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Leonardo Noto (leonardonoto) | 37 comments Hello there,

I'm Leonardo Noto (nom de plume) and I am the author of three works: two novels and one memoir. I am a physician, a question writer for medical students/residents who are preparing for the medical board examinations, and an independent author. I am a former military battalion surgeon and I was a paratrooper. I live with my American bulldog puppy, Haldol, who is 100lbs at only 10 months! I also practice mixed martial arts (I especially love Brazilian jiu jitsu), play guitar (poorly), and read voraciously.

My books:

1. The Life of a Colonial Fugitive: An historical thriller based in the American Revolution. Young Jonathan E. Lee is falsely accused of heinous war crimes by his treacherous regimental commander! Jonathan is forced to flee the colonies to save his neck from the hangman's noose, fighting his way across a stormy Atlantic and then joining a mercenary army that is deploying to warring Siam, a kingdom that is squirming under the iron-fist of a madman.

2. The Cannabinoid Hypothesis: 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!

3. Intrusive Memory: The true story of how I survived sadistic child abuse and resulting PTSD to accomplish my goal of becoming a physician.

Thanks for reading!
Dr. Leonardo Noto (nonfiction book reviews) or follow me on Twitter @DrLeonardoNoto (medical tweets).

message 2: by Leonardo (last edited Dec 28, 2012 07:20PM) (new)

Leonardo Noto (leonardonoto) | 37 comments THE LIFE OF A COLONIAL FUGITIVE

A Warrior’s Reminiscence

June 1783: The blazing orange, tropical sun creeps above the rattan-studded horizon to announce the dawn of another sweltering day in the island paradise of Phuket, Siam. The gentle ocean breeze wafts the smell of decaying flesh into my nares as I survey the carnage of the past days’ fight from behind the cover of a thick palm. Less than a yard away, the dark skin of a dying enemy soldier is covered with vicious red ants, slowly eating him alive as he bellows out in pain-laden death throes. I climb out from my jungle concealment and walk across the sandy beach to ask the dying man in the Siamese tongue if he would like for me to speed the end of his life. The dying soldier is too feeble for speech, barely managing a slight affirmative nod of head. I unsheathe my sword and run the man thru his jugular, stepping back respectfully as the blood gushes from the jagged wound that I have inflicted upon his neck. As I watch the life drain from the young man’s sad face, I find myself reminiscing on the first time I gazed into a pair of youthful eyes prematurely aged by the horrors of war.

September 1778 (Five Years Prior): An otherwise dull Tuesday suddenly transformed itself into a frenzy of excitement as my older brother, Henry Lee III, arrived unexpectedly in Leesylvania1 for the first time since the beginning of the colonial revolution. Mother and I had been taking our tea under the shade of our estate’s great wrap-around porch while observing our slaves working the adjacent cotton fields when Henry’s silhouette had appeared over the horizon. Mother jumped up excitedly, spilling her tea and leaving a stain on the white-washed railing, which she quite uncharacteristically ignored as she cantered down the steps to meet him.

I waved half-heartedly at my brother but remained seated for we had not parted on favorable terms and I was, frankly, not excited at the prospect of his return. Henry clambered down from his raggedly thin horse, gave Mother a hug, and then walked towards me with a pronounced limp of the right leg. I shall never forget
the look of my brother’s gaze that day; gone was the shine of boyish innocence from his icy-blue eyes, replaced now with the penetrating stare of a man who had witnessed the animalistic brutality of combat. Henry’s body was transformed too, skinny now, his two-year-old uniform that had been so painstakingly sown by my mother hanging from his bones like beggar’s rags. Quite ashamed of my initial indifference, I rose from my rocking chair and hurried to assist Henry as he clumsily scaled our porch stairs.

1. ”Leesylvania”: The unofficial name of the region of Northern Virginia that lies adjacent to the Potomac River, near the present site of Washington City, where the Lee Family settled after emigrating from the British Isles.

“This leg of mine, it’s never been the same since my horse fell atop me at Brandywine Creek. Anytime I ride for more n’ an hour it cramps up somethin’ awful.” Henry mumbled as his face twisted into a grimace of agony.

