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
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.