domingo, 15 de junio de 2014

Paul Preston: The Spanish Patient

Para los interesados en el relato directo de algunos acontecimientos históricos reproduzco un texto (en inglés) del historiador hispanista Paul Preston a propósito de la agonía y muerte del General Franco, con algunas referencias al libro que publiqué sobre estos hechos bajo el título: "El paciente de El Pardo"

Paul Preston.  The Spanish Patient
                 José Luis Palma Gámiz, El paciente de El Pardo (Madrid: Rey Lear, 2004)

Paul Preston
From the late 1950s, General Franco took an increasingly passive role in daily political affairs, reverting to a watchful role, dejando hacer a sus ministros.  Hunting, shooting, fishing and watching cinema and later television occupied much of the time left over from interminable audiences both civilian and military.  Years of investment in terror was still bringing its returns in terms of the fear that inhibited much of the opposition.  That combined with a large security apparatus ensured that he had little reason to think that his rule was threatened.  The only area in which it can be said that his attention was fully engaged was with regard to the succession.  He had pursued a slow strategy in the Civil War and engaged in a massive repression thereafter precisely in order to guarantee that his regime would last for a very long time.  Not for Franco the thousand-year Reich of Adolf Hitler – the Caudillo dreamed rather of an eternal regime.

            By the late 1950s, his closest comrades and advisers, especially General Camilo Alonso Vega and Admiral Luis Carrero Blanco, began to urge him with increasing vehemence to make arrangements for the succession.  To some extent, he had already done so in 1947 with the Ley de Sucesión which had declared Spain to be a monarchy without a king, Franco to be regent for life and granted him the power to appoint his own royal successor.  Now, to make a choice meant recognising his own mortality and so Franco did so with crab-like slowness.  The road that he took was to instruct the relevant functionaries to draft further constitutional laws that would bind the eventual successor and prevent him from changing the regime.  Thus, when Franco pronounced the now famous words ‘todo está atado y bien atado’, he might as well have said ‘mi sucesor está atado y bien atado’.

            However, his eventual choice, of Juan Carlos de Borbon, ensured that many of the Caudillo’s more extreme followers did not share his confidence that the designated successor’s oath of loyalty to the Fundamental Laws and institutions of the Movimiento would guarantee the survival of the regime unchanged.  As time passed, and signs of the dictator’s mortality became ever more unmistakable, a kind of fearful paranoia took hold of the hard-liners who were known collectively as the ‘bunker’ and most particularly of those who felt most vulnerable, the dictator’s own inner circle, his wife, his son-in-law Cristobal Martinez-Bordiu and others of the so-called ‘camarilla de El Pardo’.  Suspicious of Juan Carlos’s possible democratic intentions, both Doña Carmen and her son-in-law hoped to see him replaced as successor Alfonso de Borbón Dampierre who was married to Cristóbal’s daughter María del Carmen.  Some months before the dictator’s final agony, Cristóbal in a Madrid restaurant had toasted his daughter and Alfonso as ‘el futuro Rey Don Alfonso XIV y la princesa más bella de Europa’.[i]  When Franco’s first really serious illness afflicted him in the summer of 1974, his delegation of his powers to his successor was all too brief, something that reflected those fears.  Even more so, the near terror of the Francoist hierarchy was exposed during one of the most remarkable episodes of the dictatorship – the Caudillo’s final illness in the autumn of 1975, when he was kept alive despite intense suffering, despite the please of his daughter that he be left to die in peace and despite the certainty that all the efforts to keep him alive were in vain.

