"Rum and Coke, Del?"

Del responded to the sweet woman behind the bar, "Nah, I just come from the doctor. He says I got the sugar. I gotta cut down. Gimme a draft instead."

     The effect of ethanol (ETOH) on muscle metabolism was assessed in 
     both normal (NC) and noninsulin-dependent (NIDDM) subjects in the basal 
     state and during isoglycemic hyperinsulinemia (450 pmol/L) clamp studies 
     carried out either with systemic (NC, n = 5; NIDDM, n = 5) or 
     intrabrachially (NC, n = 5; NIDDM, n = 5)ETOH infusion. On a repeat 
     study, each subject underwent the same experimental procedures, except 
     that saline was infused instead of ETOH. (1)

Sometimes, perhaps, having a little too much information is a bad thing. Del is like so many customers of the neighborhood bar. He's retired on a good pension from a company he punched a clock for for about thirty years, day in and day out, without fail. He's saved a little money and his wife worked for awhile too. So they've enough money for their little home in the nearby blue collar neighborhood. Next to the houses that but for the color of the paint would look just like theirs; the grass neatly trimmed, so are the hedges. The occasional lawn jockey or ceramic gnome graces a bit of landscape creativity (annual plantings and the like).

You go to my head, like a sip of sparkling Burgundy brew,
And I find the very mention of you, like the kicker in a Julep or two...

— "You Go To My Head" by J. Fred Coots and Haven Gillespie

Some of these lovely people bought their homes forty years ago for what it costs to buy a decent luxury car today. They can't afford the luxury cars, though. They opt for the Ford Crown Victoria or the occasional Buick or Chrysler New Yorker (except for Eddie down the street who won the lottery in '87 and has bought a new Cadillac every three years ever since).

The ladies in this crowd visit the hairdresser once a week. The men have gone to Phil's barber shop on Newfield Street for as long as they can remember. They play bingo at the church Monday nights. And they go out for a cocktail every other day or so.

     During ETOH, FGU was depressed by 81% in NC (delta = 3.32 mumol/min.100 
     mL tissue) and by 48% (P < 0.05) in NIDDM (delta = 1.21 mumol/min.100 
     mL tissue). Local ETOH infusion did not affect FGU in either NC 
     (1.18 +/- 0.23 vs. 1.1 +/= 0.11 mumol/min.100 mL tissue in the 
     baseline condition and 4.12 +/- 0.65 vs. 3.97 +/- 0.35 in 
     insulin-stimulated conditions) or NIDDM (1.05 +/- 0.29 vs. 1.1 +/- 
     0.19 mumol/min.100 mL tissue in baseline condition and 2.72 +/- 0.82 
     vs. 2.83 +/- 0.51 in insulin-stimulated conditions) subjects. (1)

The other thing they have in common is that their medicine cabinets are full of pills. Pills for high blood pressure. Pills to lower blood sugar. Pills to sedate. Pills to reduce inflammation. Pills to help with the myriad ills that befall humans of a certain age. They often say a cheerful hello upon meeting at the pharmacy and share concerns about children and grandchildren, and concerns about the cost of all of their pills.

Roll out the barrel, we'll have a barrel of fun...

— "Beer Barrel Polka" by Vladimir Timm, Jaromir Vejvoda, and Zeman Vaclav with English Lyric by Lew Brown

Now, years ago, the neighborhood used to socialize quite a bit. When Charlie and Arlene lived down the street, they'd have wonderful cook-outs and roll their bar out of the kitchen onto the patio behind the house. Charlie was a real party lover. Arlene was a great cook. The great old records from Sinatra and Jerry Vale would be playing. If Patch and Irene came over they'd bring their Polka records and everyone would dance and have a ball. Yeah, the neighborhood couples would come over on a Saturday evening and Charlie would be behind his bar, making drinks in cute glasses with different color fish on each one (so that you'd know whose drink was whose). The bunch would go through a bottle of J&B and a bottle of Four Roses in an evening. Charlie and Arlene would go through a fifth of Canadian Club.

