Goodreads Authors/Readers discussion

Action/Adventure > The Cannabinoid Hypothesis

Comments Showing 1-9 of 9 (9 new)    post a comment »
dateDown arrow    newest »

message 1: by Leonardo (last edited Jul 09, 2014 04:58AM) (new)

Leonardo Noto (leonardonoto) | 38 comments Free on Kindle until July 13th!

A dark medical/crime techno-thriller. Frank Shoemaker, M.D. is the world's preeminent neurosurgeon thanks to his development of "The Shoemaker" device for the palliation of acute psychosis. Now the good doctor is wanted for an unspeakable crime -- but was it justified?

Mr. Jones is a drunkard, haunted by demons of a combat-filled past. Mr. Jones and his team of mercenaries have been contracted to pursue the elusive Dr. Shoemaker, and Mr. Jones never fails to get his man -- alive or otherwise!

Greetings, I am Dr. Leonardo Noto. "The Cannabinoid Hypothesis" is an intelligent thriller that interweaves hard medical science into a dark and fast moving tale of murder and betrayal. I hope that you enjoy reading "The Cannabinoid Hypothesis" as much as I enjoyed writing it! or follow me on Twitter @DrLeonardoNoto

The Cannabinoid Hypothesis by Leonardo Antony Noto

message 2: by Leonardo (new)

Leonardo Noto (leonardonoto) | 38 comments Chapter 1

To Susan’s horror, Dr. Frank Shoemaker prepared for the impending surgery per his usual meticulous protocol. Dr. Shoemaker strapped on his surgical mask, tightly, to prevent the fog of his breath from clouding his finely-calibrated optical loupes. The confident physician waltzed over to the basement sink with his customarily arrogant stride, surgically scrubbing his hands — ten swift strokes of the betadine-impregnated scrub brush for every square inch of his skin, scrubbing from his fingertips all the way down to his elbows. With no small amount of difficulty, the surgeon nudged the faucet shut with his foot, drenching his Italian loafers in the process, cursing as he fully appreciated for the first time the genius behind Cedar View Memorial Hospital’s motion-activated sinks. Dr. Shoemaker patted his hands dry with a sterile towel and then maneuvered into a disposable surgical gown. This was a difficult task but he had done it a thousand times before. Within seconds both of the doctor’s clean arms were tucked inside the gown’s sleeves without ever having grazed any unsterile surfaces. Finally, the surgeon gloved his able hands with a double-pair of thick latexes. He now turned to face his patient.

Susan was strapped facedown with duct tape onto Dr. Shoemaker’s weightlifting bench, an IV line inserted into the left antecubital vein of her arm, a bag of normal saline1 tacked onto the adjacent wall — the bag hanging slightly above her head to promote the flow of its fluid. Susan’s head had been shaved bare by the skilled surgeon just moments prior and then ‘painted’ with a sponge that was soaked in betadine, that ubiquitous bactericidal agent that is used in operating rooms worldwide to sterilize body surfaces. Immediately adjacent to her head was a wicker TV dinner tray that had been carefully prepared with an array surgical tools. Dr. Frank Shoemaker reached for the tray and picked up a syringe filled with thiopental, a barbiturate anesthetic used to induce anesthesia in neurosurgical patients because unlike many other anesthetics, thiopental doesn’t cause a rise in intracranial pressure2. Frank inserted the hypodermic needle into Susan’s IV port where he injected 1/5 of the syringe’s contents, a dose of 10mg of thiopental, a fraction of the dose necessary to induce a medical coma. In lower dosages thiopental is a highly effective truth-serum and Frank wanted to ask Susan a few questions while she was still able to answer them. Normally a soft-spoken man, he began interrogating his patient in the calm, yet commanding, voice that he reserved for the operating room.

“Can you hear me, love?” Frank implored.

“I think so, Frank. You sound so far away.” Susan slurred.

“Do you know why you’re here now, Susan?”

Frank could see her struggling against the drug that was just now beginning to take effect. Thiopental inhibits the cerebral cortex, the portion of the brain that is responsible for complex thought — it is hypothesized that thiopental’s truth-serum properties result from the fact that lying is a more complex task than telling the truth and thus more easily confounded.

1. Normal Saline: Sterile salt water that has been formulated so that it is roughly equivalent in concentration (actually, in osmolarity) to blood plasma. Normal saline is the most commonly used intravenous fluid in American hospitals.

