In case you have a hard time deciphering the nurse's writing, here is what it says:
Small wheel in [left] nostril.
Unable to remove.
Curious as to what kind of wheel fits up a nostril? It was one of those tires off a miniature skateboard, and the student thought it would be funny if he shot the tire out of his nose by covering the other nostril and blowing. As you can see from the referral, it didn't work.