Home' Trinidad and Tobago Guardian : December 9th 2013 Contents A12
Guardian www.guardian.co.tt Monday, December 9, 2013
Nelson Mandela wasn t
on life support and had
many family members
and doctors close by in
his final hours, a family
friend who was at his
bedside said yesterday.
Bantu Holomisa told
the Associated Press that
he had been called to
Mandela s home on
Thursday by the family
so he could visit the anti-apartheid icon before he
"You judge the mood in the house. I know the
family. It was not the same family I used to see. Even
the call itself, please pop in, we think Madiba is in
his last days, " Holomisa said.
"I assume the family was warned by the doctors."
The end came soon. The former president died
about two hours after the departure of Holomisa,
who was a former deputy minister in Mandela s Cab-
Neither the Mandela family nor the South African
government has released details on the final hours
of Mandela or given a cause of death.
The account by Holomisa, who says he has known
Mandela since he stepped out of prison in 1990,
sheds some light on Mandela s condition as his life
ebbed away and on the mood and scene inside the
Mandela home at that time.
Holomisa said Mandela s wife Graca and his former
wife Winnie, one of Mandela s daughters and several
of his grandchildren were in the house Thursday,
where "somberness" prevailed.
Mandela, 95, had been in intensive care at his
home in Johannesburg s Houghton neighborhood
since he was discharged on September 1 from a hos-
pital where he had spent nearly three months for a
recurring lung infection.
Mandela appeared to be sleeping calmly but
Holomisa said that it was obvious that he was finally
succumbing to illness.
"I ve seen people who are on their last hours and
I could sense that he is now giving up," said Holomisa,
who is the leader of the United Democratic Movement
"You could see it is not Madiba anymore," Holomisa
added, using Mandela s clan name.
Holomisa said he had previously seen Mandela
earlier this year in the hospital.
"This time around he was not on life support,"
Holomisa said, adding that Mandela was lying on
"I could see that his condition had deteriorated."
Mandela s former wife, Winnie Madikizela-Man-
dela, said last month that he was unable to speak
because of tubes that kept his lungs clear of fluid,
according to The Sunday Independent, a South African
Holomisa said he spent almost an hour at Mandela s
home until around 7 pm, or about two hours before
Mandela died Thursday night.
...He was not on life
support, says family friend
Even in death, Nelson Man-
dela continues to impart wis-
dom to us. Many who admired
the man as an anti-apartheid
freedom fighter and reconcil-
iatory visionary also followed
his health challenges in his last
days, and the family disputes
that surrounded him in his final
moments, as unresolved end-
of-life issues surfaced and
spilled over into the public
According to international
media reports, at one point doc-
tors believed Mandela to be in
a "permanent vegetative state"
and therefore recommended his
life support machines should be
turned off. Later, however, he
was reported to be "critical but
stable." All the while, there were
reports of conflict within Man-
dela s family concerning treat-
ment options, estate disposal
and burial site selection for South
Africa s first black president.
The fact is that as patients
face their own mortality, it can
be difficult for them and their
families to make even seemingly
simple decisions. Research has
shown that physicians tend to
overestimate prognostic time-
lines. Patients are sometimes
offered expensive, invasive and
time consuming treatments, at
times to little avail. Undergoing
major interventions like surgery
or chemotherapy can provide
benefit to an individual but there
are also instances where such
procedures may reduce length
or quality of life.
Palliative care medicine has
evolved to address this difficulty.
If someone is diagnosed with a
serious or life-threatening illness,
palliative care can be involved
at any point in the course of the
disease. The goal is to maximise
quality of life for whatever time
Palliative care provides com-
prehensive medical, social, psy-
chological and spiritual support
for people with terminal or seri-
ous illness. The unit of care is
not just the affected individual
but involves the support network
of the family as well.
Many details of Mandela s
condition were not made public,
which is acceptable, as his doc-
tor-patient confidentiality was
being maintained. Still, there is
much we can learn from his sit-
uation and apply to our own
lives, especially if we have a loved
one who is seriously or termi-
Here are five things we should
all know about palliative care:
• Know your loved one s pref-
erences. It can be hard to make
decisions for someone when
they are too ill to communicate.
Talk to your ill loved one to
decide what is most important
to them. Talking about death
can be tough but not knowing
what that person wishes can
add stress and conflict to the
family dynamic. Most people,
when asked, prefer to be at home
surrounded by loved ones when
faced with end of life rather than
being in a hospital on machines
unable to communicate with
• Ask your physician lots of
questions. Most good physicians
are happy to receive, research
and answer questions. Ask
about treatment options. And
don t be afraid to ask what
would happen if you decided
not to receive a particular treat-
ment. Be balanced: try to ask
about both the risks and the
benefits of anything a medical
team can offer.
• Build a good support group.
It can be family, friends and
support from your religious
organisation. When faced with
an outcome of a shortened life,
one must remember that it is a
challenge that one should not
face alone. It is also a good time
to delegate extra responsibilities
and dispose of excess emotional
• Talk about death. Remem-
ber, talking about death will not
make it happen sooner. Many
families are afraid to talk about
end of life with a relative because
they are afraid their loved one
will "give up" and die sooner.
Some families try to block infor-
mation from the dying patient.
The physician s first duty is to
the patient so if the patient
wants to know, the physician is
ethically obligated to answer
honestly. This is a good thing.
Planning for death is useful
because it can help ensure that
one s end of life wishes are fol-
lowed and interventions that are
not desired are avoided.
• Embrace uncertainty. None
of us knows when we will die.
Most palliative practitioners talk
about prognosis in ranges of
time. Although there are certain
clinical clues that give a physi-
cian an idea about how much
time someone has left to live,
these are estimates and the
physician can be proven wrong.
Predictions of time left are gen-
erally more accurate the closer
the person is to death.
No one likes to talk about
death. But talking about it with
your loved ones can give insight
that can reduce stress and con-
flict. We have control about
nearly every aspect of our lives.
Shouldn t we plan for our final
moments as well?
• Ravindra P Maharaj (MBBS,
MSc, MRCP, American Board cer-
tified in internal medicine, geriatrics,
hospice and palliative medicine) is
a lecturer in the Department of
Clinical Medical Sciences, University
of The West Indies, St Augustine
Five things to know about palliative care
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