Manika’s Plan – All Episodes

Episode 1 – Introduction

This is a story. I thought up until Jan 25, that I could interest people into listening to what I had to say about losing weight, becoming fit etc. Then I realised that it’s not my job. But what I can do is to tell a story……..so that is how it all began……….

Once, there was an Indian lady who lived and worked in the UK. Her name was Manika. By the time I heard about her, she had already passed away, but she had spent decades as a family doctor in South London.

For more than forty years, she became not just a trusted doctor, but something more, someone with an unusual secret.

I never met her. But I found out about her, when, on a long-haul flight, I found myself sitting next to someone who was the elder one of her two sons. (We agreed that I would not mention their names)

We started talking – about travel, about life, about family. It was one of those rare conversations where both people want to listen more than they want to speak, pulling the discussion deeper and deeper. I spent a good deal of time explaining my ideas for “No Biscuits”.

By the time we landed in Istanbul, we had agreed to stay in touch. As we parted, he said something unexpected:

“I think that there’s some quite special information that I’d like to share with you, something our family has never told anyone. But I have made certain commitments to my brother and father, so I need to check with them first.”

Intriguing, right?

I thought so, too. But I decided to leave it up to him to get back to me. And while I never completely forgot about our conversation, with each passing month, it slipped further from my daily thoughts.

Then, more than three years later, out of the blue, I received a message.

“Dear Will,

I’m sorry I haven’t been in touch. You must have thought I had forgotten about our conversation on the flight, but I haven’t.

After we met, I spoke to my father and brother about sharing something very personal with you. They both refused. Their reason? Neither of them knew you. And, if I’m honest, I couldn’t really argue with that. But I held on to my instinct that you would treat this knowledge with respect.

For years, there was nothing I could do.

Then, about twelve months ago, my father was diagnosed with colorectal cancer. He chose not to have treatment, partly because of his age, partly because he didn’t want to undergo the side effects of chemotherapy.

In the last days of his life, just over three months ago, he called my brother and me to his bedside. He was physically very weak by now, but his mind was still clear. He told us about a dream moment he had experienced during one of his brief afternoon rests.

In it, he was seated with our mother, Manika. The only thing he remembered after waking was that she had placed her hand on his arm and said: “You can share.”

My father knew exactly what she meant, so he called my brother and he then also agreed that I could contact you.

Two days later, my father passed away. Since then, we’ve been dealing with everything that follows a death. But now, we’re ready. If you can come to London, my brother and I will share the information….”

I was quite curious to discover more. But still, it took me another three months before I made the journey from Sofia to London.

The brothers chose to meet in a quiet corner of the Hotel Russell (as it was then), in Russell Square, central London.

First, we caught up. I also got to know the younger brother, and I felt some obligation to let him test me out as part of the preparatory process. We talked through all recent events. But after a couple of hours, we came to the heart of the matter.

This was a secret, more than anything, a professional secret that their mother had kept since she first became a doctor, more than fifty years ago.

And when they told me what she knew, I immediately understood both the power, the weight and the sensitivity of that knowledge. I also understood why it had never been possible to reveal the secret while she was still practising and even while she was still alive. She had asked them to promise not to reveal anything until after she had passed away, and you too will understand why that had to be.

In a couple of weeks, I will tell you more.

Manika’s Plan – Episode 2 – Introduction

Last time in Manaika’s Plan:

A long-haul flight, an unexpected conversation, and a decades-old secret held by an Indian doctor named Manika. Her son had promised to reveal it – but only when the time was right.

That time had come.

We met and sat in the far corner of the bar of the Kimpton Fitzroy Hotel, a grand Victorian landmark on Russell Square, London. The elder son greeted me with a firm hug, his warmth unchanged since our last meeting, several years before. The younger son, whom I’d never met, was more reserved -polite, but slightly detached, as though unsure of his role, other than as a family witness, in the unfolding, very personal story.

We settled into our chairs, and once the tea was poured, the elder son leaned forward. “Right, let’s start.”

He began at the beginning.

“Our mother was born in 1930, in Calcutta. A Bengali family, ambitious, driven. She was just 20 when she and her parents moved to the UK, right after the war, when Britain was crying out for doctors. She qualified as a General Practitioner.

She began practicing in Newham, East London, a place still bearing the scars of wartime bombing. Communities were struggling. Men worked the docks, women stitched garments in textile factories, and the National Health Service (NHS) providing free health care for all, barely a decade old, was stretched thin.

She built a solid reputation quickly,” he continued. “Hard-working, dedicated. Families relied on her. She knew their struggles, their illnesses, their hopes.”

And then – one day….

She noticed something strange. At first, she dismissed it. A trick of the mind. But it kept happening. Over and over again.