“Where are you ridin’ in from, General Washington’s camp at West Point?” I inquired, eager to make conversation to disguise the expression of shock that was plastered about my face, shock at the haggardness of my brother’s appearance.

“Yes, and a fine improvement over last season’s accommodations at Valley Forge, that’s for sure. Many a good patriot froze to death in that snowy hell.” Henry muttered bitterly. “Enough with all this talk of the damned war, let us speak on somethin’ more pleasant. How are the plans for your grand tour of Europe progressin’, Jonathan?”

“Tell us about this General Washington, Henry! Is he the hero the papers make him out to be?” Mother interjected loudly and to Henry’s great annoyance.

“I asked a polite and simple question about my brother, mama!” Henry shouted, his voice hard and calloused. “Why all this subterfuge?”

“The trip’s cancelled; it’s too dangerous to cross the Atlantic anyhow now that France has entered the war.” I stated matter-of-factly as I pulled my shoulders back and puffed out my chest. I’ve decided to join the Continental Army; I leave in three days to join my regiment.”

“And Father has given consent for this tomfoolery!” Henry demanded, his voice filled with bitter disdain.

“Father has his reservations, the same reservations he had when you were commissioned, as I recall.”

“I didn’t realize I was kin to such a fool, throwin’ away an opportunity to travel and study in Europe with full expenses
paid no less! Don’t you see my gimp leg, boy, and how ragged I look ‘cause of this endless fight. Are you really that blind or are you just plain stupid!” Henry exclaimed, his tone condescending and full of rage.

“Let us speak no more on this!” Mother begged as she fought back heartbroken tears.

“Speakin’ isn’t what I had in mind for him!” I blared across the patio, loud enough to distract the field slaves in the distance, my fists gripped white-knuckled in anger.

“I said enough!” Scolded Mother as if we were both still young boys rather than fully grown men. “This is my home and y’all will respect it!”

My brother and I glared at one another, our eyes full of hatred, fists tightly clinched. Mother moved between us, and with the greatest reluctance, for hot tempers run thick in my family’s blood, Henry and I backed down, unclenched our fists and entered my mother’s home, giving one another a wide berth as we dusted off our boots and stepped through the doorway. The three of us found Father reading the local news pamphlet in his trusty, old hickory rocking chair, oblivious to the commotion that we had caused outside due to an affliction with pronounced deafness due to his time spent fighting in the French and Indian War. Henry strolled over to him and they embraced warmly, a broad toothless and somewhat unnatural smile shone across my father’s old, wrinkled, perpetually frowning face. I stormed off to my room, ignoring Father’s thunderous calls behind me as I slammed the door shut and then fixated my gaze out of my bedroom window, lost in thought. Later that evening the family gathered for a grand feast prepared by our house servants in my brother’s honor, a feast that I begrudgingly attended after incessant nagging by Mother.

“Mother tells me you’ve just returned from Georgia, Father. How do you find our brethren in the Deep South are holdin’ up amidst all this chaos?” Henry inquired between generously-sized and eagerly partaken bites of roasted pheasant.

“They’re holdin’ up better than we are, that’s for certain, though I expect the British will attempt to change that soon enough. The British generals have no choice but to take the war to the south, as important a port as Charleston has become now and is becoming more so every day. Find yourself any new musket in the hands of a Continental and I can guarantee you that it was smuggled in through Charleston or Savannah on a blockade runner. Yes, the British will strike in the Deep South before this time next year, mark my word.” Father stated as he peered over his reading spectacles, his news pamphlet lying in its customary location, unfolded open upon his lap.

“And what of the cotton trade, Pa? Rumor has it that the Georgians are growin’ strains that produce twice, even thrice, the usual bounty.” Henry asked as he shook his head in disgust.

“Indeed they are, and growin’ it in the fertile soils of the Mississippi Territories in flagrant violation of their treaty with the Cherokee. They float the cotton on down the river to Mobile and New Orleans where the British blockade remains porous; the cost of shippin’ by barge down the rivers is less than what we pay to travel our cotton by wagon over less than an eighth of the distance.” Father said dryly with a wizened look of despair creeping across his brow. “I fear Leesylvania may only be suitable for growin’ soybeans and vegetables in the years to come. It is a thought that I have been losin’ much sleep over since my return, almost as much sleep as I have been losin’ worryin’ on you, Henry. Now, tell us of the Revolution; in what shape is the Continental Army to be found presently? It’s hard to find information in the pamphlets these days that is worth the paper it’s printed on.”