2. Intracranial Pressure: The brain is confined within the skull inside a tight, bony cavity that has only has one exit — the foramen magnum — a circular hole that is located at the skull base. The brainstem transitions into the spinal cord which then exits through the foramen magnum to enter the vertebral canal of the spine. Any rise in pressure within the skull places a patient at risk for a catastrophic foraminal herniation — a bulging of the brain downwards through the foramen magnum. Foraminal herniations compress the brainstem, the portion of the brain that controls life-sustaining bodily functions. Without a functioning brainstem, life cannot be sustained without mechanical ventilation (“life support”).

“I’m here because I killed Teddy.” Susan stated matter-of-factly, too intoxicated by the thiopental for fear.

“Yes, you did. You murdered our precious son. Tell me why you killed him?” He commanded.

“I don’t want to, Frank.” Susan began to cry, her eyes childlike as the teardrops rolled onto her rosy cheeks.

“Tell me why you killed him — tell me now!”

“I killed him…because I love you.”

It was as he had suspected. Shaking his head in disgust, Frank injected the remainder of the thiopental and Susan immediately descended into a deep medical coma. Since thiopental is a short-acting drug, lasting only 10-15 minutes, Frank next injected a second longer-acting medication, milky-colored liquid propofol, into Susan’s I.V. bag. The propofol infusion was a jerry-rigged invention of necessity — certainly not up to hospital standards — Frank hoped that it would be enough to keep Susan under for the entire operation as performing neurosurgery on a squirming patient would be a rather monumental challenge, even for a practitioner as skilled as Dr. Shoemaker. At Cedar View Memorial Hospital, Frank would have elected to use a combination of the halogenated anesthetic gases, isoflurane and enflurane, in place of propofol. But these inhaled anesthetics required a bulky vaporizing machine and were thus impossible to use under these austere conditions.

message 3: by Leonardo (new)

Leonardo Noto (leonardonoto) | 38 comments With Susan sleeping soundly, Dr. Shoemaker selected a #11 scalpel from his surgical tray and he prepared to make his primary incision. The #11 scalpel is an exquisitely sharp, crow’s-beaked, triangular blade — ideal for slicing through the thick connective tissues that bind the head and the neck just underneath the surface skin. Frank began his incision slightly above the external occipital protuberance, the bony knot at the crown of the skull, and he then continued his incision down the nuchal furrow to the level of the C5 vertebrae. The primary incision was shallow and it was intended to serve as a guide for the Bovie — an eponymous electrocautery device. A light blue, plastic-shelled rectangle with a power cord at one end and a thin electrofilament at the other, the Bovie is held like a pencil and it easily slices through even the most robust of tissues whist simultaneously cauterizing the incision, thus rendering it bloodless.

Frank held the Bovie in his right hand as he began cutting through the suboccipital musculature, cutting deep into Susan’s neck. He reached the base of her skull and the glistening vertebral bodies of C1-5, the first five of the seven cervical (neck) segments of the backbone. He now set the Bovie aside and reached onto his wicker tray for two self-retaining retractors. The retractors were shaped something like salad tongs, a perfect fit for his short and deep incision. Now in place, the retractors gently held Susan’s neck musculature and subcutaneous fascia out of the operating field, thus allowing Frank free access to the underlying vertebrae. The hardworking surgeon irrigated his operating field with a sterilized flowerpot, washing away the cautery-scorched debris as he again cursed the fact that he, arguably the world’s preeminent neurosurgeon, was being forced to perform under these Neolithic conditions. Frank suctioned the irrigation fluid away with a 10cm Rhoton-Merz suction tube that he had commandeered from the hospital and secured to his vacuum cleaner with duct tape. This contraception worked marvelously and the surgical field was soon cleared of all debris. Susan’s pearly bones now shone in the basement’s fluorescent light, entirely exposed.