He paused, choosing his words carefully.

“This is the thing….within minutes of meeting a patient…..she would see a number in her mind – a week, a month, and a year. She would soon come to know this date as the date, or week, in fact, when she simply knew that their lives would come to an end.”

I felt my pulse quicken and my thoughts tossed between incredulity and disbelief.

“She told herself it was nonsense. But it was happening with nearly every patient. If she was very tired or unwell, it wouldn’t appear. But on a normal day, it was automatic. She would sit down, listen to their symptoms, and the number would be there.”

I had to ask the obvious question. “Did she ever tell anyone?”

“No. Not for decades. Not even our father. But she kept records. Every date, every patient, every meeting, carefully noted in her medical diary. And of course, over time, in some cases years or even decades, the dates were verified against actual events. Without exception, the last date timing that she saw, proved to be accurate to within one week.”

He glanced at his younger brother, who had remained silent until now. The younger man gave a small nod, as if to confirm that, yes, this was real.

I still struggled to grasp this as truth, but the grave look on their faces told me that they were not playing around.

The elder brother continued.

“After she retired, without telling anyone, she handed over all these diaries, to her own solicitor, whom she had appointed herself and whose only task was to manage their safekeeping, for obvious reasons. He was sworn to secrecy in his handling of this task. Our family solicitor, who dealt with all the admin after her death, and dad’s, was a completely different person and company.

And even after she passed, as per mum’s instructions, it was several years before her “medical” solicitor contacted us and handed over this letter, written by mum.

I would like to read it to you now and if we then can agree on everything, I will give you a copy after.

To be continued…

Manika’s Plan – Episode 3 – Introduction

Last time in Manika’s Plan:

Manika’s son reveals a startling secret about his mother – as a doctor, Manika possessed an uncanny ability to foresee patients’ deaths with eerie accuracy, recording each date in her medical diaries. Years after her passing, a solicitor that she had secretly entrusted with these records, delivered a letter from their mother, holding the key to her lifelong mystery. So here continues the conversation in the hotel with the two sons…

Her elder son said..

So this is the letter that we received from her “secret” solicitor.

‘‘My Dear Boys,

I need to explain to you why you are reading this letter now and the events that I needed to know were already in place before I could tell you about my life and its powerful secret; something that I have been struggling to hold and manage on a daily basis, for such a long time.

Firstly, I knew that your father would pass after me and I didn’t want to burden him with managing this issue in the latter years of his life, especially when it was clear that his health was already failing. I also needed you both to be mature enough to handle the matter. Thirdly, you will understand that I had to protect and respect the confidentiality of my patients.

So I made two stipulations to my solicitor, whom I appointed without you or your dad’s knowledge The first one was that I had demanded that no details from my diaries may be used until that patient was no longer alive and secondly that an alias name be used in all cases.

So having made that caveat clear – this is what it’s all about.

Since my earliest days as a doctor, almost immediately after qualifying and starting in my GP practice, I was able to receive information (it just came to me, with no effort) about when a patient would pass, to within the accuracy of a week or so. For weeks after this, I was in total physical and mental shock, and your father thought I had fallen ill.

This bizarre ability proved itself constantly over many years and decades and I had to learn to manage the effect of this information and the weight of thre responsibility; and it wasn’t easy. Initially, I just had a list of patients, meeting dates and death dates, for much want of better words.

Over time, I was able to understand this phenomenon and its consequences more deeply.

After the first meeting, I always had a “departure” date for them. But of course, I was seeing the same patient repeatedly, at least a couple of times per year and often much more frequently. Most of my patients and their families tended to stay with me for the long term, so over my 45 years, I was seeing some people for literally decades, sometimes across three generations of one family. But this wasn’t the most interesting aspect of all.

What I came to realise, over time, was that if they changed their behaviour or habits in some way, or if I was able to successfully administer some kind of treatment to them, then, when I met them again later, I noted that the date of their passing could shift. So the ‘death date’ could shorten or extend, it was changeable, I really doubted my own sanity.

But as I became used to handling this burden of responsibility, this date movement was what really intrigued me, because over the decades, I was able to witness real changes in peoples’ lives when they decided to take control and change something. Or, in fact, contrastingly, more often than not, I also saw how some seemed powerless to change negative habits, even when they knew that they were effectively harming themselves.

So as a consequence of all this, I was able to develop, over this period, a sort of a template or plan. After I retired, I counted up my patient meetings and over 45 years it came to over 330,000 interviews, can you believe it? So much listening (And then I used to come home after work and your father and you boys still expected me to listen to you too!!) But really, I always, always felt my spirits lifting, when I was on my journey home to see you all, I love you so much.’’