“The war’s not a subject for the ears of women and children, Pa.” Henry said coldly, staring deep into my eyes and as he articulated the word ‘children,’ making it clear to all present to whom he was referring.

My brother and I spoke little over the next three days, save for common courtesies that were uttered without eye contact and in guttural tones. When Henry saddled his horse to return to his regiment at West Point, I could not find it in my heart to bid him farewell. I watched enviously as my brother’s war mount lazily meandered down our plantation’s dusty path, little knowing that it might well be the last time I laid eyes upon my brother in this life. This was knowledge that would have pleased me at the time, for in my youth I could not have imagined how much I would long for the company of my family, my brother included, in the dark years to come.

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Leonardo Noto (leonardonoto) | 37 comments THE CANNABINOID HYPOTHESIS

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.

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Leonardo Noto (leonardonoto) | 37 comments THE CANNABINOID HYPOTHESIS: Chapter 1 Continued

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 5: by Leonardo (last edited Dec 28, 2012 07:25PM) (new)

Leonardo Noto (leonardonoto) | 37 comments INTRUSIVE MEMORY

Chapter 1

The truth will set you free, but first it will make you miserable.
~James A. Garfield, 20th President of the United States of America.

It was May 15, 1995, the last day of the eighth grade. I was sitting in my third period English class watching the clock tick off the seconds to summer freedom when a sixth-grader arrived at the classroom door with a written message that would change my life forever. I’ll never know the exact wording of that little note, but my English teacher immediately told me to go to the guidance counselor’s office, even watching me as I walked down the hall, which was unnerving because she didn’t do that even when she sent someone to the office for misbehavior. I was frightened because my mother had warned me that if one of my teachers saw the bruises on my face they might call D.H.H.S. and she had even tried to cover them with makeup for the past few days. The facial bruises, by the way, were self-inflicted with a baseball bat, a self-punishment for “letting my family down.” My mother was very careful about where she hit me and she never would have been careless enough to leave bruises in such an obvious location. In fact, the first time she saw the bruises she yelled at me, not for hitting myself, but for hitting myself in a place where other people would see it. All of this was buzzing through my mind as I opened the door to the guidance counselor’s office and saw that sitting inside with the counselor was…my father!

I immediately ran out of the office. Just as I was stepping into the central corridor the assistant guidance counselor grabbed my shirt collar and yanked me into the conference room, which was immediately adjacent to the counselor’s office. I loudly demanded that I be allowed to call my mother at work and, somewhat to my surprise, she handed me a phone with my mother already on the line. My mother sounded desperate and she nervously said “Leo, Leo, wait there, I’m on my way — I’m calling Andrea and Elaine for help.” Then she hung up. Andrea and Elaine were my mother’s younger sisters, identical twins, and I was glad to hear that she was calling them because Elaine and her husband were respected attorneys and I was feeling like I could really use a lawyer right about now. I was certain that the guidance counselor would put me into Department of Health and Human Services (D.H.H.S.), Child Protective Custody, and I didn’t want to be molested or turned into a house-slave as my mother had told me that I would be if this ever happened. My mother was a social worker and she knew about these kinds of things so I believed her entirely on the matter.

The guidance counselor opened the door to her office and, with a stern expression on her Wicked Witch of the West face, motioned for me to enter with a curl of her pencil-thin index finger. I acted like I was moving towards her and then, without thinking, bolted out of the room, down the hallway, and out of the school at a full sprint. The assistant guidance counselor gave chase, and she was very close to catching me for the first hundred yards until we exited the school building and I started running down the hill, at which point the counselor’s dress began to trip her up. I kept running until I had crossed the street in front of the school and entered the woods, woods which were thick with spring growth — the perfect hiding place. I don’t know how long she chased me because I didn’t look back again until the woods got so thick that I was forced to slow to a walking pace to avoid the spiders’ webs that were strung between the trees. Finally, I dared a look back over my shoulder and I realized with relief that I had escaped.

