Medical Thriller

CHOKE … Between the covers

Choke Header

LisaLisa 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.

ChokeMultinational 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.

Choke footer

AT WHAT COST … Between the Covers


Sacramento. Capital city of California. Named after its river, which was in turn named after the most holy offering in the Catholic liturgy. But there is nothing sacred and everything profane about the butchered corpse found on the river levee. Maybe ‘corpse’ is the wrong word for what lies at Detective John Penley’s feet. The pouring rain, caught in the glare of the crime scene halogen lights, patters remorselessly on a headless, limbless trunk. It had been a man. And that man, judging by the Aztec inspired tattoo spreading over what is left of the chest, was a member of a Latino gang, The West Block Norteños.

awclThe remains of Daniel Cardozo are hauled off to the city morgue to join those of several of his professional associates who have met a similar fate in recent months. Penley and his new partner Detective Paula Newberry know only that the killer is also a butcher, perhaps not by trade, but certainly by intent. They also become aware that the human remains are minus their soft tissue organs – hearts, livers, kidneys.

Newberry and Penley make an uneasy pair. Newberry, because she is treated like a leper by fellow officers ever since she orchestrated a surveillance sting that ended the careers of a couple of corrupt cops in the department. And Penley? His mind is forever straying to thoughts about his young son Tommy whose life is slowly but inexorably drifting away as he waits his turn for a kidney transplant.

As the tale unfolds, there are echoes of England’s infamous and unsolved Whitechapel Murders. As with the person who slaughtered prostitutes in that fateful London autumn of 1888, Penley’s killer seems to have more than a rudimentary knowledge of anatomy. And, like the detectives in Victorian London, Penley is actually sent a kidney as a taunt, but unlike the Ripper’s handiwork, the one Penley receives is most definitely human.

 L’Etoile’s story rapidly adds an extra dimension to the standard hunt for a ruthless serial murderer, as it become a medical thriller, too. The villain is, we soon learn, harvesting organs for the lucrative international trade in spare body parts. Like so many other aspects of life, the search for viable organs operates on two levels; the first is, of course, the regular – and highly regulated – world of transplant waiting lists; the second operates within the freemasonry of hard cash, and the opportunities afforded to unscrupulous traders – and their desperate customers – by The Dark Web.

It all too quickly becomes horribly personal for Penley and his family. His son narrowly avoids being given an intentionally damaged kidney, and it is clear that the detective’s personal anguish has handed the killer an invaluable tool with which he can torment the man whose professional job it has become to unmask him and bring him to justice. With someone hacking into hospital records and falsifying clinical data, Penley runs out of people he can trust, and is forced to play a dangerous game of deception with the killer, his colleagues and – worst of all – his own family.

jamesThe author (right)  certainly knows his way around the American justice system, with his background in probation, parole, investigation and prison operation. An experienced Associate Warden, Chief of Institution Operations, Hostage Negotiator and Director of Parole, he has also done extensive homework on the medical background to the complex world of organ donation and transplants. The plot rattles along with scarcely a breath being drawn, and in Penley and Newberry, L’Etoile has created a partnership which is complex and attractive enough to feature in more adventures further down the line.

At What Cost is published by Crooked Lane Books and is out now.



Blog at

Up ↑