“Here!” yelled the woman next to her, a bleached blond twenty-something-year-old in a bedazzled T-shirt, waving her arms energetically. “Right here.”
Georgia turned to her in surprise. A few seconds later, the flight attendant appeared at the end of the row, regarding the woman with a similarly dubious look. “You’re a doctor?”
“I’m a dancer.”
“Thank you,” said the flight attendant, baffled, “but we’re looking for a doctor.”
“She’s a doctor,” said the woman, triumphantly pointing to Georgia’s carry-on bag. The flight attendant’s eyes followed the woman’s finger, landing on the bag, where Georgia Brown, M.D. was stitched at the top. The flight attendant pivoted, her eyes drifting from Georgia’s high ponytail to her giant rhinestone hoops to her clothing: a threadbare green T-shirt, emblazoned with the words Foosball Wizard; a maroon smoking jacket; flared orange pants; and a pair of Lucite-heeled sandals. The flight attendant consulted a list in her hand. “Any chance you have your medical license with you, ah, Dr. Brown?”
“No one carries their medical license around,” said Georgia.
“What seems to be the problem here?” A wiry older gentleman made his way up the aisle, all irascible eyes and ferocious hair and stubble: Gregory House, personified.
The flight attendant relaxed. “Are you a doctor?”
“I am Dr. Magnus Doellman,” said Gregory House.
“Oh thank goodness, we have a situa—”
“I am a herbologist. But I volunteer frequently at the hospital.”
The flight attendant faltered, torn between two evils. By now, the people in the rows of adjacent seats had awakened and were eying the spectacle, turning around in their seats. A scrawny guy in a beanie raised his hand. “I’m a herbologist too,” he said, prompting his friends to collapse in helpless guffaws. Dr. Doellman glowered.
The flight attendant eyed Georgia again. “What kind of doctor are you?”
“A urologist,” she said emphatically; the flight attendant needed to know what she was getting here.
Apparently urology trumped herbology in this particular emergency, because the attendant nodded. “Okay,” she said. “Please come this way.”
* * *
—
They walked past two dozen rows of people glued to their electronic devices until they reached the rear galley, where the sprawling form of a man filled the floor. Someone had laid him out perpendicular to the aisle, his head in the kitchen area and his large feet, shod in a polished pair of wingtips, near the jump seats. With one look, Georgia knew: this was bad. In medical training, the first thing they taught you was to answer one question: Sick or Not Sick? Not Sick covered a lot of territory, from legitimate but non-emergent medical needs to a whole bunch of asinine things for which people routinely showed up in hospital ERs. In med school, she’d seen—they’d all seen—people for dumb complaints all the time: zits, paper cuts, emergent requests for liposuction.
On the other hand, you had the Sick People. These were the MIs, the septic patients, the ones with blood vessels full of clots or lungs full of fluid or kidneys full of toxins, hovering at the precipice dividing the living from the dead. From an academic standpoint they were interesting, but they also held a peculiar disastrous power: they possessed the potential to take you with them, metaphorically speaking, if you made a mistake. And sometimes they took you with them, literally speaking, as in the case of certain neurotoxins and infectious diseases.
It was apparent to even an untrained eye that this man belonged in the Sick category. Georgia stretched a hand toward him and he stared at her with the vacant panic of a mole, beads of perspiration dotting his flushed forehead.
Aside from his sudden impairment, he looked healthy, as far as she could tell. She gripped his shoulders and leaned her ear against his chest: his heart rate hovered in the 160s, way too fast; his breathing sounded shallow, but without sounds indicative of pneumonia or asthma. Examination of his abdomen revealed no bowel sounds; also no distention or apparent tenderness. Enormous black orbs swallowed his irises, so she couldn’t discern his eye color; peering into his mouth, she observed a dry, caked tongue, without any swelling or redness in the back of his throat.
The flight attendants offered a brief rundown: he’d seemed flushed but fine as he boarded, but he’d begun to look a little strange as the flight took off, becoming heated and restless as the miles piled up. The attendants had proceeded cautiously; he hadn’t been rude or disruptive, but they had all seen plenty of personality disorders manifest themselves mid-flight. As the flight progressed, though, it became clear this was not an intercontinental freakout brought on by alcohol or anxiety; by the time they’d cleared the landmass of Greenland he was confused, followed by outright hallucinations and a brief, terrifying seizure. Following their in-flight protocols for medical emergencies, the attendants had contacted a physician on the ground, who’d directed them to obtain vital signs and enlist the help of any doctor who happened to be on board.
The man let out a feverish yelp as a flight attendant dabbed his head with a wet, rolled washcloth held by silver tongs. Frantic, he clawed at the skin beneath his eyes, flopping like a banked salmon, his nails digging into the soft tissue of his face.