In the woods it rapidly dawned on me that time was not working in my favor. Soon the police would be after me, if they weren’t already, and if I wanted to make it home without getting arrested for truancy I had better hurry up. I exited the woods and jogged down the side of the highway until I reached my neighborhood, about a two mile run. I was out of shape and winded by the run so I allowed myself to slow to a walk when I reached my block. My plan was to make it home, grab as much money and food as I could find around the house, then hide in the backyard behind the shed until I figured out what to do next. It wasn’t much of a plan but trying to think when you’re running from the police is a lot harder than it sounds. Just as my house was coming into sight I heard a car horn blaring behind me. I looked back, thinking that I was about to get run over, and I saw that it was Andrea in her Explorer. She leaned out the window yelling in her thick Mississippi drawl, “Leo, hurr’ up an’ get in. The police er’ out lookin’ for ya’.” I hesitated for a moment then reluctantly climbed into the front seat. Andrea immediately started driving whilst simultaneously dialing my mother on her brand new, high-tech cellular phone.

My mother told Andrea to take me to Stony Creek Hospital in Dove, Mississippi because the school guidance counselor and D.H.H.S. had scheduled a family evaluation for us there and there was no way to get out of it. Andrea assured me that I wouldn’t have to go inside the hospital if I didn’t want to, which is the only reason I didn’t jump out of the Explorer and take off running again. Andrea and I drove down Nicety Road the fifteen-some-odd miles to Dove and then up the hospital’s steep driveway. Stony Creek was a large, sprawling, one story building with reflective windows that prevented anyone outside from seeing into the patients’ rooms. It was an intimidating place, sterile and cold.

message 6: by Leonardo (new)

Leonardo Noto (leonardonoto) | 37 comments Andrea parked the Explorer then attempted to coax me inside the hospital, unsuccessfully — there was no way in hell that I was going into a mental hospital voluntarily. She eventually gave up and walked inside the hospital alone while I stayed in the Explorer, hunched down in the seat so that people wouldn’t see me. Andrea came out a few minutes later flanked by four large men and I immediately locked the doors to the Explorer although, in hindsight, a wiser plan would have been to take off running again. God I was scared and I prayed for The Lord to please help me. I had heard about the horrible things that happened in mental hospitals and if I had had the means I would have murdered all four of those men to have stayed out of there. The four hospital orderlies surrounded the Explorer, one at each door, and Andrea electronically unlocked the vehicle with her keychain. I grabbed the first solid object I saw, a full Coca Cola can, and I tried to defend myself with it but I was no match for the four of them. The orderlies grabbed me, wrestled me out of the vehicle and onto the ground, and then carried me inside like a slaughtered pig, one man holding each of my limbs.

The four men hefted me into a small, barren, white-bricked room and strapped me face down onto a leather-hard restraining bed with a rubber restraint wrapped tightly around each of my appendages. They then started examining my whole body, including my genitals, for wounds and tattoos — examining me none too gently at that. The restraining bed was cold and hard, as were the hands that were violating me, and I was so afraid that I nearly urinated on myself. I said another prayer, begging God to help me, but to no avail. The next thing I remember is a large bore needle being jabbed into my buttocks and the whole world going black as I tried in vain to fight the drug that they had forced into my body.

I awoke at some point later, how long I can’t be sure, groggy from the drugs but still full of fight, like a dog backed into a corner by a man trying to club him to death. I immediately began trying to force my way out of the restraints, struggling and struggling to exhaustion and beyond before finally accepting the futility of this effort. I then attempted to chew the rubber arm restraints off and I had made a fair amount of progress on the right arm cuff when the towering orderlies reentered the room, unstrapped me, hefted me off the table, each man with one of my limbs again grasped tightly in his hands, and strapped me into a pampoose. A pampoose is a full-body straight jacket attached to a wooden backboard and being in it is very painful, a bit like being strangled by a python. I was left in the pampoose for several hours, which I know for a fact because the staff was required to check my peripheral circulation once every hour to make sure that none of my limbs were necrotizing, that is to say dying, from lack of circulation. Several people have actually died outright from being physically restrained like this — the pampoose is that tight. Eventually, I was transferred back to the restraining bed, but not before I had had the opportunity to urinate all over several of the bastards who had been manhandling me all day long. That would prove to be the highlight of my stay at Stony Creek and I still remember it rather fondly.

