”

There were a lot of reasons for this: he had been around for a long time; he was a well-known member of the community; and he was known to deal fairly with the less well-to-do clientele who lived in the neighborhood. But beyond all that, there was one big reason we all used him: Riley’s was open until midnight.

This was not true of the chains—at least then. During the day, they were there for you, full service, shiny floors, bright lights, and well-stocked shelves. But when the sun went down, the lights turned off and they went home.

That system didn’t work for the ER. We were not licensed to dispense medications, and evening was when things got busy. Evening was when the waiting room began to fill with coughing children whose mothers thought they felt warm; with asthmatics, whose breathing was starting to worsen; with people who had fallen and hurt themselves; with the elderly, who were having vague chest and abdominal pains that they hoped was just a little gas. Sometimes it was.

A lot of those people had had their symptoms for much of the day, hoping whatever it was would go away. But as the light grew dim, as the fevers went up and the breathing grew worse, they would finally get themselves into a car and come to the hospital. In those days—and since then as well—I thought of those people as the ER’s—and Riley’s—special responsibility.

By that I don’t just mean Riley’s Pharmacy; I mean Riley. Yes, he had other pharmacists who worked for him, and yes, I am sure he did go home some nights. But most of the time, after the sun went down, if someone needed an antibiotic, or a refill on their asthma inhaler, and if I picked up a phone to call it in, it was Riley I would be talking to.

So one day, after a couple of years of phone conversations, I decided that I wanted to meet him face-to-face. It was easy to arrange. After all, I was not only a doctor; I was a patient. I was in my midforties then, and like many of my own patients, I had some cholesterol problems and a touch of high blood pressure, and I too had prescriptions that needed to be filled. I don’t remember what pharmacy I had been using. But I do remember that one night, after the customary couple of calls to Riley, I realized that I needed some way to tell him that what he was doing mattered. So a few days later, after working the seven-to-three shift, I drove over to his pharmacy, walked in with my prescriptions in hand, and said hello.

At first it felt a little strange. For one thing, he didn’t look anything like my image of a pharmacist, and I don’t think I looked too much like many of the physicians he was used to. I was after all a refugee from the sixties. My hair was long, I had a full beard, and when I talked I sounded like I was from California.

Riley reminded me of the sort of old man you might see in rural America, sitting on his front porch in bib overalls, overweight, smoking a cigar, and telling stories. That day he wasn’t smoking a cigar, but he was probably smoking a cigarette. He was a chain smoker, and this was well before the days in which smoking cigarettes was banned in stores and health facilities. Riley sold them, and he smoked them as he did so. That was who Riley was.

This did not mean he was unprofessional. On the contrary. While his store was old, it was clean, it was organized, and it had all the things that patients needed. And that was also who Riley was.

We shook hands, I gave him my prescriptions, and we talked for a bit while he filled them for me. We got along immediately. We talked about family; and we talked about patients.

We both took care of the same people after all: those who came to the ER for much of their care, and who did so mostly at night. This generally meant that they were poor. And we both knew that these people were hardworking and honest, loved their families, and served their communities. In short, we had nothing in common, except that we both thought that taking care of people who didn’t have much money was a good thing to do.

So after that first meeting, every couple of months, as my prescriptions needed refilling, I would stop by and say hello for a few minutes and chat, becoming gradually more comfortable in our conversation. One day I asked him whether he had ever been robbed. After all, his store was open till midnight, he was almost always alone there, and there certainly must be money in his cash drawer. Wasn’t he scared?

I remember his smile, calm and unafraid. “No,” he said. “I keep this.” Then he reached under the counter, took out a short-barreled rifle, and showed it to me—not to touch, just to look at. I didn’t ask him anything else. I just nodded at it and said something useless like “Well, I see what you mean.” He put it back under the counter, we chatted a bit more as he finished my prescriptions, and then I left.

I didn’t think that much about it. At that time, it was common to have a weapon in an establishment frequented by the public. Also, while our friendship was real, it was still a workplace friendship. Finally, despite years in the ER seeing what people can do to one another, I still didn’t expect that sort of violent encounter to happen to anyone I knew personally. So I was surprised one day a year or so later when I came to work to hear everyone talking about what had happened at Riley’s the night before.

It had evidently been around nine or ten o’clock. He was, as usual, alone in the store. A young man, perhaps in his late twenties, had come in and at first had just wandered about, looking at items on the shelves. Then, presumably when he was sure that there were no other customers, he came over to the prescription drop-off area. Riley went to assist him. But when he asked the young man what he needed, the man took out not a sheaf of prescriptions but a revolver. He pointed it at Riley and told him to give him all the cash.

I don’t know precisely what happened next—whether Riley went to the cash register and pretended to be getting out the money, or whether he just reached under the counter. I do know that he came up with his gun, pointed it at the man’s chest, and pulled the trigger. The man dropped to the floor and did not move again. Then Riley called the police.

They came immediately, called the coroner to deal with the body, and took Riley’s statement about what had happened. I talked to the coroner later, and he said that Riley’s aim had been good and the wound was through the heart. It was his opinion that the man had died nearly instantly. I don’t think the police even took Riley down to the station, or if they did, they let him go home later that night. When the dust and paperwork had settled, the shooting was ruled self-defense and a justifiable homicide. And from a legal point of view, that was that.

