‘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.”

Pic­ture: AFP

Nel­son Man­dela cel­e­brates his 86th birth­day with his wife Graca Machel, left, and ex -wife Win­nie Madik­izela Man­dela,right, in his ru­ral home town of Qunu on July18 2004.

Pic­ture: Pen­guin Ran­dom House

The au­thor of ‘Man­dela’s Last Years’, Lieu­tenant-Gen­eral Ve­jay Ram­lakan, with Madiba.

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