I had had the misfortune of being admitted to Stony Creek on a Friday afternoon, and since the psychiatric staff was off on the weekends, I was left on the restraining bed until Monday morning. The staff had begun letting me off of the bed briefly, twice per day to eat because it’s easier to feed someone orally than intravenously, which was the other option since I was malnourished to a borderline state of starvation at this point in my life. It is also easier to put a drug in someone’s food than it is to inject it several times every day and I know that they were doing this because I refused my apple juice during my first meal on the suspicion that it might be drugged and the staff proceeded to force me to swallow it. I would later learn that one of the drugs they were giving me was Mellaril, an antipsychotic/sedative medication with a plethora of rather nasty potential side-effects including: Parkinsonian neurological dysfunctions (i.e., intractable tremors and drooling) and tardive dyskinesia (an irreversible movement disorder of the muscles of the face), to name a few. Other lovely side-effects of this drug range from permanent pigment depositions in the retina, painful muscle dystonias, and neuroleptic malignant syndrome — a constellation of dangerously high fevers and muscle rigidity that can progress to kidney failure and death. Fortunately, I didn’t develop any of these horrific sequelae but I’ll never forgive the people who forced that poison into my thirteen-year-old body because it very well could have done permanent damage. Never during this time was I allowed to see anyone I knew, including my parents, or given any explanation for why I had been forcibly institutionalized. I gave up on God on that restraining bed since it seemed a foregone conclusion that if God would not help me now He must not exist.

While contemplating my behavior at Stony Brook I would like my readers to keep in mind a few salient points. I was only thirteen years old, I was from a horribly abusive family, and I had been “brainwashed” by my mother to think that D.H.H.S. and their associates wanted to place me into foster-care, where I had been told by my mother that I would be sexually assaulted. The only way, in my mind, to avoid foster-care for not only myself but also for my younger siblings, was to keep my mouth shut and, quite frankly, I was almost certainly correct about this. It is also pertinent to note that I didn’t consciously know that I was an abused child. I know that this may be difficult to conceptualize for those who have not been in a similar situation, but I suppose that it is analogous to the old saying “we were poor but we didn’t know it.” Children only have one family and it is only natural for them to assume that what goes on in their family is “normal,” at least for them if not for their peers. Making matters worse, my mother had done a wonderful job of playing me against my father and I considered him just as much of an enemy as I did D.H.H.S. I was in an inescapable Catch-22 where, in my mind, I couldn’t help myself without harming my mother and my brothers, all of whom I still loved dearly. I very deliberately and rationally, based on the information at my disposal at the time, made the decision to protect my family at the expense of myself. Of course that didn’t mean that I was any happier about my present situation, and since the futility of direct resistance had become painfully obvious, I quietly vowed that I would run a “guerilla war” against my “captors” at Stony Creek.

That Monday I was released from the isolation room and transferred to a room on the adolescents’ floor. It was a reasonably comfortable room, save for the fact that my next door neighbor was a sixteen-year-old Gangster Disciples’ gangbanger from Johnsonville named ‘Twinkie.’ Twinkie bore a striking resemblance to Mike Tyson and he had the appearance and mannerisms of someone who didn’t shy away from using violence as a routine form of communication — he had been admitted to the hospital for raping two of his preadolescent cousins. Across the hall was Mac, a seventeen-year-old Vice Lords’ gangbanger, also from Johnsonville, who had been admitted by his family after being shot in the leg by the same Gangster Disciples set of which Twinkie was a member. I’ll never forget the first time I saw the gaping bullet hole in his leg, a wound which Mac’s doctors had decided to leave open to heal on its own via scarring, a process that in medical circles is referred to as ‘healing by secondary intention,’ i.e. without stitches. Mac had a large afro hairdo and he must have stood at least 6’5’’ — one of the things I first thought when I saw his mangled leg was that that was probably the end of a promising basketball career. Believe it or not, Twinkie and Mac seemed to get along really well, although they both scared the heck out of me.

