A middle-aged man with a black eye and scrape over his cheek sat on the gurney, obviously upset. He said he went into the local McDonalds to take a dump. Just as he was settling in to do his duty, a “crazy guy” he had never seen before broke into the stall hollering at him and accusing him of some insult.
The crazy guy got even more upset when my patient denied what he was being accused of and hit him across the face.
It was clear my patient’s face was not seriously harmed, so I asked if he had been injured anywhere else. In response, he pulled the sheet off his lap and showed me a large gash in his leg and a big blood clot on the end of his penis.
My mind started to spin. Something didn’t make sense. The man’s pants were clearly not cut, but he had serious injury to his genitals. I actually opened my mouth to ask him to explain. Then, I remembered an important detail and shut my mouth again. The patient had told me right at the beginning that he was attacked while taking a dump at McDonalds. In that situation, his pants might have been removed from danger but he would have been even more vulnerable.
I have never seen a penis injury like this before. The knife cut the foreskin in two and nipped off the very tip of his penis. It was still bleeding quite a bit.
We cleaned him up. I stitched the laceration on his leg. I put some stuff called Surgicel on the bleeding part of his penis. It helps promote clotting. And I had him hold pressure on it. Then, I made arrangements for him to be taken to a larger hospital for evaluation by a urologist. I really have no idea what sort of treatment they might recommend for this injury. If you cut the tip of your finger off like that, you just need to keep a dressing on it and it will heal up fine. But a nipped penis? I have no idea.
So, lesson learned: keep your pants up when you are taking a dump at McDonalds.