            The most trustworthy reconstructions of that bizarre and fateful episode in recent Spanish history have come from the pens of doctors – from that most humane of those who looked after Franco, Dr Vicente Pozuelo in his book, Los 476 últimos días de Franco (Barcelona: Planeta, 1980), from the most loyal of his retainers, Dr Vicente Gil in his book Cuarenta años junto a Franco (Barcelona: Planeta, 1981), and from the great surgeon, Manuel Hidalgo Huerta in his book Cómo y porqué operé a Franco (Madrid: Editorial Garsi, 1976).  And now there arrives one of the most interesting of all, from the youngest of the members of what came to be known as the equipo medico habitual, the thirty-eight specialists in different fields who attended Franco during the five weeks of his final agony.  At the time, José Luis Palma Gámiz was a thirty-one year-old cardiologist and precisely because of that relative youth, his fascinating book provides a fresher vision, respectful of all the protagonists of his story, but unencumbered by the reverence for Franco that pervades the pages of Pozuelo, Gil and Hidalgo Huerta.  His book is also remarkable for the clarity and realism with which it is written.  He also brings into his story not only the dictator’s family but also characters often forgotten, such as Juanito, Franco’s faithful ayuda de camara (batman), or Nani and Lina, his nurses since his thrombo-phlebetis of 1974.  Lina was a lively and witty brunette from Ceuta and Nani, a gallega from Santiago de Compostela.  Franco was utterly bewitched by her and she was devoted to him, acting like an over-indulgent mother, spoiling him and calling him ‘churriño’ and ‘mi rey’.[ii] 
It was exposure to the stabbing autumn winds of Madrid when a frail Franco addressed a huge crowd in the Plaza de Oriente on 1 October 1975 that set off the escalation of medical crises which ended in his death fifty-one days later.  His son-in-law was keen that the dictator maintain his political presence, commenting, on 13 October, to a colleague who asked after his health that he was ‘como un toro’.  Yet only the day before at the closing of a function at the Instituto de Cultura Hispánica, television viewers had seen an emaciated Franco struggling without success to rise from his chair.[iii]  After a day of nose-blowing on 14 October and other symptoms of influenza, the first signs of the crisis to come emerged in the early hours of the morning of 15 October.  In Dr Palma’s evocative phrase ‘A esas horas, todo el palacio de El Pardo, como es costumbre desde hace cuarenta años, esta en silencio y a oscuras’.   Franco awoke in a cold sweat with pains in his chest, shoulders and left arm: he had suffered a heart attack but insisted that he was merely suffering indigestion.  When the cardiologist Vital Aza read his electrocardiogram and diagnosed acute infarct, he was appalled to discover that Franco had refused to suspend his work programme, holding eleven formal audiences on Thursday 16 October and watching films in the evening.  Deeply preoccupied by what this might mean, Cristobal was reluctant to believe Dr Aza.   Against the advice of Aza, Pozuelo and other doctors, Franco insisted on chairing a cabinet meeting on Friday 17 October.[iv] 
"Les médecins du Caudillo" según un periódico francés de la época

He refused to have the ministers come to his bedroom or to go to the meeting in a wheelchair.  His alarmed doctors conceded only on condition that he wore electrodes connected to a heart-monitor which had been brought from the Ciudad Sanitaria La Paz.  During the session, his condition was worsened by news of the Moroccan ‘green march’ on Spanish Sahara.  Leaving aside such ‘disobedience’ when he gave higher priority to duties of state, Franco was regarded by all of his doctors as an ideal patient, deferential and uncomplaining in the face of physical pain.

            On Saturday 18 October, Franco got up and worked in his study for the last time, probably writing his last will and testament with the aid of his daughter Carmen.  On Sunday 19 October, he heard mass and took communion.  Later, with Dr Palma, he watched the televised match in which Atlético de Madrid beat Barcelona 3-0.  Palma disliked having to sleep over in El Pardo because at night it was in total darkness as a result of Franco’s orders that lights be switched off to save energy.  At 11 p.m. on the night of 20 October, the dictator called the nurse Lina to complain of chest pains, cold sweats and vomiting.  He had another heart attack.  Although his sheets were soaked with sweat and vomit, no one knew how to get access to the linen room (almacén de lencería) to change them because, said one of the staff, ‘en cuarenta años en esta casa nunca se ha molestado a nadie después del toque de retreta’. 
Primero de una larga serie de confusos partes médicos 