Those not from the Deep South may be surprised to learn that little nowhere towns like Johnsonville, Mississippi have street gangs, and this fact is something of an interesting social phenomenon. The black migration northwards during the 50’s and 60’s was followed by a counter-migration back to the south during the late 80’s and 90’s. Along with this migration came street gangs, especially the black Chicago-based gangs, the Gangster Disciples and the Vice Lords, who began springing up chapters in virtually every city and small town in the cotton belt. As a result of this influx of street gangs, Memphis became a major drug distribution point and several high-ranking gang members, many still taking orders from their bosses in Chicago, set up there. In the early 1990s, Johnsonville, Mississippi, a small town that rests about a forty-five minute drive south of Memphis, had a violent street war between the Gangster Disciples and the Vice Lords. Mac was one of the turf-war’s many casualties.

The other patients in Stony Brook included the typical cases seen on adolescent psychiatric wards: sexually abused children, drug-addicts and drug-dealers (cocaine was big in the Memphis metro-area during the 1990s), violent criminals, and the occasional paranoid schizophrenic. Stony Creek specialized in treating adolescent criminals and I’ve often wondered if this was a deliberate decision on the part of the administration or whether the hospital ended up that way by chance due to its proximity to Memphis, consistently one of the most violent cities in the country. When I first met the other male patients I was immediately disgusted by the fact that so many blatant thugs had managed to weasel their way out of jail by being admitted to a psychiatric hospital. Honestly, at least half of the male patients should have been behind bars and they must have had really great lawyers to have been able to sucker the legal system into sending them to ‘treatment’ instead of straight to prison. The female patients were another story entirely. Sexual abuse, rampant promiscuity, and suicide attempts were the rule on the female-side of the hall — the only exception that I recall in the whole bunch was a schizophrenic girl who, as it turns out, attacked me the first time I laid eyes upon her, throwing me out of my chair and onto the floor because she thought that I was “makin’ da voices come again.”

I met my psychiatrist for the first time around noon that Monday and my mother was there for the conference, there and wearing lots of makeup and a nice dress. I was glad to see her and I gave her a hug and asked her to please get me a lawyer because I was scared and I just wanted to go home. Dr. Agarose was a middle-aged, balding man with a truly gargantuan head and I remember wondering if he had to special order his glasses to find a pair that fit. The guy also bore a close resemblance to the psychologist from The Simpsons and I still wonder if that character was modeled after him. During the meeting I was as reticent as my mother was loquacious. My mother immediately began accusing me of having horrible behavioral problems and she broke down crying as she moaned, “I just don’t know what’s wrong with him, he used to be such a good kid.” And then, I shit you not, she started coming-on to my psychiatrist, right there in front of me! He blew her off but my mother persisted and Dr. Agarose actually had to say “let’s redirect our conversation back to Leo now” more than once during the session. My mother continued accusing me of all manner of horrible behavioral problems, from abusing my brothers to doing drugs, all the while putting on a rather pathetic show of crocodile tears. I was enraged —

message 7: by Leonardo (new)

Leonardo Noto (leonardonoto) | 37 comments I had taken care of her kids, gone without food to save her money, helped her dictate her college midterms, and listened to her respectfully while she accused me of chasing my father away on countless occasions, never having complained, not even once. Now, there I was, locked up with a bunch of rapists, druggies, and gangbangers, keeping my mouth shut to protect this woman and it obvious, even to me, that she didn’t give damn about me. Not one damn! I stormed out of the session and decided that I didn’t love my mother anymore and that I never wanted anything to do with her ever again.

The staff grabbed me as soon as I stepped out of Dr. Agarose’s office and they slammed me to the floor. I hit the ground with a loud “thud” — it hurt something awful because the carpeting was paper thin and the floor was rock solid underneath. One large man put all of his weight on my back, using his knee as a lever against my spine, as four or five other orderlies grabbed my arms and my legs. The man on my back was so heavy that I could hardly breathe and I started gulping for air like a bass in the bottom of a rowboat. Dr. Agarose and my mother came out of the office, my mother’s excessive makeup running down her cheeks like a Saturday Night Live skit, her face coated with the fake show of tears that I’d seen so many times before. She patted my hair while I struggled wildly against the orderlies, my anger now boiling past the capacity for rational thought. Realizing the futility of my struggle, I began banging my head on the floor trying to knock myself out to make it all go away. One of the hospital staff members grabbed my hair to hold my head up as I tried to scream, unable get in enough air to yell because of the weight of the obese man who was on top of me. My mother eventually tired of the show and she stood up, the tears ceasing immediately as she began having a professionally-toned conversation with my psychiatrist. They walked away talking about me the way doctors speak to one another about an interesting case study, like the Elephant Man for instance, and not long afterwards I was mercifully injected with a sedative that temporarily put me out of my suffering.

