Tran­scend­ing sad­ness of death

The last months be­fore Nel­son Man­dela’s death were per­haps the most con­tro­ver­sial and sto­ried of his en­tire life. Now the head of his med­i­cal team, for­mer sur­geon-gen­eral of the SANDF has writ­ten his own ac­count of those last days to set the record straig

The Star Early Edition - - INSIDE -

SATUR­DAY Novem­ber 30 is marked as “Day 90” in my per­sonal note­book. These note­books were ac­quired by me dur­ing a visit to the Pen­tagon in the US and they were cov­ered in black leather. The panel called them my “black books” and they con­tained my notes about Madiba. In them, I would sum­marise progress on a reg­u­lar ba­sis and, for­tu­nately, be­cause of the sys­tem I had de­vised, they proved most help­ful, at times more so than the clin­i­cal notes.

The ref­er­ence to 90 days was the length of time Madiba had spent at home in Houghton. In that week, he had im­proved to such an ex­tent that Steve Ko­mati de­cided to ac­cept a long-ex­ist­ing in­vi­ta­tion to the World Di­a­betes Congress that was to be held in Mel­bourne, Aus­tralia, early in De­cem­ber. He left on a flight that night.

The per­vad­ing view of the Char­lie Team panel was that, of all his sys­tems, Madiba’s heart was the most ro­bust. If com­pro­mised, “we” would be in trou­ble. Thus far, it was re­mark­ably healthy.

On the morn­ing of Sun­day, De­cem­ber 1, (Brigadier-Gen­eral Zola) Dab­ula was called to Houghton be­cause a “sit­u­a­tion” had arisen. A dan­ger­ous ir­reg­u­lar­ity of Madiba’s atria had de­vel­oped. His blood pres­sure had low­ered dra­mat­i­cally and the doc­tors had de­cided to try to cor­rect the ir­reg­u­lar­ity through car­diover­sion. This had failed.

The signs of in­flam­ma­tion had also in­creased greatly overnight and it seemed that Madiba was back in sep­sis.

The sit­u­a­tion re­sulted in an emer­gency gath­er­ing by the panel and at­tempts were made to con­tact Ko­mati, who was still on the flight to Aus­tralia.

Mid-morn­ing, there was an­other at­tempt to cor­rect the ir­reg­u­lar­ity through car­diover­sion and this suc­ceeded.

By now, Ko­mati was in the tran­sit lounge at Perth wait­ing for the flight to Mel­bourne and in touch with Dab­ula.

Dab­ula felt he should con­tinue to the con­fer­ence, as the sit­u­a­tion would be eval­u­ated at the af­ter­noon panel meet­ing. Ko­mati was of a dif­fer­ent opinion. Bet­ter to re­turn home, he felt, but he took Dab­ula’s ad­vice.

The af­ter­noon meet­ing noted that there had been some sta­bil­i­sa­tion and de­cided to con­tinue some other as­pects of the treat­ment, in­clud­ing dial­y­sis. Overnight, the sit­u­a­tion re­mained sta­ble.

On Mon­day, De­cem­ber 2 there was still some swelling of his feet. Madiba, though phys­i­cally much im­proved, was still sleepy and re­luc­tant to be aroused.

Tues­day, De­cem­ber 3 was a dif­fi­cult day for ev­ery­body on the med­i­cal team. The pre­vi­ous night’s panel dis­cus­sion had re­vealed dif­fer­ing 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.

Ev­ery treat­ment regime comes with its neg­a­tive im­pact on other parts of the body, and the art of medicine is bal­anc­ing these neg­a­tive side-ef­fects while ad­dress­ing the pri­mary prob­lem. Madiba had de­vel­oped side-ef­fects to most of his treat­ments over the years.

That Tues­day also ini­ti­ated a new phase. To that point, a fight­ing spirit and a steely re­solve had char­ac­terised all Madiba’s health bat­tles. Now it seemed, to those of us who had been with him for years, that he was no longer fight­ing back.

