how did the nail get in? If it went through the floor of the mouth it would have left a swath of destruction through jaw muscles, the tongue, and maybe some salivary glands, before embedding itself into the roof of his mouth and piercing his brain. I can't imagine there not being a lot of blood from the hole it would make going in.
Once in though, it probably wouldn't be hurting too much except for the swelling around the damaged tissue, and the entry points where it came in. Like a toothache. But how could you miss the hole it punched through your tongue?
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