Although Franco was able to watch a film on Wednesday 22 October, his condition had begun to deteriorate badly.  As a result of his heart not pumping fully, there were signs of fluid on his lungs and serious renal difficulties.  Unable to sleep, he complained of fierce pains in the shoulders and the lumbar region.  He had had a third heart attack.  His death was accidentally announced on ABC News in Washington and in several European capitals.  Spasms of terror ran through the upper reaches of the Francoist political class, fearful that the Dictator would take their privileges with him to the grave.  The majority of the doctors who were now part of the ever-growing medical team believed that daily reports about the Caudillo’s progress should be issued, but what Dr Palma calls ‘los oscuros intereses de algunos’ worked to keep the reality of the Caudillo’s situation hidden from the Spanish people.  Cristóbal Martínez-Bordiu reluctantly agreed but insisted that the reports should use highly technical circumlocutions such as ‘insuficiencia coronaria con zona eléctricamente inactivable’ instead of ‘massive infarct’.  On various occasions, senior Francoists would urge the doctors ‘que hiciéramos médicamente lo imposible por mantener al dictador sentado en su poltrona para toda la eternidad’.  In contrast, Franco’s wife and daughter were concerned only that he did not suffer unnecessarily.[v]

On 24 October, Dr Palma was invited to take lunch with the family.  He was deeply impressed by the quality of the wine served and amused by Doña Carmen’s chatter about ‘Adolfo’ (Hitler) and ‘Benito’ (Mussolini).  Before lunch was over, Palma was called urgently to Franco’s bedside.  His face twisted with pain, soaked in icy sweat, he was throwing himself about the bed.  He had suffered a brutal bout of ‘cardiac insufficiency’.  It was a reflection of his intense pain that his diastolic pressure briefly rose to 22.  More specialists were added to the medical team as dental problems flared up and he began also to suffer abdominal distension as a result of stomach haemorrhage.  It was quickly to become apparent that the sheer variety of Franco’s problems was causing conflicts between both his various medications and his various specialists.  The neurosurgeon, Sixto Obrador Alcalde suggested that the gastric haemorrhages were the consequence of medication.  Certainly heparin given intravenously to thin the blood, partly because of his thrombo-phlebetis and also to facilitate the transfusions, exacerbated bleeding from ulceration while morphine given to ease his pain paralysed normal gastric function.  When his dental specialist, Dr Juan Jose Iveas Serna, was called, he noticed specks of blood in his sputum and commented to Dr Obrador that this surely meant that Franco had pneumonia.  Obrador agreed but advised him ‘Tú vete a lo tuyo y no te metas en camisa de once varas que aquí cada cual hace lo mismo, nadie quiere comprometerse ni quedar a mal con nadie’. (‘Just stick to your own speciality and don’t stick your nose in other people’s business because that’s what we’re all doing here.  No one wants to take a stand or upset anyone.’)  Even in the benevolent account of Dr Pozuelo, it is clear that no one wanted to take responsibility.[vi] 

On Sunday 26 October, after a further internal haemorrhage.  The gloomy medical report issued on 28 October led to the widespread assumption that the end was nigh and several radio stations played suitably lugubrious music.  By 29 October, he was receiving almost continuous blood transfusions.  Throughout this time, he was in acute pain.  In his green striped pyjamas, he seemed to Dr Palma to be like a prisoner, ‘un viejo indefenso y doliente que reclamaba ayuda desde el fondo oscuro de sus angustiados ojos’.  Understandable compassion for their patient saw Palma and others of the medical team affected by a kind of Stockholm syndrome which lead them to shelve any hostility they might have felt towards the dictator.[vii] 
Dres C. Martínez-Bordiú y JL Palma

