This had to be drugs.
She lowered the pitch of her voice. “Cocaine? Meth?”
The older flight attendant, still gripping the man’s forearms, swung around. “I really don’t think so.”
Georgia had to admit this man didn’t project the aura of the typical meth head. Even though currently he could best be described as delirious, he was clean-cut and well-dressed, with the look of a businessman. But with stimulants, you never knew. An insistent little clanging at the periphery of her consciousness began to intensify as she regarded him. She’d forgotten something, or there was something she’d overlooked. She kept thinking of nursery rhymes, which made no sense. Nursery rhymes? But the thought wouldn’t go away.
For a moment she found herself hung up on the image of Alice in Wonderland chugging the potion that sent her sprouting like a sequoia toward the heavens. Did Mystery Man drink something in the hopes of getting . . . bigger? But this wasn’t quite it. Not Alice, not the Queen of Hearts, not the Cheshire Cat. It was . . . the Mad Hatter.
Now she knew why she’d been reminded of nursery rhymes; it was a mnemonic they’d learned in med school for the symptoms of a particular kind of toxicity: anticholinergic poisoning. Red as a beet, blind as a bat, mad as a hatter, hot as a hare, full as a flask, dry as a bone.
Red as a beet: flushed skin. Check.
Blind as a bat: dilated pupils. Check.
Mad as a hatter: raving and confused. Check.
Hot as a hare: warm to the touch. Check.
No way at the moment to assess the fullness of his bladder—full as a flask—in order to ascertain whether he suffered urinary retention, but it seemed a reasonable assumption. The last one—dry as a bone—threw her, however. His mouth was dry, certainly, but she thought again of his damp forehead, and her certainty diminished.
Anticholinergic people were never sweaty.
As she watched, the pretty flight attendant dipped her washcloth in a basin and swiped the man’s forehead again, creating a shiny rivulet of water snaking down his temples. He wasn’t sweaty! He was wet. For a second, a flush of self-congratulatory excitement swamped her: she hadn’t studied this stuff since medical school, and somehow she pulled this diagnosis out of her ass? With great effort, she resisted the urge to shout Eureka!
“Help me,” she instructed the attendants, rolling the patient onto his side in order to pull off his sport coat and button-down. “We need to undress him; he’s overheated.” To the older flight attendant she added, “Can you open the plane’s emergency medical kit? I need an IV kit and a bag of saline. And some kind of sedative.”
The flight attendant jerked a metal box open. “We do have IV equipment and saline,” she said, “but our kits don’t contain sedatives.”
“How about we commandeer some from the passengers?” Georgia asked, yanking the man’s shirt off. “I’m sure there’s plenty of Xanax on board.”
“How would he take it? We can’t get him to drink anything.”
Georgia paused to give this thought. “There might be a mom on board with rectal valium for a kid’s seizures.”
The younger flight attendant, battling the man as she tried to remove his pants, looked up in alarm. “Say what?”
The other flight attendant took control of the conversation. “Rectal valium is a nonstarter,” she said firmly.
With the man’s outer layer of clothing shed and the white cotton T-shirt he wore underneath yanked up, they all noticed them at the same time: several small round patches affixed to the skin under the man’s shoulder blades.
“What are those?”
Georgia pulled them off and inspected one. Gebruiken als nodig is voor braken. The writing on them was in a foreign language—she guessed German or Dutch—but they were likely a brand-name form of scopolamine, a common anti-nausea medicine in European countries. Another thought occurred.
“I need to see where he was sitting. Quickly.”
The flight attendants eyed one another. “He was sitting in first class,” one of them offered. Georgia looked toward the front of the plane and then down at her patient; first class was a long way off. “How did you get him back here?”
“When it became obvious he was getting sick, we asked him to move,” said the younger woman, a freckled strawberry blonde. “He was getting kind of belligerent, so we lined up a couple ABPs to help.”
“ABPs?”
“Able-Bodied Passengers.” Like medicine, aviation apparently had its own set of confusing acronyms. “We don’t want to leave someone combative near the cockpit, so we generally move them back here if we can.”
“I’m sure the pilot appreciates that. Is there any way I could ask him a question?”
The flight attendant smiled sweetly. “Her. Captain Lucke. And yes, I can convey anything you need to her.”
“Okay,” said Georgia. “Let me check out his seat first.”
The flight attendant complied, leading her to the first-class cabin, where ice tinkling against real glass broke the swishy hush of the plane’s ventilation system. The passengers who weren’t knocking back cocktails had donned their complimentary masks and gone to sleep in their fully reclining seats. The attendant gestured to a window seat occupied by a stout older woman dressed in black. The aisle seat—presumably the guy’s seat—was vacant, and an array of objects littered the flat area on the seat divider: a tablet, a crystal glass, some of those weirdly appealing little bottles of alcohol, a round white ceramic dish full of nuts. None of it was what she sought. She thrust her hand into the pocket on the back of the seat in front of her, feeling her way past the linear edges of the airline magazines and the smaller flat expanse of a barf bag. At the bottom, her fingers curled around something crinkly. She hoisted it into view.
A small rectangle: divided by perforations into smaller squares, the metallic coating on them peeled back to expose several empty spaces that had at one time each held a pill.
“Diphenhydramine?” asked the flight attendant, reading the back of a foil pack.
“Yep,” she said, giving in to an inappropriate surge of elation as they hustled back to the rear of the plane. “Benadryl! This must be anticholinergic poisoning.”
She explained her theory: somewhere, the man had gotten ahold of prescription medicine patches for nausea. For whatever reason, he put on too many of them—either he forgot he had the first ones on when he added the others, or he held a “more is always better” philosophy, or maybe they weren’t working so he tried more. In any case, he didn’t remove them once he reached the airport, and they probably caused him to feel itchy. So he took diphenhydramine—generic Benadryl—to treat the itching, and he took too many of those as well. This would explain why he got much worse after the flight took off: Benadryl and scopolamine were both in a class of medicines that inhibited neurotransmission at a certain kind of receptor. In large quantities, they could cause these kinds of symptoms.