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Book Excerpt: The Devil You Know

Created July 10, 2017 by Freida McFadden

Dr. Jane McGill is in heaven.

She’s got a great job at a VA Hospital, an adorable daughter, and a loving husband. Granted, it would be wonderful if her preschooler wouldn’t wake her up at three in the morning, and it would be a miracle if her husband would change the toilet paper roll once every millennium. Still, in most ways, she has the ideal life she’d always imagined.

Then Jane discovers that Dr. Ryan Reilly is the VA’s newest vascular surgeon. Dr. Ryan Reilly, a.k.a. Sexy Surgeon, a.k.a. the biggest jerk she ever loved.

A decade ago, Jane broke up with the Sexy Surgeon to marry the Nice Software Engineer, but as cracks and crevices appear in her marriage, she can’t help but wonder what life would have been like if she’d made a different choice. Or if it isn’t too late to change her mind…


I haven’t even seen my first patient of the day yet and I am utterly exhausted.

A deep fatigue comes over my body (and soul) as I walk into the Veterans’ Administration (VA) Hospital where I’ve been employed for the past year. Generally, I like working at the VA. The salary might not be as great as in the private sector, but you can’t beat the benefits and the hours. For example, in addition to not having to work weekends, I get thirteen paid holidays and thirteen sick days every year. On top of that, I’ve got twenty-six vacation days. Honestly, sometimes I wonder how that leaves any days left to actually work.

I also like serving the veteran population. Yes, I do miss working with female patients (female patients do occur, but are rare—like a random curly fry in a sack of regular fries), but I feel good about treating people who have served their country. And after spending way too many years at the county hospital in Manhattan, it’s really, really nice to have a population of patients that speaks English.

Most days I like my job. Today… I’m just tired.

I slip into the elevator just before the doors slide shut. There are a handful of us in the elevator, and there’s also George. George is a middle-aged, painfully serious-looking guy with a buzz cut who operates this elevator. Like, he sits on a stool and presses the buttons for people. In the time I’ve worked here, I can’t figure out why on earth we need someone to press buttons for us in the elevator. I know in the olden days, they used to have elevator operators, but that was when elevators operated by some sort of complicated pulley system. Now all you do is hit buttons. I think I can handle that. I mean, I’m a doctor.

“Hi, George,” I say.

George grunts in my direction. You’d think an elevator operator would be more personable.

I get out of the elevator at the sixth floor, and head to Primary Care C, which is where I work most days. I head down the long, dimly lit hallway with peeling green paint covering the walls. When I first started working here, I was told that renovations would start on Primary Care C in one month. But I soon realized that they meant “one month” in VA time. In human time, that’s around five years, give or take. So renovations are still pending.

The first room on the right is where our receptionist Barbara is seated in a desk facing the chairs of the waiting area. Barbara is in her fifties, with a blond mullet, too much mascara, and a raspy smoker’s voice. Maybe this is an unfair generalization, but in the time I’ve worked here, I’ve decided that VA receptionists range in quality from terrible to absolutely horrendous. Barbara falls somewhere in the middle. She’s not as bad as the absolutely horrendous receptionists, but she’s not as good as the terrible ones.

“Hi, Barbara,” I say brightly.

Barbara glances up at me from her iPhone and smiles thinly. That’s another thing about Barbara—she doesn’t like me. And her dislike of me can’t be changed by a plate of brownies brought for her on two separate occasions.

I notice that there are two men seated in the waiting area. “Are any of my patients here yet?”

Barbara doesn’t answer me right away. She finishes the text message she’s writing, then finally says, “It’s 8:25. Clinic doesn’t start until eight-thirty.”

“But…” I look back again at the two men waiting patiently in the waiting area. I know there’s no point in arguing with Barbara. She’s got her way of doing things, and even though it’s not how I think they should be done or how any logical human being would think it should be done, it doesn’t matter. She will work here till the day she dies. Anyway, I notice that under the first patient’s name, the chief complaint says “testicular pain”—I can wait for that.

I head down the hallway to the examining room I’ve been assigned for the day to make sure it’s presentable. When I walk inside the room, it looks like it was ransacked by a burglar during the night. There are hospital gowns strewn everywhere, crumpled pieces of white paper from the examining table littering the floor, and even the mouse from the computer is dangling off the edge of the desk. Because I know nobody else will do it, I walk around the room, gathering up the dirty gowns to toss in the laundry hamper in the room, then I pick up all the litter on the floor. I wish I had a mop to give the room a once-over, but I haven’t been here quite long enough to feel the need to purchase a mop yet.