By 30 October, there were signs of peritonitis.  On being told of the heart attacks and the serious intestinal complications, concerned that Spain had no effective head of state, Franco called for the implementation of Article 11of the Ley de Sucesion.   This was the situation that Cristobal Martínez Bordiu, had dreaded.  The Caudillo’s dentist, Dr Juan José Iveas Serna, told a colleague, Dr Julio González Iglesias, of his conviction that the decision to keep Franco in El Pardo was made by Cristobal Martínez Bordiu.  If that was the case, it must have been because he did not want the Spanish public to realise the gravity of his father-in-law’s illness and hoped thereby to control the situation.  According to Iveas Serna, the yernísimo’s ‘intervenciones en las enfermedades del Caudillo no pudieron ser más nefastas y disparatadas’.[viii]   Now, Cristóbal and the president of the council of ministers, Carlos Arias Navarro, thrown together in alliance, hoped to get Juan Carlos to accept an interim position, as he had reluctantly done a year previously, but now he refused.  Franco was no longer Head of State.  Sections of the press began to build up the image of Juan Carlos and to talk of Franco in the past tense.  The determination of the El Pardo entourage to keep Franco alive despite his intense suffering was not unrelated to the fact that the term of office of Alejandro Rodríguez Valcárcel as President of the Consejo del Reino and of the Cortes was due to end on 26 November.  If Franco could recover sufficiently to renew Rodríguez Valcárcel’s mandate, the clique would have a key man in a position to ensure that the president of the council of ministers chosen by Juan Carlos would be ‘reliable’.[ix] 
By the night of Sunday 2 November, Franco’s intestinal haemorrhage was intensifying.  The bed, the carpet and a nearby wall were soaked in blood.  Despite considerable sedation, the dictator was suffering appalling agony.  Dr Pozuelo extracted from his pharynx ‘un coagulo como un puño’ (a blood clot the size of a fist), which indicated that a major blood vessel was perforated.  However, the use of coagulants to stem the bleeding was not possible precisely because his heart condition required anticoagulants to thin the blood and assist its flow.  In the late afternoon of 3 November, the scale of the haemorrhage was such that Franco was losing blood both rectally and orally faster than it could be transfused and the vomiting of blood was severely affecting his respiration.  The medical team believed that, without aggressive intervention, Franco might die at any moment.  Dr Hidalgo Huerta, by his own account, thought there was very little that could be done.  However, faced by intense pressure from the Caudillo’s son-in-law and with little optimism, he said that ‘la única posibilidad, aunque muy remota, es intentar una operación, aun teniendo un diagnóstico incierto, y ver si podíamos hacer algo sin quedarnos de brazos cruzados viendo morir a un hombre en el impresionante dramatismo  de una hemorragia cataclísmica’.  However, apart from Cristóbal Martínez-Bordiu, Dr Hidalgo Huerta and the anaesthetist Roberto Llauradó Sabe, among the other members of the equipo médico ‘la opinión reinante era abstencionista’.   Even Dr Hidalgo Huerta had grave doubts about trying an emergency operation because oedema (swelling) of his neck, upper arms and chest led him to suspect that there had been a massive thrombosis of the superior vena cava.[x] 

At this point, Hidalgo Huerta informed both Juan Carlos and Arias Navarro that Franco’s death was imminent and the Caudillo’s chaplain, Father José María Bulart, led prayers at his bedside.  However, Cristobal Martinez Bordiu intervened once more, saying that he had sat Franco up in bed and noted that the oedema of his upper thorax had disappeared which signified that there was no thrombosis of the superior vena cava.  Opinion switched back in favour of an intervention.  With no time to get Franco to a properly equipped hospital, he was pushed on a trolley to an improvised operating theatre in the first-aid post of the guard at El Pardo, in the words of Dr Iveas Serna, ‘poco menos que en una cuadra y en condiciones tercermundistas’ and, in those of Dr Palma, ‘era como retrotraerse a la guerra del 14’.[xi]  A copious trail of blood marked his route.  Even at this stage, there were voices within the medical team opposed to a surgical intervention.  Hidalgo Huerta commented that if it were his own father, he would operate which seemed to convince the other members of the team.  Nevertheless, he then addressed them with the words ‘Yo opero si vosotros decís que opere.  Pero, de ninguna forma, cargo solo con la responsabilidad’.  In the course of a three-hour operation, from 9.30 p.m. to 00.30 a.m., supervised by Dr Hidalgo Huerta, the medical team discovered a blood clot weighing two kilos and the ulcers which had opened an artery.  In the course of the operation, Father Bulart gave him extreme unction.  Nine litres of blood had been transfused and the ulcerations sutured.  Franco survived the operation but was now found to be suffering severe vascular congestion and uraemia (a morbid condition of the blood due to the retention of urinary matter normally eliminated by the kidneys).  This renal failure was probably caused by tiny clots gathering at the kidneys as a result of the weakness of his heart combined with the scale of the transfusions.  He now had to have constant dialysis.  By Friday 7 November, the gastric haemorrhages had begun again and it was proposed by Pozuelo that Franco be moved to a properly equipped hospital, the Ciudad Sanitaria La Paz.  When Pozuelo informed him, Franco said ‘No me deje’.  In the afternoon of a cold and wet autumn day, he was taken there in a military ambulance.[xii]

