I tucked my tie in my shirt. One of the flight attendants handed us latex gloves and I leaned in to pinch the bridge of the man’s nose and ask what had happened. He remained silent but the flight attendant spoke up, “He said he hit it on a counter as he bent over to pick up his briefcase this morning.”

The man took over: “It had stopped bleeding before I got on the plane but it wasn’t coming from the inside until a few minutes ago.” I asked him the usual questions about being on aspirin or other blood thinners. Was he a free bleeder or had any problems with bleeding in the past? No, no and no.

Classic first aid teaching says to pinch the cartilage of the bridge of the nose to stop a nosebleed. I did this, but nothing happened. The blood continued to pour out of his nose. I looked to Susan and said, “This may not be so easy.” She nodded and began to rifle through her purse.

“He did just have vodka right before it started,” the flight attendant volunteered, pointing to the small empty bottle lying on the seat next to him. Susan and I looked at one another knowingly. Alcohol can raise the blood pressure acutely in some people, particularly those with high blood pressure already.

“Do you take blood pressure medicine?” I asked him. “Do you have any on the plane?”

“Yes,” he answered, “and no.” He turned away, the blood still flowing. Suddenly, I began to piece it all together as a severe disruption of the plexus of blood vessels in the mucosa underneath the bridge of the nose, possibly worsened by elevated blood pressure. I had neurosurgery partners at home who would treat intractable nosebleeds by snaking a tiny microcatheter up from the groin into the arteries of the nose to inject a type of glue directly into the vessels. Invariably, that would stop this type of hemorrhage.

None of that and none of them, however, were with us at 15,000 feet.

“Anyone have any nasal spray?” I asked. “Afrin specifically?” Afrin is basically neosynephrine, a potent vasoconstrictor, and would be ideal to put on a tissue stuffed deeply in the nose.

“And a tampon?” Susan added, holding up a tampon from her purse and smiling. Multiple eyes turned toward her.