The man from the state mental hospital who was well known to the urology service came rolling in on a gurney accompanied by 2 attendants at about 6:15 in the morning. It had been a long, busy night, and I wondered if I could escape without seeing up until my 7AM relief arrived. Moments later, the nurse comes running down the hall.

“This is a urologic emergency!” she announced urgently.

I ran down the hall into the room, wondering what could be the matter. The man was laying flat, eyes clenched tight, arms straight at his side and fists clenched tight. I pulled down the covers and lifted up his gown, shocked at what lay in front of me…

(maybe you should put the kids to bed before finishing reading this…)

His pe-nis was the color of an eggplant, and nearly as big as a small one. Swollen and purple, with little drops of blood comign from the base of it. THere, at the base of his pe-nis, was the threaded top of a plastic soda bottle, completely encircling the shaft.

I ran down the hall to a supply cabinet, the rushed back up with the cast saw. My eyes wide, I clenched it in one fist and said to the state hospital attendant, “This should get it off!”. He swallowed hard. “Should I leave the room?” he asked. “No, you can stay if you like.”

We made two cuts in the plastic to remove a 1 cm section and the constricting ring popped right off. Urine immediately squirted out of the end, and the purple blood, devoid of oxygen drained out, helping the color return to normal.

I sent a text page to the urology resident, who showed up at the desk laughing. “Is this a joke?” he asked…”Did you get a picture before you cut it off?”. Two more urology residents and the attending eventually showed up to see the results of the patient’s mischief prior to beign discharged.

I finished my billing sheet and paused at the line requesting a diagnosis. Stumped, I pushed the paper aside to do other work. Moments later my attending scribbled his sage words, “Foreign body tourniquet to the pe-nis”