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Matt, I'm attaching a pure python version to serve as a better map for how to implement this in C.
* it incorporate the recent lru_cache algorithmic updates (moving the root around the circular queue to re-use old links).
* it shows which parts should be implemented in C using a regular type and shows how to call it from pure python.
* it gives hints on use of #defines and PyDict_GetItem
* the critical sections are marked so you can use the GIL rather than using locks.
* there are hints for what datatypes to use (only the hits and misses need the ability to grow beyond sys.maxsize).
* it shows how to access the named tuple from within the C code (using a straight PyObject_Call).
* this code passes the test suite and should be directly translatable (and very fast).
* please follow the model and use PyList objects instead of C structure for links
* let me know if there are any questions.