Chapter 2

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, th e 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 Ben 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.”

I tidy up the examining room after Mr. Burnham leaves, then go back to the waiting area to retrieve my next patient. As I walk down the hall, I run into Lisa Karabinakis, another physician on Primary Care C, and also probably my best friend at work. Despite how close we’ve gotten since I started working here, I can count on one hand the number of times we’ve socialized outside of work. Actually, I can count on one finger . Once—we’ve gotten drinks once.

“You look tired,” Lisa notes.

I make a face at her. “Thanks for noticing.”

Lisa has a two-year-old son and has had plenty of bad nights, but she never looks tired. Maybe because her usual look is allowing her long, curly black hair to hang loose around her face and running down her back. It makes her look like she just got out of bed, although in the best possible way. The “just got out of bed” look is aided and abetted by the fact that she’s wearing an outfit that she bought at Forever 21 (her favorite store of all time) that looks exactly like a pair of flannel pajamas. I could never get away with something like that, but somehow, she rocks it.

“We had a late night last night too,” Lisa says. “We went to see the new Hugh Jackman movie. Oh my God, that man is so sexy. I think I’m going to move him up to number two on my list.”

Lisa and her husband each has one of those lists of celebrity men that they’re allowed to cheat with if the opportunity were to somehow arise. Well, at least Lisa has the list. She takes it very seriously, which I understand because I believe that if Hugh Jackman really met Lisa in real life, he might have difficulty turning her down. The list has also included, at one time or another: Ryan Gosling, Colin Firth, Jude Law, Bradley Cooper, Justin Timberlake, Keanu Reeves, and Prince Harry. I’m not entirely clear on the current occupants of the list, although I think she’s gotten rid of some of the British stars, reasoning it’s less likely she’ll randomly run into them.

Despite Lisa’s urging, I don’t have a list like that. I’d never consider being unfaithful to Ben, even for a celebrity guy that I’d never meet in a million years who would never hook up with me anyway.

“You’ve got a treat,” Lisa tells me. “Your boyfriend is waiting for you out there.”

I frown at her. “Huh?”

She winks at me. “ You know.”

I stare at her, my tired brain struggling to interpret her clues. Then it hits me. “ No ...”

“Oh yes. ”

“But he’s not scheduled for today,” I say, my voice taking on a whiny edge.

She shrugs. “Well, he’s there. Maybe Barbara added him on.”

Great.

I walk the rest of the way to the waiting area with about as much enthusiasm as Mr. Burnham had earlier. As soon as I reach the waiting area, I find Barbara painting her fingernails at her desk, with the list of patients lying on the table. I can already see that an additional name has been scribbled in Barbara’s handwriting. Even though I’ve told her multiple times not to add on patients without checking with me first.

“Dr. McGill!”

I look up and see seventy-one-year-old Herman Katz hurrying across the waiting room with outstretched arms. Herman Katz is the bane of my existence. During my short stint at the VA, I have had him in my examining room dozens of times. Or maybe it just feels like dozens of times. Although I think it actually has been dozens of times. These days, it’s a rare treat when I look at my patient roster and don’t see his name on the list.

It makes me feel all the more guilty that I know Mr. Katz loves me.

“Thanks for seeing me on such short notice, Dr. McGill,” Mr. Katz says breathlessly .

“No problem.” I shoot Barbara an accusing look, but she’s too busy making stripes on her nails to notice. “Come with me.”

Mr. Katz eagerly follows me down the hall. While it’s not a stretch to imagine Jason Burnham being on the front lines in Iraq, it’s more of a stretch to imagine that Herman Katz was ever a soldier. Granted, that was quite a long time ago—he fought in the Vietnam War. But I’ve met plenty of old guys that I could easily imagine fighting for their country. Mr. Katz is not one of those guys—his short stature, slight build paired with a rotund belly, and large overbite don’t really suggest war hero to me. Neither does the fact that he makes an appointment with me every time he gets so much as a splinter.

I don’t bother to have Mr. Katz change into a gown. Most of his complaints don’t require a gown or even a physical exam at all. The last time I saw Mr. Katz, he wanted my opinion on whether he should go to a jazz festival. (He was worried it might be too loud and harm his ears.)

I load up my patient’s medical record in the computer, even though I know it by heart. Immediately, I see pages and pages of my own notes.

“What seems to be the problem today?” I say. I’m trying to keep the irritation out of my voice and remain compassionate. Mr. Katz is a really nice man. He’s just lonely and a little neurotic. It’s not his fault .

“My left hip is acting up,” he tells me, his graying eyebrows furrowed together.

“ When does it hurt?” I ask. “When you’re walking?”

Mr. Katz shakes his head. “No, not really.”

“Does it hurt just sitting there? Like, right now?”

“No.”

“When you’re exercising?”

That’s a trick question. I know he doesn’t exercise. Because it causes a sharp pain in his right temple. I learned more than I ever wanted to know about that in October.

Sure enough, Mr. Katz shakes his head. “No.”

“Does it hurt at night? In bed?”

“No.”

Okay, I give up. “Mr. Katz, when does it hurt?

He thinks for a minute. “It hurts when I do this…” He stands up, spreads his legs apart, and lifts his left hip while simultaneously fully externally rotating it. I half expect him to start singing, “I’m a little teapot, short and stout!”

It’s genuinely very hard not to start laughing. “Well, how often do you have to do that?”

“I guess not too often,” he admits.

“Okay,” I say, “so maybe just try not to do that anymore? ”

At first, I’m certain he’s going to argue with me. But maybe he senses that I’ve barely slept in the last twenty-four hours and takes pity.

“Listen, Dr. McGill,” he says quietly. “I just need to know…”

I raise my eyebrows at him. “Yes…”

Mr. Katz squeezes his sweaty hands together. “Do you think that it could be… you know, cancer ?”

“It’s not cancer,” I tell him. “I promise you. It’s definitely not cancer.”

For the first time since he came in today, Mr. Katz smiles at me. He’s happy. Well, at least until next time.