The hardworking physician next grasped his surgical drill and he began removing a semicircular portion of Susan’s skull base, leaving the outer layer of the bone — the periosteum — intact to preserve the blood supply to its underlying bone. The periosteum would keep the skull flap viable, that is to say alive, during the procedure. This was extremely important since any dead tissue left in the surgical field would serve as fuel for infection — necrotic bone, in particular, serves as a favored harbor for pathogenic bacteria in postoperative patients. Having secured the bony flap into place with surgical tacks, Frank next exposed the cerebellum, the posterior-most portion of the human brain which overlies the brainstem like an ill-fitting hairpiece and functions as an integral component of the motor (movement) system, responsible for functions such as coordination and balance. The cerebellum is the portion of the brain that when inhibited by alcohol produces the staggering gait of drunks. Frank gently moved the cerebellum out of the way with two scoop-like brain retractors as he exposed his target — Susan’s brainstem. The brainstem is responsible controlling the life-sustaining functions of respiration, heart rate, and awareness (as opposed to unconsciousness). Arising from the brainstem are 10 of the 12 cranial nerves3, the nerves that are responsible for carrying all of the sensations that arise from the human head.

Frank gently teased away the brain’s thick protective covering, the dura, with a pair of Jeweler’s forceps to expose the root of cranial nerve #5. He positioned the nerve root between his open scissors, closed his fingers, and with one snip deprived Susan forever of her ability to feel the left side of her face. He repeated this procedure on the right, permanently destroying Susan’s facial sense-of-touch. Frank skipped cranial nerves #3, 4, and 6, nerves which collectively command the movements of the eyes — he would be dealing with his patient’s eyes directly soon enough. The busy surgeon next targeted the root of the seventh cranial nerve. Another two snips of his surgical shears and Susan’s face was permanently paralyzed and her sense-of-taste gone forever. The room was filled with Frank’s laughter and the staccato snips of his scissors: Cranial nerve #8 — responsible for hearing and balance — “snip, snip;” Cranial nerve #9 — controlling the ability to swallow — “snip, snip;” Cranial nerve #10 — responsible for modulating ‘housekeeping’ bodily functions such as digestion — “snip, snip;” and lastly, cranial nerves #11 and #12 — responsible for turning the head, shrugging the shoulders, and moving the tongue — “snip, snip.”

The longest and most delicate phase of the procedure now completed, Frank shifted his attention to the C3/4 region of the spine. He hummed the ubiquitous medical school mnemonic, “C3, 4, 5 — keep the diaphragm alive,” as he gently isolated the phrenic nerve. The phrenic nerve controls the activity of the diaphragm, that large sheet of subcostal (under the ribcage) musculature that powers the act of breathing. Without a functioning diaphragm, life is not possible except with the aid of mechanical respiration; indeed, the vernacular term for a mechanical ventilator is ‘life-support.’ The phrenic nerve arises from the C3, C4, and C5 levels of the spinal cord and the function of the diaphragm muscle is usually preserved in spinal cord injuries that occur below C4, and lost in lesions that occur above the C4 level.

Frank bent Susan’s head forward to increase the space between her fourth and fifth cervical vertebrae. He inserted the Bovie between the C4 and C5 vertebrae, severing her spinal cord and permanently disabling all control of, and reception of sensations from, his patient’s body. His work on the brainstem and spinal cord now complete, Dr. Shoemaker drilled several small holes into Susan’s skull. Next he drilled matching holes into Susan’s craniotomy flap and then he stitched the flap back into place using thick suture. He slowly released his self-retaining retractors and watched the suboccipital musculature slide back

3. Cranial Nerves: Cranial nerves #1 and #2, responsible for sense-of-smell and perception-of-light (i.e. sight), respectively, arise

message 4: by Leonardo (new)

Leonardo Noto (leonardonoto) | 38 comments into place like a magician’s Rubik Cube. Frank next sutured the layers of sturdy suboccipital fascia back together. Then he approximated the overlying skin and delicately closed his incision using finely thread suture.

The third stage of the operation was a crude procedure and the thought that his able hands would be performing it disturbed the great surgeon to no small degree. Dr. Shoemaker’s operation had thus far deprived Susan of all her sensation and motor control with two notable exceptions: her vision and her sense-of-smell. Though Frank would have preferred a more finesse approach, the cranial nerves that transmit these functions arise deep in the brain and getting to their nerve roots was logistically impractical under such austere conditions. Dr. Shoemaker picked up the Bovie and began the only reasonable operative alternative — resecting Susan’s eyes from her orbits. This procedure was completed in less than two minutes and Dr. Shoemaker tossed his patient’s eyes across the basement, laughing as they splatted against the wall. Finally, he shoved the Bovie into Susan’s nose and cauterized the roof of her nasal cavity, destroying the fine projections of cranial nerve #1, depriving Susan of her sense of smell. His task completed, Dr. Shoemaker stepped back for a moment to admire his work before tearing off his surgical gown and climbing the basement stairs. Susan would spend the rest of her life a prisoner inside her own body: unable to move, unable to see, unable to smell, to hear, to taste, or to feel. Yet she would be very much alive — able to think, able to suffer.