I suppose that it is quasi-normal for an adolescent to declare that he hates a parent and is never going to speak to them again only to let it blow over in time. I was not a normal adolescent and the day that I realized that I no longer loved my mother I meant it. The rest of the time I spent at Stony Creek was a waste of my insurance company’s money by any estimation. I refused to cooperate in any therapy and I would simply sit quietly during the sessions and ignore anyone who spoke to me. I considered myself a “political prisoner” and my behavior during the next few weeks at Stony Creek went from bad, to worse, to worst. It is little wonder why the staff at Stony Creek began to believe my mother’s lies about her “defective child’s” inexplicable behavioral problems.

My pent-up rage against my mother, my father, and my infuriation about my forcible detention at Stony Creek consumed me during the two months that I was held as an inpatient there. Despite the fact that I was sedated on Mellaril to such a degree that I occasionally fell asleep whilst standing, my “guerilla war” against Stony Creek had reached fully operational status. I had managed to read, and to destroy, nearly every book in the school library (at least fifty) by using a rather simple method — as I read the book I would randomly tear out pages, hide the pages in my pocket, and then throw them into the large waste basket in the hall as we filed past it in line from activity to activity. I overheard a few staff members discussing how much money the health insurance companies paid Stony Creek per patient, around $1,000/day, and I became determined to prevent Stony Creek from making any money off of my “imprisonment.” I even went so far as to do rough calculations using estimated salaries of employees, electricity costs, etc. to estimate approximately how much damage I had to do everyday to negate the profit margin that the hospital was making off of me. Looking back, as far as I can tell anyhow, my calculations were fairly accurate. In addition to destroying just about everything that I managed to get my hands on, and without ever getting caught, I would also leave the hot water running in my room’s shower and sink in an attempt to run up the electric bill. One day I decided to leave the hot and cold water running simultaneously since, I reasoned, that I may as well attack the water bill while I was going after the electric. To my delightful surprise, the amount of water coming out of the sink facet was now greater than its draining capacity and it spilled over onto the floor while we were all attending a mandatory church sermon. To add insult to the injury, Stony Creek’s rooms were constructed below the level of the central hallway to allow for easy wheelchair access — every room had a small ramp built into the entrance — and the water accumulated to at least three-to-four inches before anyone noticed the massive puddle that was creeping its way out of my room! That resulted in at least $10,000 worth of damage, or at least that’s what I heard the staff saying to one another in the hallways.

Needless to say, Stony Creek’s staff hated me with a passion. After the psychiatrists went home for the evening the orderlies would punish me by holding me up with my arms behind my back, which was really painful, and by letting the other patients openly make fun of me and, on occasion, rough me up a bit. In the staffs’ defense, I was an extremely difficult patient in a hospital that largely specialized in dealing with juvenile criminals and they really were utterly unqualified to handle a child like me. Overtime many of the other patients came to admire me — two seventeen-year-old criminals even took to referring to me as “the kid with balls.” After eight weeks, the powers that be at Stony Creek decided that they had had enough of Leo Noto and they arranged for my transfer to Pleasant Breeze Hospital, a long-term mental facility in Jefferson, Tennessee. My last night at Stony Creek was sleepless and I spent the restless hours trying to make sense of how my once ‘normal’ life had degenerated into this living nightmare.

message 8: by Leonardo (new)

Leonardo Noto (leonardonoto) | 37 comments Leonardo wrote: "THE CANNABINOID HYPOTHESIS: Chapter 1 Continued

With Susan sleeping soundly, Dr. Shoemaker selected a #11 scalpel from his surgical tray and he prepared to make his primary incision. The #11 ..."

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.

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