It is remarkable to meet someone who busts a quart-a-day. Even the Big Leaguer alcoholics seem to peter out at the fifth, if not the quart, of hard liquor. I keep two mental lists over time –

  • most xtreme human variance, and
  • most xtreme (survived.)

It’s an honor to be on the survived list AND the most extreme list.  Most people don’t push the envelope and land afterwards.  The over-a-quart club is pretty exclusive.  That’s getting into embalming range for alcohol consumption.  Even Russians would get worried about someone who drinks like that.

The screw-top liquor bottle was not meant for manly men like these boys.  A widespread complaint went around the old USSR – Gorbachev insisted that vodka bottles be sold only with a stopper or cap that could be used again to cap the bottle!  Why would someone want to do that – just throw it away, capped or uncapped, when you’re done!  What, are we to be pantywaists that have a sip and RECAP THE BOTTLE?

Things like a potassium of 6.0 I had a guy who ran around six, for various reasons. The ER would call, and say he’s got a K+ of 6.0, and I’d ask them if he was walking and coherent, and they’d always say ‘yes.’ I’d tell them, give him a shot of kayexalate, send him home, I’ll see him in clinic next week.

That is NOT good evidence based medicine, and I wouldn’t do that anymore, because some pipsqueak with access to the Washington Manual would insist that, sight unseen, he/she could absolutely say from her/his august medical opinion, that that was BAD MEDICINE. Except for the patient who wouldn’t follow physiological standards of Evidence-Based Medicine, I would agree.

Now, to be realistic, every time I’d see him in clinic, I’d give him a big hug, and say “You’re alive!!” He would be as excited as I was. For him, every day was a bonus. He was in his eighties, and lived with his extended family. That was years ago, he’d be a hundred if he’s still around today.  But in today’s McMedicine, what do you do?  Call 911 and send him to the ER, that’s what.  And then you call the nephrologist for emergency dialysis.  And then you admit him when he pops into his usual arrhythmia when he’s down below 4.5 – that’s a quick potassium shift, and his heart wasn’t so nimble.  You don’t need experience or training – anyone could kill him with good intentions.  McMedicine is all about killing the outliers.  It’s like thinning the herd.  I wonder what happened to him…
I’ll get to the rummy story tomorrow….

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