Georgia forced herself to think, sequentially and logically, through a differential diagnosis as the flight attendants strained to hold the man down. One possibility seemed more and more likely here. Otherwise healthy male, with sudden agitation and mental status changes? Not sepsis: the attendants reported his blood pressure as high, not low. No reported history of head trauma. Even though he looked red and had scratch marks on his arms, there were no other signs to indicate anaphylaxis, ruling out an allergic reaction.
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 studi
ed 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.
In tandem, they looked at him as Georgia finished: eyes wide, flared nostrils, teeth clamped in feral ferocity. He whipped his head from side to side. “Where exactly are we right now? Can we land?” she asked.
In answer, the attendant gestured to the flight-tracker screens in the galley. They were heading northeast along the great circle route between the eastern seaboard of the United States and Frankfurt, Germany, currently placing them over the middle of the Atlantic Ocean. Landing was obviously not an option.
“Okay,” Georgia said, hoping she sounded more confident than she felt. “Treatment for anticholinergic poisoning is largely supportive. Although I think there is some kind of antidote. I’m not a toxicologist, of course, but I’m hoping he’ll do much better now that the patches are removed.”
She took what action she could: after a discussion with a physician on the ground, she cobbled together a treatment plan, systematically proceeding through a checklist of available options. She stayed in the back with him; he was dead weight, so snowed that he’d sprawled out diagonally across the galley floor, limbs flung akimbo with the confident, space-snatching thoughtlessness common to most men and all small children. He snored, too: throaty reverberations that shook his entire body.
By now, the plane had gone dormant; overhead lights out, engines droning, no one moving. Georgia sat on the galley floor, her back pressed against the metal of a cabinet, feeling the soothing mechanical vibrations of the plane’s innards through the floor. After what felt like an eternity, she’d almost fallen asleep when something jarred her into full consciousness.
Her patient’s snores had stopped. As she watched, he rolled onto his side, facing her, and opened his eyes.
4
FELIX CULPA
MARK
Mark McInniss looked up to find the proportions of the world had shifted in some fundamental way: sizes blown out of whack, angles off-kilter, surfaces entirely wrong. He blinked and looked again. An institutional-appearing gray cabinet stretched above his head toward a distant ceiling. He could not figure out where he was: in a bunker of some kind? A . . . jail cell? His head throbbed as if he’d awoken from a world-class bender, so this last thought, though frightening, was not impossible.
As his vision began to resolve, he realized he must be on an airplane, although his position, lying supine, seemed to indicate a problem. Confusion swamped him, along with a dawning awareness that he must have somehow made an ass of himself. He whipped his head to the side and then relaxed. He must be in first class, in a reclining seat. A very uncomfortable, very hard seat.
A light hand gripped his forearm. “Are you thirsty?” said a woman. Right away, he liked her voice; if her words had been script, they’d be one of those looping, artistic fonts you see on placards and memes. A warm voice, musical and smart and slightly hoarse. He stretched his neck to see who it belonged to, but an alien object in his mouth distracted him: a baked rock, etched with salty, hardened cracks, had replaced his tongue. He tried to speak but could manage only a raspy bark.
The hand retreated from his forearm and returned bearing a cup. It was exquisite; nothing in the h
istory of humanity had ever felt as good as the sensation of this cool liquid rolling down his tongue and along the sandblasted gorge of his throat. He raised his head to guzzle it, not minding as it splashed down the sides of his face. As his thirst abated and the water puddled in the hollows of his collarbones, it occurred to him he must not be wearing a shirt. He looked around, discovering he was stretched out along the floor of the galley, his shirt and pants and shoes missing.
So. Quick summation of his circumstances: he was lying half-naked and groggy on the floor of an airplane. What the hell was going on?
He wanted to ask the water-bestowing angel, but before he could force the words past his newly restored tongue, his head lolled back, felled by an immense gray mist of fatigue.
* * *
—
The next time he opened his eyes, things were marginally clearer. He was flying back to Europe from the United States. He knew he hadn’t been feeling well as the flight took off, but he couldn’t quite remember why. Apparently he’d done something stupid, assuming, of course, that whatever had happened to him was personal in nature and not the result of having been conked on the head by a terrorist or hit by a suitcase during a cabin depressurization or some other random event beyond his control. For a hopeful moment he considered these scenarios, but quickly rejected them. As best he could tell, the rest of the plane was behaving normally, which would be unlikely in the face of a major disaster.
None of this mattered now, however, because a woman’s face hovered into view just above him, riveting his attention. It was an arresting face, not quite beautiful, from the apex of her wide jaw to her small, slightly rounded nose to her curved forehead. It was also an animated face, the wide amber eyes alight with intelligence and curiosity and energy, rimmed with a beautiful band of brown, complementing her coloring: dark red hair, skin dotted with light brown freckles. He resisted the absurd urge to reach up and trace the swell of her cheekbone.
The Antidote for Everything Page 4