Now the medications are interesting.
Fentanyl is an analgesic. Its a synthetic opioid and is very useful in both acute and chronic pain. It should most certainly have been declared to his supervisors that he was prescribed it.
Midazolam is interesting too. Its quite strong, even in mild doses, and in combination with fentanyl would be quite disabling, although 45 hours is well beyond the half life of the drugs, even combined.
I'm presuming the "stress test" relates to a cardiac test? Its a wonder he didnt fall asleep on the treadmill.
Medications
I had that same cocktail 2 weeks ago during a routine colonoscopy. Administered through IV at 9am, procedure took about 30 min or so. After my wife drove me home pretty much slept all day and through the night. Next morning still tired and groggy but able to get around, but ate very little. At 48 hours still tired but ravenously hungry, and at 56 hours felt normal.
If he had a similar procedure and followed all the orders, it's very possible he hadn't eaten much in 3 days, and had been "fully cleansed" as the doctors are fond of saying.
Fentanyl is an opioid most commonly used for severe pain in terminal cancer patients, when morphine alone isn't effective anymore. Our Swedish medical agency also recommends using fentanyl when there is severe chronic pain due to other circumstances, when morphine is not enough.
Fentanyl is about 150 times stronger than morphine. It depresses the CNS and one common side effect is reduced breathing/breathing difficulties. When used to treat chronic pain it is administered through via skin patches although cancer patients may get it as pills for oral consumption. It is of course extremely dangerous to operate any kind of machinery when using this drug. It does not say if the pilot had a patch or a pill - pills usually clears faster than patches that are designed to deposit a certain amount over time.
Fentanyl is also extremely dangerous to combine with sedative drugs since they interact to make the overall effect stronger in both medications.
Midazolam is a very strong sedative, a member of the bensodiazepine family. This is, in Sweden, only used as anaesthetic in hospitals due to its complicated and potent sedation effects and because it is very easy to overdose. Just as Fentanyl it depresses CNS and can result in breathing depression or the heart just stopping beating.
Both these substances are working via enzyme CYP3A4, which explains why the side effects become more severe when combining them.
So, the story about the pilot using these two substances in combination because of some cardiac test is just not plausible. For use of these two in combination you would have either an extremely irresponsible physician that prescribes substances at a whim, a pronounced substance abuse or some sort of invasive surgery followed (or caused) by extreme pain.
I find it confusing that FG claims it was a stress test that was conducted since Fentanyl+Midazolam can have detrimental effects on breathing capability AND heart function, with heart faliure as the ultimate life threatening condition. Either you have very strange procedures on that side of the pond or someone has got things mixed up.
As I said. I am confuddled by this.
I am not very surprised that the Capt reported for duty though. Due to the CNS depression you're not capable of thinking correctly even though you truly believe you are perfectly fine.
I had one such experience when I thought I was perfectly OK after surgery involving some huge amounts of sedatives. It wasn't until later I realised that I was totally whacked and I was glad my surroundings didn't listen to my declarations of fitness and instead strapped me in the back seat of the car. In hindsight I am sure I wouldn't even have gotten out of the parking lot at the hospital without wrecking the car, running over some pedestrians and ending up in a bicycle parking lot...