Upstairs, Dr. Shoemaker picked up his suitcase and his carry-on bag as he walked out of his front door, pausing for a moment to say goodbye to the home that he knew he would never see again — except maybe on CNN’s Headline News. It was a six bedroom, multimillion dollar, Malibu home where he had lived with his wife and his beloved son, Teddy, for what had been both the greatest and the worst year of his life. A tear rolled down Frank’s cheek as he climbed into his Maserati and backed out of his sunbaked, palm-lined driveway. The drive to Los Angeles International Airport was uneventful and Frank arrived for his flight to Mexico City with time to spare. His adrenalin still pumping from his day’s work, Dr. Shoemaker popped an Ambien as he settled into his seat, having to be physically awakened by the flight attendant after they had landed. Dr. Shoemaker apologized to the flight attendant in unaccented Spanish and deplaned. In the airport he purchased a ticket to Havana, Cuba, where he was expected by an old friend. Just before he boarded the plane, Dr. Shoemaker dialed the Malibu Police Department from his cellphone and stoically confessed his crime, telling the police where they could locate Susan.

The young Cuban couple who sat next to Dr. Shoemaker on the plane to Havana undoubtedly would have been shocked to know that they were sitting next to the world’s most renowned neurosurgeon. Dr. Shoemaker couldn’t even imagine what they would have thought if they knew that they were seated adjacent to the man who had just committed what would soon become one of America’s most notorious crimes — he smiled as he thought about it. Dr. Shoemaker ordered a glass of Glen Livet and sipped it neat while he indulged in the view of the sparkling Caribbean Sea as it rolled gently thousands of feet below the aircraft. Dr. Shoemaker felt at peace with the world for the first time in his life — for the first time, he felt free.

message 5: by Leonardo (new)

Leonardo Noto (leonardonoto) | 38 comments To kindle my new discussion group, all three of my books will be $0.99 on Amazon from 31 Dec to 02 Jan! Listed below are the links to my Goodreads discussion group (active until 29 Jan) and the link to my Author Central page on Amazon, where you can find links to all three of my works.

message 6: by Leonardo (last edited May 01, 2013 07:55PM) (new)

Leonardo Noto (leonardonoto) | 38 comments Currently on sale for 99 cents (Kindle version)! or follow me on Twitter @DrLeonardoNoto

The Cannabinoid Hypothesis

The Cannabinoid Hypothesis by Leonardo Noto

message 7: by Justin (new)

Justin (justinbienvenue) | 2163 comments I love the title! I think its quite catchy. I may check this book out.

message 8: by Leonardo (new)

Leonardo Noto (leonardonoto) | 38 comments Thanks, Justin. I hope that you like it...I have to warn you that that one is dark as hell (actually, most of my stuff is, but "The Cannabinoid Hypothesis" in particular!).

message 9: by Leonardo (new)

Leonardo Noto (leonardonoto) | 38 comments Free on Kindle until July 13th!

A dark medical/crime techno-thriller. Frank Shoemaker, M.D. is the world's preeminent neurosurgeon thanks to his development of "The Shoemaker" device for the palliation of acute psychosis. Now the good doctor is wanted for an unspeakable crime -- but was it justified?

Mr. Jones is a drunkard, haunted by demons of a combat-filled past. Mr. Jones and his team of mercenaries have been contracted to pursue the elusive Dr. Shoemaker, and Mr. Jones never fails to get his man -- alive or otherwise!

Greetings, I am Dr. Leonardo Noto. "The Cannabinoid Hypothesis" is an intelligent thriller that interweaves hard medical science into a dark and fast moving tale of murder and betrayal. I hope that you enjoy reading "The Cannabinoid Hypothesis" as much as I enjoyed writing it! or follow me on Twitter @DrLeonardoNoto

The Cannabinoid Hypothesis by Leonardo Antony Noto

back to top