At my old job, a nurse used to bring patients to our examining rooms, give them gowns to change into, and get their vital signs before I came in. Here, it’s up to me to retrieve my own patients and check their blood pressure. But to be fair, at my old job, I didn’t get twenty-six vacation days, thirteen paid holidays, and thirteen sick days. I got four sick days. It meant I came to work wearing a mask a lot. One time I came to work clutching a vomit trough.

I go back to the waiting area, where Barbara has placed a big red check mark next to the name of my patient. That’s her job—placing that check mark there. I genuinely have no idea what else she does.

“Jason Burnham?” I call out.

A man in his late twenties rises reluctantly to his feet. Damn, he’s handsome—he’s got a soldier’s solid build with firm muscles lining his arms and visible under his T-shirt. As I watch him make his way out of the waiting room, I can’t help but ogle those muscles. It’s not that I don’t think my husband is sexy, but it’s different when you’re looking at a guy who you haven’t been married to for the last six years. There’s a jolt of excitement when it’s somebody new and different, and most definitely off limits.

I have to admit, I miss it.

Just a little bit.

I can tell by the look on Mr. Burnham’s face that he isn’t terribly thrilled that I’m the one who’s going to be examining his testicles. I’m sure he’d prefer a male doctor. Still, I think it’s melodramatic the way he acts like a man being led to the electric chair as I take him to the newly cleaned examining room.

“Mr. Burnham,” I say to him. “My name is Dr. McGill. Would you please change into a gown for me?”

Jason Burnham nods miserably.

Examining testicles is not my forte. I’ve gotten better at it since my patient population has become primarily male, but I’m nowhere near as good at that as I am at, say, finding the cervical os. Testicles just seem so… delicate. Obviously. But I’m getting better. As far as I can tell, the key to doing a good testicular exam is not accidentally saying something dirty during the exam, which is extra challenging when your patient is so damn attractive. I’m going to work on that today.

I return to Mr. Burnham, who is now sitting miserably in the examining room. I smile at him. “Now I hear you’re having some pain?” I begin. “In your… testicles?”

I haven’t said anything dirty yet, so I’m doing great.

“Yeah…” Mr. Burnham shifts on the examining table. “My right one.”

“Okay,” I say. “Does it hurt all the time? Or just sometimes?”

(Was that dirty? I don’t think it was. Go, Dr. McGill!)

My patient looks like he wants to crawl into the laundry hamper. “No, not all the time. Just when I’m having sex. Sex with partners or with… myself.”

God, I feel sorry for this guy.

I ask several more testicle-related questions, but it’s clear we’re just postponing the inevitable: the moment when I’m actually going to have to examine these bad boys. After several more non-dirty questions, I end up just asking him to lift his gown, which is somehow anticlimactic. It seems like there ought to at least be some wine and candles involved.

Mr. Burnham’s testicle seems completely fine to me. It’s not red or enlarged, and even though there’s only so much you can palpate a testicle without feeling like a sadist, I genuinely don’t feel anything remotely like a cyst or mass. I report the good news back to my patient:

“I don’t feel anything hard,” I say. Crap! “I mean, there’s nothing enlarged down there.”

Damn it.

Mr. Burnham frowns. “But it’s really tender.”

I shake my head. “I really don’t feel anything.”

Generally, the next step in the testicular exam is transillumination. To do this, you turn off all the lights in the examining room and hold a bright light to the posterior of the testicle with one hand. If you’re a female, you should probably be holding a rape whistle at this point.

In any case, I don’t see any utility in transilluminating Mr. Burnham’s testicle. There’s nothing there. And even if he did have a cyst, it wouldn’t explain how much testicle pain he’s having.

Jason Burnham’s eyebrows knit together. “So what’s causing this, Dr. McGill?”

I have no clue. But that’s the great thing about primary care.

“I’m going to refer you to our urologist,” I tell him. “He’s a great doctor.”

Mr. Burnham nods, looking somewhat relieved. I think I had him at “He’s.”

You can purchase The Devil You Know and Freida McFadden’s first book about Dr. Jane McGill, The Devil Wears Scrubs, on Amazon.

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