The Medicine Stick, Holorifle and Survivalist's Rifle have a nice combo of hitting hard while still firing fast. The only issue I could see with these is, speaking from experience, you MAY have difficulties surviving the Big Empty with the Medicine Stick alone (ammo becomes an issue despite the fact that Lobotomites drop .45-70 Gov't), though I'm betting it could be done.
Also depends on your level, when starting OWB. I went there around level 35, they were carrying Hunting Rifles instead of Brush Guns.
So they dropped .308 instead of .45-70.
Bad times for someone with a Brush Gun/Medicine Stick.
I can also imagine there are points where the weight of Microfusioncells becomes an issue for bringing enough ammo with you to some places when using the Tri-beam laser rifle or Holorifle.
Optimzed MFCs is the way to go then and Pack Rat as a perk to take. That will solve any weight problems.
Still, the Tri-Beam requires a lot of attention, as it wears down pretty fast even with the durability mod installed.
But I have to say, it was my weapon of choice in OWB whenever things got really hot, was so glad to have it with me there.
Again, speaking from experience, it was Lucky that saved my ass when all my other guns were running out of ammo in the Big Empty. .357 rounds are arguably -THE- most common rounds in the Mojave, and as long as a character with a nice crit rate is using it, Lucky's crit damage makes up for it's otherwise low base damage. Lucky to be Alive and Better Criticals can make it even MORE deadly, to the point where the gun is capable of hitting over 1000 damage in a single shot. Lucky's one weakness is a rather slow reload speed. ALSID on the other hand does much of the same, but ammo for it is DEFINITELY an issue, weighing a decent amount and never being found in containers, as it's not native to the Mojave.
I think That Gun is all around superior to Lucky.
5.56 is easier to get by in quantities than .357, and gives you more choices with .223, HP, AP and Match rounds. and most importantly, it doesn't take a decade to reload.
Regarding OWB, I went there not knowing carry weight wouldn't be an issue, so I arrived with Gobi and 120 JSP rounds, a Tri-Beam with 300 bulk MFCs and That Gun with 70 .223s and 60 5.56APs.
So, ammo appeared to be a potential problem at the beginning, until I started converting the crap out of anything I could grab or buy.
5mm deliver Lead, Primers and Powder for 5.56, .45-70 do the same for .308 rounds, and I turned every SEC, ECP and MFC I could get into optimized MFCs for the Tri-Beam. That worked out pretty well, and I left with much more ammo as I had on arrival.
I'd choose the Medicine Stick or Lucky. TBH I'd have a tough time choosing between the two given my experience with the Big Empty, though yeah, I'd probably end up choosing the Medicine Stick if forced to choose. I'm sure either would work though.
Playing through the whole game with one of these? Dunno. .45-70 is quite a rare caliber still, even if you happily brake down other ammo, .45.70 cases are quite a bottleneck.
And Lucky isn't that awesome, when you have to reload it during a battle or facing high DT enemies.
I really like Lucky, it is my early game sidearm of choice, but I always replace it with the more versatile That Gun, once my Gun Skill and STR meet its requirements.
A .308 chambered rifle, ideally Gobi, and a 5.56 pistol, preferrably That Gun, just seem more viable to me