Some of the cocaine molecules tumbled into the coronary arteries and began constricting them and reducing blood flow to the heart. At the same time the cocaine began to diffuse out of the coronary vessels into the extracellular fluid, bathing the hardworking heart muscle fibers. There the foreign compound began to interrupt the movement of sodium ions through the heart cells’ membranes, a critical part of the heart muscle contractile function. The result was that cardiac conductivity and contractility began to fall.

Simultaneously the cocaine molecules fanned out throughout the brain, having coursed up into the skull through the carotid arteries. Like knives through butter, the cocaine penetrated the blood brain barrier. Once inside the brain, the cocaine bathed the defenseless brain cells, pooling in spaces called synapses across which the nerve cells communicated.

Within the synapses the cocaine began to exert its most perverse effects. It became an impersonator. By an ironic twist of chemical fate, an outer portion of the cocaine molecule was erroneously recognized by the nerve cells as a neurotransmitter, either epinephrine, norepinephrine, or dopamine. Like skeleton keys, the cocaine molecules insinuated themselves into the molecular pumps responsible for absorbing these neurotransmitters, locking them, and bringing the pumps to a sudden halt.

The result was predictable. Since the reabsorption of the neurotransmitters was blocked, the neurotransmitters’ stimulative effect was preserved. And the stimulation caused the release of more neurotransmitters in an upward spiral of self-fulfilling excitation. Nerve cells that would have normally reverted to quiescence and serenity began to fire frantically.

The brain progressively brimmed with activity, particularly the pleasure centers deeply embedded below the cerebral cortex. Here dopamine was the principal neurotransmitter. With a perverse predilection the cocaine blocked the dopamine pumps, and the dopamine concentration soared. Circuits of nerve cells divinely wired to ensure the survival of the species rang with excitement and filled afferent pathways running up to the cortex with ecstatic messages.