Franco was wheeled directly to an operating theatre, with both the uraemia and gastric ulceration intensifying, at 5.30 p.m., another intervention began.  It lasted four and a half hours, required the transfusion of five and a half litres of blood and saw two thirds of his stomach removed with a view to reducing the amount of gastric wall subject to ulceration.  Dr Hidalgo was considerably more optimistic after this second operation than he had been after the first because of the positive reaction of Franco.[xiii]  However, over the next two days, it became evident that the Caudillo’s renal function was worsening ing and he was having breathing difficulties.  By Wednesday 12 November, there were further gastric haemorrhages and blood was seeping into his bronchial tree.  The possibilities of alleviating his condition were now virtually non-existent without what the increasingly pessimistic Dr Hidalgo Huerta called a ‘tremenda mutilación’.  Thereafter, Franco was kept alive by a massive panoply of life-support machines, regaining consciousness occasionally to murmur ‘qué duro es morir’.   Vicente Gil visited him and won no friends by commenting ‘Es que un hombre que esta soportando con una dignidad tan ejemplar esta agonía, porque es increíble lo que le están haciendo soportar, pienso que debería morir con la dignidad que le ha caracterizado siempre.  Con la dignidad de un hombre’.[xiv] 

By Friday 14 November, the Caudillo took a dramatic turn for the worse.  He needed a ventilator to assist his breathing and his white cells began to increase.  Then, the sutures from his previous operation burst and a further massive haemorrhage began.  His blood pressure plummeted.  Franco’s stomach was massively distended as a result of the peritonitis and the doctors proceeded to an intestinal puncture and a peritoneal lavage which revealed corrosive intestinal liquids in the peritoneal cavity.  A third operation at 4.00 o’clock began in the afternoon to re-suture his stomach and also to insert a number of drainage tubes to extract liquid from his abdomen.  Thereafter, Hidalgo Huerta’s team remained deeply pessimistic, convinced now that they had reached the limit of surgical possibilities.  For two days, Franco’s condition remained stable and they began to hope.  However, at 10 p.m. on Monday 17 November, another massive intestinal haemorrhage began which resisted all efforts to stem it until 6.00 a.m. on Tuesday morning, by which time Franco had been given a further three litres of blood.  In the course of the day, his breathing faltered and his blood pressure remained low.[xv]