In my ear­lier con­ver­sa­tions with Makaziwe Man­dela, I had de­bated with her about her un­der­stand­ing of “tran­si­tion­ing”. This was sup­pos­edly when a hu­man be­ing en­ters the spirit world to pre­pare for the next ex­is­tence.

In this pe­riod, the soul is said to be in two sep­a­rate worlds and part of both. The limbo re­mains while it waits for some­thing in this world be­fore fi­nally passing on. Makaziwe was a firm be­liever in such in­terim pro­cesses and told me she had seen this when her close rel­a­tives had passed away, in­clud­ing her brother Mak­gatho

and her mother. Madiba had him­self wit­nessed the slow death of his son.

Dur­ing Mak­gatho’s last days, Madiba and Makaziwe had many mo­ments of re­flec­tion on life and its mean­ing. She was a re­li­gious per­son of strong con­vic­tion and a life­long be­liever in God. When she asked her fa­ther, faced with a dying son, whether he be­lieved in God, he had not an­swered di­rectly. In­stead, he had said that he be­lieved in in­fin­ity.

Was Madiba now tran­si­tion­ing? Makaziwe was firmly con­vinced that he was. What was he wait­ing for be­fore he would pass on?

The med­i­cal team were now hav­ing to treat a re­cur­rence of the heart prob­lems. With the con­comi­tant de­crease in blood pres­sure, ther­apy had to be up­scaled from the pre­vi­ous day’s lev­els.

At the panel meet­ing that Tues­day evening, we ac­cepted that the sit­u­a­tion was pre-ter­mi­nal. While me­chan­i­cally ad­dress­ing all the blood re­sults and the ma­chine reports, the over­whelm­ing feel­ing among the team was that “we are in the hands of God”. I had de­cided to con­vey the sit­u­a­tion to Pres­i­dent Ja­cob Zuma and spoke to him that night. He took the news som­brely and asked to be kept in­formed. I hung up won­der­ing what mes­sage I would give the pres­i­dent the next time we spoke.

I also asked Dab­ula to let Ko­mati know what was hap­pen­ing. Ko­mati’s re­sponse was to im­me­di­ately ar­range to fly back to South Africa.

While he was in the air, Madiba was in se­vere re­frac­tory sep­sis. His blood pres­sure sup­port had been raised to max­i­mum lev­els, which turned his skin grey and dusky. He was now ven­ti­la­tor-de­pen­dent. His ther­apy had reached the max­i­mum.

Fifty-seven years ear­lier, on De­cem­ber 5, 1956, Madiba and 155 other po­lit­i­cal lead­ers had been ar­rested and charged with trea­son. It was the time of the pop­u­lar Congress move­ment and the Free­dom Char­ter. They were heady days, when even the gov­ern­ment crack­down seemed dwarfed by a grow­ing spirit of de­fi­ance and revo­lu­tion.

On this Thurs­day, 57 years later, Madiba was tran­si­tion­ing. He was still re­ceiv­ing dial­y­sis and was mov­ing slowly in re­sponse to be­ing touched by his med­i­cal team. His av­er­age blood pres­sure was drop­ping and his res­pi­ra­tory lab­o­ra­tory re­sults showed the grav­ity of the sit­u­a­tion. The panel had agreed to con­tinue his blood pres­sure sup­port and an­tibi­otics.

By that morn­ing, Ko­mati had re­turned. From the mo­ment he left Mel­bourne, he had ex­pected to hear the worst. On land­ing, he had SMSed Dab­ula for an up­date and, when the re­sponse took half an hour, his anx­i­ety mounted. As he reached his home, an SMS came in from Dab­ula: “We are okay.” Ko­mati quickly fresh­ened up and, though jet-lagged, drove to Houghton. I up­dated him.

Mid-morn­ing, we de­cided to in­form the fam­ily that those who wanted to visit Madiba should do so.

