Prelude to a Scream

Set in San Francisco, Nisbet's first novel in nearly a decade (Death Puppet, 1989) is the literary equivalent of a David Lynch film: surreal, grotesque and more than a little kinky. Melding a contemporary urban folk myth about kidney robbers with a high-tech horror plot about medical hackers tracking unsuspecting organ donors through computerized hospital files, Nisbet describes the medical misadventures of Stanley Ahearn, a 47-year-old loner cynical about the value of life. After a night spent drinking with a gorgeous, green-eyed woman, Stanley wakes up in a bloody sleeping bag in Golden Gate Park with a searing pain in his back. Taken to a hospital by a big-hearted wino, Stanley finds that he has been surgically relieved of one kidney. Informed by doctors that his remaining kidney is terminally diseased, Stanley sets out to find his femme fatale, determined to have her accomplice ""kidney bandits"" replace what they removed. His trek through the criminal and digital underground brings a tragic, absurdist resonance to the hard-edged medical horror idiom. Nisbet uses his formidable descriptive skills to portray a freakshow of desperate characters, including a nurse passionately attracted to his scars and the twisted black-market organ harvesters. Although Nisbet blurs the story's more visceral scenes with a semi-narcotic haze, the denouement, in which Stanley forces the drug-addled surgeons to perform an emergency transplant on him at gunpoint, will have readers clutching their managed-care medical cards for security. (Aug.)