Three years ago Charlie went into the hospital and never came out. Arlene said that she didn't understand what the doctors said was wrong with Charlie. Some of the guys from the V.A. would sneak him a little hooch once in awhile and he'd savor it as if it was nectar from Heaven. After they buried Charlie, Arlene sold the house and went to live with her daughter out west somewhere. She kept in touch for a little while, but now she doesn't even send Christmas cards.

Oh, yeah I'm drinkin' again, and thinkin' of when you loved me,
I'm havin' a few, and wishin' that you were here...

— "Drinking Again" by Johnny Mercer and Doris Tauber

While they boys are out golfing, there's a few of the girls who get together at Marie's house and have an "eye opener." They take turns each week getting a bottle of Smirnoff. If they don't consume the whole thing they skip a week and then the next gal picks up her turn the following week. They used to mix the vodka with tomato juice but now that most of them have to take the stomach acid pills, they changed to Ginger Ale. Just a bunch of the gals sitting around the kitchen table having a drink and a smoke and talking about good times.

It was at the Friday afternoon Senior Center luncheon that they all noticed it first: "Drinking and Seniors: A talk with Dr. Malcolm Greenbaum."

     In summary, systemic ETOH infusion impairs both
     body and forearm glucose uptake in NC and NIDDM subjects;
     this effect was more apparent in NC than in NIDDM at both
     the whole body and forearm level. (1)

They had a laugh down at the bar that night at the expense of Dr. Greenbaum. "What's left for Seniors if we can't have a little pop now and then?" Estelle cackled a bit until her smokers' cough caught up with her. Marie gave her a tissue.

The other day, my doctor told me if I keep drinking like this, I won't live to a ripe old age.
I told him, look, I see a lot more old drunks than I see old doctors!

— Comedian Joe E. Lewis from his album It Is Now Post Time (Reprise LP No. 5001)

Three days later, on her way to Marie's, Estelle drove her car through a red light and into the fence of the condominium complex on Fenn Road. She was taken to the hospital.

Tony drove to the hospital as soon as he could after he heard the message on their answering machine. He sat with a man who looked young enough to be his grandson, perhaps. The man said he was the Intern treating his wife.

"Intern. What's that? I wanna talk to a doctor."

The man replied to Tony, "I am your wife's doctor, sir..."

Tony's son had always told him that if anything bad happened, get the people who're asking him to make decisions to write everything down on paper. The paper revealed the same strange words that the young doctor had confused Tony with: 'Acute EtOH withdrawal' 'impending renal failure' 'abdominal fluid accumulation.'

Tony took the paper to Dr. Clarke's office right away.

"Has your wife been drinking to excess lately, Tony?" Dr. Clarke's voice sounded almost apologetic, and was soft. He took a long time to get the question out of his mouth.

It's time to go home now and I've got an aching head,
So I give her the car keys and she helps me to bed.
And then I tell her, as I turn out the light,
I say, "My darling, you were wonderful tonight.

— "Wonderful Tonight" by Eric Clapton

"Nope. No. I'm the drinker in the family, doc. And I've been takin' it easy since you said I got the sugar."

"For someone your wife's age, if she has, let's say, three or four drinks in the course of the evening, it's as if she's taken 2 cups of sugar and eaten it, Tony..."

After Tony got Estelle home the next day, he went to the cabinet in the den and poured himself an anisette, and tried not to think about things.

(1) CITATION:  Avogaro, A.; Valerio, A.; Miola, M.; Crepaldi, C.; Pavan, P.; Tiengo, A.; del Prato, S.; "Ethanol impairs insulin-mediated glucose uptake by an indirect mechanism." Journal of Clinical Endocrinology and Metabolism; Italy, June, 1996 81(6):2285-90.

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