I then phoned Win­nie Madik­izela-Man­dela’s of­fice and asked her staff to en­sure that she came im­me­di­ately to visit Madiba and not wait for her daugh­ters to re­turn from Lon­don, where they had gone to as­sist with the première of the film about Madiba’s life, Long Walk to Free­dom.

As the news spread of the re­quest to the fam­ily, me­dia en­quiries came thick and fast. The Pres­i­dency wanted to is­sue an up­date, but I re­quested that this be put on hold.

Madiba’s close house­hold staff and po­lice body­guards were all al­lowed to visit him, some for the first time since he had re­turned home. It was a time of tears and sor­row. Silently, in dig­nity and rev­er­ently, they trooped in and spent a few min­utes at the foot of the bed be­fore leav­ing so that the next group could en­ter.

Close fam­ily and the tribal el­ders from the East­ern Cape also vis­ited him. When Mandla Man­dela was in the room, Madiba’s eyes opened and he recog­nised his grand­son. Then his eyes closed and he drifted back to sleep.

It was now dark and a hushed sad­ness en­veloped the house.

All fam­ily and non-med­i­cal staff had been up to the room and left filled with pro­found grief.

Madiba had never looked so ill to them be­fore.

The med­i­cal staff on duty were all som­bre, their faces drawn and blank. There was noth­ing to do ex­cept fol­low the pro­to­cols that had kept Madiba alive over the past six months. De­spite all the med­i­cal ex­per­tise avail­able, noth­ing more could be done.

Dab­ula, Ko­mati and I stayed for the whole day and at­tended to the fam­ily and of­fi­cial mat­ters.

For Ko­mati and me, this was un­like any other cri­sis Madiba had faced. This time, he seemed at peace with his de­te­ri­o­ra­tion, if such can be said. He ap­peared to have with­drawn from the sit­u­a­tion. Al­though his breath­ing was shal­low and his blood pres­sure drop­ping, his ex­pres­sion was one of tran­scen­den­tal peace.

Be­sides the med­i­cal team, at Madiba’s bed­side there was now only Win­nie Madik­izela-Man­dela. Dressed in a dark out­fit, her eyes red and teary, she sat mo­tion­lessly at his side.

When the ven­ti­la­tor alarms went off, Ko­mati ad­justed the ma­chine so that there were no loud noises. Madiba started the long, deep sigh­ing con­sis­tent with the last stages of res­pi­ra­tory fail­ure.

In barely a whis­per, I heard Madik­izela-Man­dela say: “Doc­tor, he is gasp­ing.” Nei­ther Ko­mati nor I could look at her di­rectly and she low­ered her gaze.

As the mon­i­tors in­di­cated car­diac asys­tole, I glanced at my watch. It was 21:48. I then looked at Mrs Madik­izela-Man­dela and said: “Mama, he has de­parted.”

As a now-still Madiba lay, with his hand 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 dream-like 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.

Sound­lessly, the med­i­cal team per­formed some of their last rit­u­als and tasks.

The fam­ily mem­bers in the house were called in. Graça Machel and some of the grand­chil­dren en­tered in tears.

Ear­lier, it had been em­pha­sised to us that the “clos­ing of the eyes” was not to be done by any­body other than a se­nior mem­ber of the Madiba clan or a mem­ber of the AbaThembu roy­alty. This was to be ar­ranged by Dab­ula.

Down­stairs, I found al­most all mem­bers of the Man­dela fam­ily gath­ered in the dif­fer­ent lounges. Dab­ula was out­side the house.

“It’s time for the el­ders to close his eyes,” I said to Dab­ula and, al­though it was dark, I could see the sad­ness in his ex­pres­sion. He nod­ded.

Next, I in­formed the pres­i­dent.

SHAR­ING CARE: Nel­son Man­dela, seen here pay­ing his last re­spects af­ter the death of Ade­laide Tambo on Jan­uary 31, 2007, at her home in Sand­hurst. Madiba’s own passing was peace­ful at the end.

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