‘Winnie held his hand’: Doctor remembers Madiba’s last breath
Doctor’s startling revelations on Madiba’s death lift lid on bedside dramas
His official date of death is December 5 2013, but on a wintry night six months earlier Nelson Mandela stopped breathing.
Shortly after midnight on June 8 that year, Madiba, 94 and in frail health, was gently turned onto his left side in his bed in his Houghton home. He stopped breathing and had a “terminal event”.
His nursing team went into overdrive and alerted his doctors, who feared he “might have died”.
But after urgent medical intervention he was revived and put onto a ventilator. Within minutes, he resumed breathing by himself.
Shortly after he had been resuscitated, his wife, Graça Machel, walked into the room. She was unaware of what had just happened until being notified by doctors.
Standing beside him, Machel said: “Papa, you are going to be OK. Hang in there, Papa! You are going to be fine.”
These and other previously undisclosed details — including that it was his former wife, Winnie Madikizela-Mandela, who was holding his hand when he died, and not Machel — have been revealed in a new book about Madiba.
Mandela’s Last Years — written by the former surgeon general of the South African National Defence Force, Lieutenant-General Vejay Ramlakan, and published by Penguin Random House — goes on sale tomorrow.
Ambulance caught fire
While Good Morning, Mr Mandela, written by his former personal assistant Zelda la Grange, laid bare the squabbling and power struggles in the Mandela family before and after his death, Ramlakan’s 238-page book is described as “the true story of Nelson Mandela’s final journey by the head of his medical team”.
Ramlakan divulges in extensive detail the shocking events of June 8.
Not only did Mandela — who was “literally fighting for his life”, Ramlakan said this week — need to be resuscitated, but the military ambulance in which he was rushed to the Pretoria Mediclinic Heart Hospital from Houghton caught alight en route.
It was previously reported that the ambulance broke down, but the book details how, barely 20km into the journey, the vehicle stalled in the fast lane and was engulfed in black smoke.
“This was awful. Madiba in an ambulance on fire,” Ramlakan writes.
Miraculously, the situation was quickly brought under control and, 30 minutes later, a back-up ambulance was on its way.
Ramlakan also speaks candidly and in depth about the clandestine operations and military protocols that were implemented to counter media scrutiny.
‘Strange, gripping and powerful’
The book — to be released on the eve of Mandela Day — also reveals details of spy cameras found in the former president’s Houghton bedroom, his hospital room, on the fence of his Qunu property and even in the morgue he was taken to in Qunu.
Ramlakan does not identify those thought to be responsible for planting the cameras.
He outlines how hoax bomb threats and decoys were used to fool the media and the public when Madiba was in hospital.
“We wanted people to know the facts about Mandela’s activities and his health, because in the years immediately prior to his death, media reports on his health were filled with intense speculation and rumour.
“What was hidden from them was a truth that was strange, gripping and powerful,” Ramlakan writes.
The former three-star general retired from the defence force in 2015 shortly after coming under fire for his role in signing off on upgrades costing more than R22-million at President Jacob Zuma’s Nkandla home.
In the first two sections of the book, he describes Madiba’s health issues during his early political life, his incarceration, and his years as president and afterwards.
Alzheimer’s fears
In the final section of the book, documenting the last six months of Mandela’s life, Ramlakan highlights the toll that internal family politics had on the failing health of the Nobel peace laureate.
“We were privileged to have his family ask us to tell this story and have thus been able to satisfy all ethical concerns,” Ramlakan said.
At many points during Mandela’s final years, Ramlakan and the medical team assigned to look after the former president — called the Charlie Team — were deeply concerned about his health.
On one occasion in 2008, Ramlakan recalls, he noticed that Mandela — who had just turned 90 — was unusually listless.
“There were no obvious signs of ill-heath but I was concerned that his lack of interest in daily affairs masked something else, such as Alzheimer’s, dementia and/or depression,” he writes.
Ramlakan asked his defence force colleague Dr Zola Dabula, who was operational commander of the presidential medical unit, to assess Madiba’s mental state.
Plagued by doubts
Ramlakan recalls that Madiba referred to Dabula as his “homeboy”, because both had roots in the Eastern Cape.
“Soon Mandela confessed [to Dabula] that he was sad and somewhat depressed,” Ramlakan writes.
“The sadness derived from his incarceration, which had deprived him of time with his family. He felt guilty for past neglect due to his role in the liberation struggle and also believed that this still affected relationships within his family.”