The hospital was besieged by journalists.  Enormous sums were offered for photographs of the dying dictator.  Dr Pozuelo indignantly rejected fabulous offers only to discover later that the Marqués de Villaverde had already made full use of his own camera.  In fact, given the security arrangements, he was the only person who could have done so and he did so openly, despite the protests of Dr Palma.[xvi]  Franco was alive but only just, barely conscious, and entirely dependent on the complex life-support machinery.  Cristóbal Martinez-Bordiu asked Hidalgo Huerta one last time ‘¿crees que puede hacerse algo más?’  Hidalgo Huerta refused to operate yet again.  As a last resort, Cristóbal Martínez-Bordiu and Vital Aza continued treating the Caudillo with antibiotics and sulphonamides.  Finally accepting that it was to no avail, Cristóbal obliged the other members of the team to leave.  The Caudillo’s daughter Nenuca insisted that he be allowed to die in peace.  At 11.15 p.m. on 19 November, the various tubes connecting him to the machines were removed.  Although his son-in-law initially agreed, according to Pilar Cernuda, citing the diary of one of Franco’s military aides, Lieutenant-Colonel Antonio Galbís, pressure from the Caudillo’s military staff, Alfonso de Borbón Dampierre and some of the doctors saw the initial order to cease treatment rescinded.  The final crisis began in the early hours of the morning of 20 November.  Despite frantic efforts at resuscitation, by 3.30 a.m. Franco was dead.  However, loath to give up, Villaverde urged Vital Aza to give Franco a last heart massage.  It was in vain.  He probably died shortly afterwards.  The official time of death was given as 5.25 a.m. on 20 November 1975, the official cause as endotoxic shock brought about by acute bacterial peritonitis, renal failure, bronco-pneumonia, cardiac arrest, stomach ulcers, thrombo-phlebitis and Parkinson’s disease.  The embalmers could begin their work.[xvii]

[i] José Luis Palma Gámiz, El paciente de El Pardo (Madrid: Rey Lear, 2004) p.64.
[ii] Palma Gámiz, El paciente, p.44.
[iii] Palma Gámiz, El paciente, p.55.
[iv] Palma Gámiz, El paciente, pp.19, 59-60, 68-78.
[v] Palma Gámiz, El paciente, pp.108-21, 135-6.
[vi] Palma Gámiz, El paciente, pp.124-30; Dr Vicente Pozuelo, Los 476 últimos días de Franco (Barcelona: Planeta, 1980) pp.227-9; Julio González Iglesias, Los dientes de Franco (Madrid: Editorial Fénix, 1996) p.393.
[vii] Palma Gámiz, El paciente, p.31.
[viii] González Iglesias, Los dientes, pp.366-9.
[ix] Arriba, 14, 18 November 1975; Javier Figuero & Luis Herrero, La muerte de Franco jamas contada (Barcelona: Editorial Planeta, 1985) pp.35-6, 50-1.
[x]  Manuel Hidalgo Huerta, Cómo y porqué operé a Franco (Madrid: Editorial Garsi, 1976) pp.19-24; Pozuelo, Los 476 últimos días, pp.231-4.
[xi] González Iglesias, Los dientes, p.366; Palma Gámiz, El paciente, p.146-8.
[xii] Pozuelo, Los 476 últimos días, pp.234-6; Hidalgo Huerta, Cómo y porqué operé, pp.26-4; Palma Gámiz, El paciente, pp.149-68.
[xiii] Hidalgo Huerta, Cómo y porqué operé, pp.48-55; Palma Gámiz, El paciente, pp.171-5.
[xiv] Dr Vicente Gil, Cuarenta años junto a Franco (Barcelona: Planeta, 1981) p.212; Hidalgo Huerta, Cómo y porqué operé, pp.55-8; Palma Gámiz, El paciente, pp.176-81.
[xv] Hidalgo Huerta, Cómo y porqué operé, pp.59-68; Pozuelo, Los 476 últimos días, pp.238-41; Palma Gámiz, El paciente, pp.182-5.
[xvi] According to Jaime Peñafiel, El General y su tropa (Madrid: Ediciones Temas de Hoy, 1992) pp.29-35; Pedro J.Ramírez, El año que murió Franco (Barcelona: Plaza y Janés, 1985) p.255; Palma Gámiz, El paciente, pp.187-92.
[xvii] Arriba, 20 November 1975; Ya, 20 November 1975; Pozuelo, Los 476 últimos días, pp.224-41; Hidalgo Huerta, Cómo y porqué operé, pp.68-70; Figuero & Herrero, La muerte, pp.102-12; Luis Herrero, El ocaso del régimen. Del asesinato de Carrero a la muerte de Franco (Madrid: Ediciones Temas de Hoy, 1995) pp.274-80; Pilar Cernuda, 30 días de noviembre. El mes que cambió la historia de España (Barcelona: Editorial Planeta, 2000) pp.133-40; Palma Gámiz, El paciente, pp.205-12.