I worked at a large academic hospital as a urology physician assistant in the 1980s, when we had a patient transfer to our unit in the middle of the night. He was a psychotic patient that severed his penis with a kitchen knife, and my attending physician had performed a 10 hour surgery to reattach it. He wrote strict orders in the chart not to remove the patient’s hand restraints for any reason in large capital letters to make it very clear.

I started making afternoon rounds at 3:00 PM the next day and noticed the chaplain entering this patient’s room. I continued around the hall and entered the patient’s room at 3:20 PM. I saw a bloody floor and a foley catheter on the bed with an inflated balloon surrounded by the patient’s penis. No patient was on the bed.

I followed the bloody trail to the bathroom. I heard the patient calling from the bathroom, “Lord help me,” over and over again. I tried to open the bathroom door, but it was impossible because the patient was holding the door from the other side with his full strength. I decided to try a different ploy. I said “Mr. Jones, the Lord sent me to help you.” Still the door would not open. I finally called for security and noticed one of the nurses looking quite stricken. I realized that she was the one that had removed the patient’s hand restraints.

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Security came, and they were able to open the door. We slid the patient along the bloody floor, lifted him on the bed, restrained him and started IVs. I placed the penis on ice. When the surgeon was notified of the incident, he was livid. The nurse tried to defend herself by saying the patient seemed very lucid and needed to eat lunch.

I inquired of the chaplain what the patient had said prior to “degloving” himself. He said that the patient had been attending church and had met a woman. He felt guilty about having sex with her. When she broke up with him, he was devastated. He wondered what his church would say about this incident.

My attending decided that he would not re-attach the penis a second time and performed minimal surgery, allowing the man to urinate only. In retrospect, the patient should have been placed on the psychiatric ward, but they had refused the transfer, stating that the patient needed surgical nursing care.

It is difficult to understand when patients harm themselves. We spend our lives trying to make things better for patients. We have the surgical and medical skills to improve lives but are woefully unprepared to save patients from their own self hatred. Often times we must surrender to the love of families, communities and mental health providers.

At the time of this incident, we were interviewing for an additional PA. He asked if scenarios like this happened frequently at our facility. I had never encountered a similar case at the time, and I hope I never have a patient harm himself like that again.

Maria Bips, is a physician assistant in Decatur, Ga.