It is important to note that Osler was referring to a time before antibiotics and before artificial ventilation had been invented. He was referring to a time when lung infections were commonly bacterial, and the resultant death did, indeed, allow one to escape the ‘cold gradations of decay’!
With COVID viral pneumonia, however, one struggles to breathe as one struggles to suck air into one’s water-logged lungs. The person will also experience the unpleasant effects of accumulating carbon dioxide. The mildly- euphoric effects of cerebral hypoxia (associated with the ‘old person’s friend’) will be completely lost. The effort needed to breath is often described as a ‘slow drowning’. This drowning is such that exhaustion will soon result, as one gives up the effort, and sinks to their death.
Sir William Osler & ‘the old man’s friend’
If, in these last desperate stages, sophisticated medical facilities are available, it is full active ventilation that is likely to be employed. Active ventilation involves the person being sedated and an endotracheal tube positioned in the throat which prevents any possibility of communication. A muscle relaxant is administered and the machine takes over the breathing process. While the ventilator can prolong ‘breathing’ indefinitely, this is not always enough to maintain life. With a ventilator, one’s last conscious worldly experience may be the insertion of intravenous lines, rectal and urinary evacuation tubes, and the essential endotracheal tube. As the muscle relaxants flow and you stop breathing, the machine takes over.