But despite these feelings of guilt, Mandela told Dabula that he did not regret the path he had taken.
The end of 2008 saw the military medical team taking over all aspects of Mandela’s healthcare, a move that Ramlakan says was not unanimously welcomed.
He writes that Mandela was “sub-clinically unwell” by 2010 — the year of the Soccer World Cup — and describes clashes between the medical team and Mandela’s staff.
When bedsores were detected in 2010, while Mandela was at home at Qunu, his medical team “instituted certain measures — fewer visits, for example — that Mandela’s staff were used to arranging without considering his wellbeing”, Ramlakan writes.
“Not for the first time there was a clash between the medical team and the household staff. The medical records showed that Mandela was often exhausted by the round of daily activities — and had been even when he was president — but his staff seldom took account of this.”
When important visitors were turned away, the staff voiced their disapproval.
Clashes with La Grange
As Mandela’s health deteriorated, clashes with La Grange increased, Ramlakan writes. He says La Grange was “unhappy with the turn of events regarding the healthcare of her boss, and began challenging aspects of the system”.
He writes: “She was voluble and assertive and went into direct conflict with the medical team. Mostly she seemed not to understand that the healthcare system is the most regulated of professions and correctly so: issues of life and death are always present.
“Her officiousness created an unfortunate sideshow. And as all doctors know, a sideshow can take the focus off the patient with disastrous results.”
Honouring Mandela’s legacy
La Grange said she would “not respond directly to any queries other than to wish Dr Ramlakan well with his book”.
She added: “He has captured his experiences and opinions, just as I have captured mine.
“We all choose how we wish to remember Madiba and best honour his legacy.”
Ramlakan shows that even as Mandela’s life was drawing to a close he still took pleasure in watching his favourite sport, boxing.
Less than three months before he died, Mandela watched a Floyd Mayweather bout on TV.
Less than a month before his death, on Friday November 8, Madiba “surprised Mrs Machel and kissed her as she bent over him to straighten the linen. This made her very happy and she was a woman in raptures for the rest of the day,” Ramlakan writes.
“His will to live was phenomenal and his survival, given his state of health, was incredible.
“After 20-some years of watching him exercise his iron will, I had put down his survival to his unparalleled strength of mind. But now I witnessed his sheer physical body strength. Not many possess this.”
The final days
Towards the end of November, Madiba’s condition deteriorated and his doctors and family had to make some tough decisions.
“Tuesday, 3 December, was a difficult day for everybody on the medical team,” Ramlakan writes.
“The previous night’s panel discussion had revealed different views of how to treat this crisis. Some felt that nature should be allowed to take its course. The larger group were not prepared to accept this attitude and instead guidelines were set within which further escalation of treatment would not be encouraged.”
Ramlakan says he noticed that Madiba’s steely resolve and fighting spirit were waning, and it appeared that he was “transitioning” — preparing for death and whatever it might bring.
He says his discussions at the time with Mandela’s oldest living child, Makaziwe, showed that she also believed her father’s time had come.
Mandela’s condition deteriorated. He became ventilator-dependent and his skin turned grey and dusky.
The family were notified and close household staff and police bodyguards were allowed to visit him.
It was a time of tears and sorrow, Ramlakan writes.
Silently and reverently, those close to him — including Eastern Cape elders — entered the room, spent a few minutes at the foot of the bed, then left to make way for others paying their final respects.
Madiba’s eyes opened as his oldest grandchild, Mandla Mandela, heir to the Mvezo chiefdom, was in the room. He appeared to recognise Mandla before he closed his eyes again and drifted back to sleep.
A few hours later, Madiba took his final breath.
It was Madikizela-Mandela who was sitting at his bedside when his heart stopped beating.
Quiet sobbing
“I glanced at my watch 21:48, and informed her, ‘Mama, he has departed,’ ” Ramlakan writes.
“As a now still Madiba lay, with his hands in hers, in the soft glow of the bedside lamp, all of us experienced a sorrow the depths of which we had not experienced before. The room was filled with a peacefulness that gave it a dreamlike quality and though every second ticked on the wall clock, every action gently floated into the next.
“The silence was broken by quiet sobbing from Mrs Madikizela-Mandela as she nestled her head besides Madiba’s still body. Wave after wave of quiet sobs broke her bowed frame. After the medical team performed some of the last rituals, Mrs Machel and some of the grandchildren entered the room in tears.”