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Lisa Towles is over-cautious. Said no-one, ever. In this beguiling and occasionally confusing novel she has assembled the ingredients thus: a small cup of altered reality, two large helpings of global conspiracy, three spoonfuls of domestic noir, just a drizzle of romance, two apparently unconnected plot lines, some roughly chopped historical legend and, most importantly, a generous dash of finely ground medical thriller.

We find ourselves darting between two apparently disconnected stories. In the dark morphine silence of a San Francisco hospital ward, Certified Nursing Assistant Kerry Stine has a blistering migraine. One of the ward’s residents, Rosemary Castiglia, has terminal lung cancer and is only hours away from that fine and private place – the grave. But where is her medical chart? And, even more pressing, where is she?

So begins a nightmare for Kerry Stine. She flees the hospital, pursued by the administrators who believe that she is responsible for Rosemary’s disappearance. Her apartment is no refuge, as she emerges from the shower to find a stranger who, carrying bags of groceries, has let himself in and demands to know what she is doing in his apartment.

On the other side of the country a bio-scientist, Adrian Calhoun, has squared the circle, turned base metal into gold, captured a unicorn and solved Hilbert’s 16th problem in algebra. In short, he has found a cure for cancer. To be precise, he has found a cure for lung cancer. A treatment that will shrink tumours even faster than they have grown. It seems that not only has the God of Lost Causes been smiling on Calhoun’s research, but he has also received the nod from the God of Irony. Who else could have determined that the treatment consists of intensive cigarette smoking? Of course, these cigarettes are not stuffed with fine Virginia tobacco, but with a secret blend of herbs and medicaments that not only attack the invasive cancer cells, but leave the smoker with a heightened sense of well-being.

Multinational pharmaceutical companies and the giants of the tobacco industry have not achieved their wealth and success through philanthropy, however, and when they learn about Calhoun’s discovery there is only one solution that will prevent them from taking a huge commercial hit, and that is to eliminate Calhoun and destroy all evidence of his research. While he and his colleague Grace Matson are pursued by hitmen, Kerry Stine’s nightmare becomes ever more vivid and violent. She is kidnapped and drugged. In her more lucid moments, myriad questions spin and whirl around her brain. Who is the woman chained next to her in the darkness of her prison cell? What happened in her childhood that was so traumatic that it shut down all subsequent recall?

The two story lines burn away like separate fires in the narrative, but it is only in the final few pages that Towles provides the accelerant that makes them burst into one fierce blaze. She leaves it late, but such is her confidence as a writer that she knows it will work. She opens the curtains to reveal a dystopian world which reminded me very much of the dreamscape of David Lynch’s masterpiece, Twin Peaks, where someone walks into a scene, says something which is obviously deeply significant but too enigmatic to be immediately obvious to us. Menacing characters appear, disappear and then reappear. Towles never allows us to settle. She has written her chapters short so that we are constantly put on our guard, forced to re-evaluate, and constantly question what we think we know about the characters in the story.

Choke is many a mile away from being your standard crime novel and it is almost impossible to tag it as being safely in any particular genre. If your crime fiction taste buds are dulled with the repetition of ‘same old, same old,’ then get hold of a copy of Choke. It will make you think. Buying choices can be found here.