Claiborne Middleton, III, was a 56-year-old Wall Street executive who had been a closet drinker since his teens. His colleagues and family knew that he would have several martinis at lunch and several cocktails before dinner. However, they were not aware that he also drank before taking the train to work from his home in Connecticut and that he drank secretly during work hours. He was a functional alcoholic. Over the past year, he had noted disturbing symptoms, which he did not share with his wife: lethargy, fatigue, loss of appetite, and nausea. He also had noted that his stool was light colored. He continued to drink, despite knowing that these were symptoms of cirrhosis of the liver, which had killed his father. His wife had noticed that his skin and the whites of his eyes were yellow and that he was confused and forgetful. However, she was also in denial about what these symptoms meant. Eventually, Claibornes deteriorating condition became impossible for her to ignore and she made an appointment for Claiborne to see his physician. Even without blood tests, it was evident to the physician that Claiborne was severely jaundiced and that his abdomen was distended with fluid (ascites). He ordered a series of tests, and the results are summarized in Table 53.

The physician diagnosed him with cirrhosis of the liver and suspected hepatorenal syndrome. He admitted him immediately to the hospital, where he was placed on water restriction and started on spironolactone. A large volume of ascites fluid was removed from his abdomen. Despite these interventions, Claiborne died 5 days later of liver and kidney failure.