In the ER, the general feeling was one of shock. But at the same time, we all felt that Riley had done the right thing. He had defended himself, perhaps even saved his own life. Certainly he had made sure that no one would try to rob him again. If anything, Riley’s stock in the ER had gone up. On the one hand, there were no high fives. But at the same time, we had all seen seriously wounded and dead people come to the ER after a robbery, and the fact that in this case the victim was the robber was okay with us.

Riley was not in the store the next day or the next. But within a week or so, he was back at work as usual, although I think that at first—perhaps permanently—he stopped working nights. I do know that a couple of weeks later I realized that I had not spoken to him, so I went over one afternoon just to say hello and find out how he was doing.

When I entered the store, even from across the room, I could see that something was wrong. He did not smile or greet me. He just looked up at me and nodded, obviously tired.

I asked him how he was. He didn’t answer for a moment. Then he said, “I can’t sleep.”

I thought I knew what he meant.

“But you are safe now. Nobody’s going to try to rob you again,” I said.

He nodded. He continued to look at the counter. Even so, I could see that his eyes were red. Whether from sleeplessness or tears I couldn’t tell. He went on as if I had not replied. “He comes to me when I dream,” he said.

And suddenly I understood.

I said nothing. I did not know what to say.

Riley shook his head, still looking at the counter. Then he went on quietly.      “He was so young.”

He paused. Then he looked at me. “He didn’t know what he was doing. He had a life in front of him, and I took it away.” He said it as if he were reading it from a newspaper, with no emotion, only a deep fatigue that hinted at a hidden reservoir of pain. “I’m sure that’s why he comes,” he said.

For a little while we both were silent. Then I tried again.

“But if you hadn’t shot him he might have killed you,” I said.

He shrugged slightly. “Maybe. I don’t know. Maybe not.” His eyes were closed now, and he continued to shake his head. “But I did kill him. Now I can’t stop thinking about him.”

I didn’t know how to respond. So I responded as a doctor. “Are you seeing someone about this?”

His eyes opened, and he thought about the question for a moment. Then he said something about how the pastor from their church came to talk to him. “But that doesn’t change what I did,” he said.

We both were silent, he sitting in his chair behind the counter, I standing on my side at the place where I would normally hand him prescriptions.

I thought about what he was trying to say. Then suddenly, as if some thoughtful stranger had handed me a note, I found myself asking, “When he comes to you, does he talk to you?”

Riley looked up at me, surprised. He thought about it. “No,” he said, “he just comes. I don’t think he has ever said anything.”

“Do you know why he is coming? Do you think he wants anything from you?”

His answer was uncertain. “I don’t know,” he said.

I suddenly felt like I was treading water in the middle of a deep ocean, knowing nothing of what swam beneath me. All I knew for sure was that the good man sitting in front of me was in hell, and I did not know how to help him. At the same time, I felt as if I were right about something: whatever was going on in Riley’s heart, it seemed to me that forgiveness was the key.

So after a moment I said, “The next time he comes, why don’t you ask him what he wants?”

He looked back at me, frowned, and nodded just slightly.

I went on, “Maybe he just wants you to apologize. Maybe he wants to forgive you. But you have to ask.”

Something worked. Around then he took a deep breath and reached over on the shelf for my small bag of prescriptions. “Thank you,” he said.

I did not see him for several months after that. I heard that he had been taking a lot of time off, and other pharmacists were working his shifts. But one day when I came into work, the doctor I was relieving told me that Riley was in the hospital. He had had a small heart attack and was in some congestive failure.

So on my lunch break, I went up to his room and knocked on the door. He was sitting in bed, and in chairs around him were several members of his family—I believe his wife and I think a grown child or two, but I can’t be sure. I know that he introduced me around, saying a couple of nice things. They all said hello. Then when I turned to Riley, they politely started talking again among themselves.

I remember very little of our conversation. I know that it was not a long one. I know that I asked him whether he had talked to the man in his dreams. And I remember that he nodded at me, without smiling.

I asked him what he had said to the man. “I did apologize,” he said, “but I don’t think he said anything back. I’m not sure.” He paused and then said, “He doesn’t come by much anymore.”

I did not know what to say. I shook his hand and told him to take it easy and get well, and then I went back to the ER.

I never saw him again. A few months later I heard that he had had another heart attack at home, and this one he did not survive. I think he was already in the process of selling the pharmacy, but certainly after his death the building was sold and I think did not open again. By then we had started a system of giving small medication starter packs to patients if the pharmacies were closed, and life went on.

Except for the young man who had come to his store with a gun. And except, of course, for Riley.

Paul Seward has been a physician for nearly fifty years, and has spent the majority of those years working in emergency rooms on both coasts. He is a graduate of Stanford University and Harvard Medical School, and did his internship and residency in pediatrics at UC San Francisco. Seward is an Emeritus member of the American Academy of Pediatrics and the American College of Emergency Physicians. Now retired, he and his wife live in Vermont.