We had to have a pause here for a couple of minutes, as the boys were a bit overcome with emotion and I gave them some space for a few minutes.

The elder son recovered and continued reading…

“My plan was built on these thousands and thousands patient interviews and treatment sequences. Because when I had a sequence of treatment over days, weeks, months, years or decades, I could see the effect on the…let’s just call it the “due date”. So I knew, unbelievably, what effect any treatment was having and I could judge its effectiveness. This contributed to my success rate, and I think it is why I retained so many of my patients for so long.

Going back to the release of the diaries, at some point, after the due diligence has been completed, the solicitor will start to release to you my first batches of diaries, and you will be able to read of and then monitor the cases, through the passage of time.

My wish has always been to share this, but it has to be shared correctly and with someone who will act responsibly and morally with the information received and to use it to help others”.

The elder son paused here, partially overcome again with emotion, then steadied himself, and said:

“So you see, this is what is happening….based on what you told me and based on Dad’s dream, we are hoping that you are the right person to use this information in the correct way. The only question is……

To be continued…

Manika’s Plan – Episode 4 – Introduction

For the first time the younger son spoke up, in a rather agitated voice, pushing himself forward in his chair:

“The only question for me is…what do you propose? How are you going to handle this information, and how will you do justice to our mother’s legacy? Without looking at him, but out the corner of my eye, I could both see and sense that the elder son, who remained silent was also holding his brother’s unspoken thought.

The younger son’s eyes, voice and total energy said, very clearly, ‘‘why should I trust you?’’

What could I say? It told me that the relationship between him and his elder brother was not sufficient for him to believe the word of his elder brother, nor the message received from his deceased mother. He, maybe rightly, wanted his own proof of my word, my ability to honour the memory of his mother and maybe a guarantee that I would not somehow take advantage of the privilege that I was being given

I knew, like it or not, that this moment was probably my only chance to win their full approval. I could easily blow it and I could feel my stress level rising.

I had to think fast but remain calm and let my heart speak first. This is what came into my head.

‘‘Look, I know this is not easy, you have only received an indirect message about releasing this information from your mother via your father, neither of whom are with us any more, so I understand both the burden of responsibility and the uncertainty of allowing me into the centre of this highly personal situation.

You need to trust me. Where does trust come from? Only one place, the truth. How do you measure the truth? You compare words with deeds overtime, and you see the evidence of truth repeated, you look for any gaps between the words and the deeds.

I cannot create that trust without due process, so you have to decide to let me begin that process and let it be slow and careful, but let it begin. That is how you will trust me.”

Let’s agree this.

It is you who will receive the diaries, from time to time, as we know, from your mum’s solicitor, and it’s only you who can release them, so that is totally under your control and always will be. And I will always be accountable for the diaries to which I have access, let’s record it formally.

When you receive any diaries, you can give me one, and I will produce a draft blog, draw from it, write up the story and I will send it to you before I release it via the newsletter and so you will have an editorial veto on the content and the style. Then it will be my task to win your trust and confidence in the way that I tell the story.’’

There was a long pause – the younger son, with his head lowered, stared at the floor. Eventually he raised his head, looked at his elder brother, who gently nodded and with that the tension ebbed away and the younger son sighed and said: “I am still not sure”.

I don’t know why, but this was my last desperate attempt to rescue the situation.

‘‘The last thing I can say to you both, is, please don’t forget that I am someone who knows suffering, for most of my life, real hardship. I have known the depths of despair and disappointment, more than most, on many days, on many afternoons particularly.

“What do you mean?” said the elder son, with a furrowed brow of intrigue and concern.

‘‘It’s very simple’’ I said. ‘‘Since the age of 10, I have been a dedicated, loyal supporter of Stoke City Football Club – that’s all I need to say’.

They looked at each other, there was a long pause, then they both looked at me and burst out laughing. It was over….

(End of Introduction – now begin the stories, Albert, Marjorie and…)

Manika’s Plan – Episode 5 – Albert (No.1)

Ah, a reluctant patient. Manika pokes her head around the door to glance into the waiting room, to see Albert, still seated in a prayer like position, holding both hands together with his head and gaze lowered to the floor.

“Albert”, she calls, and then glancing at her notes, she asks slightly louder, “Mr Biggins?” He looks up, and with a heavy sigh, rises very slowly and awkwardly to his feet and edges unwillingly towards them.

Manika asks his, she assumes, wife: “Who made this appointment? “I did” she says. “It’s me who can’t sleep”. Manika is slightly confused that they seem to have two patients in one session, one who booked the appointment for the other, who doesn’t want to attend and she who booked it who both wants and needs help.

Manika manages to get them both into her room, shut the door, consider locking it, to prevent an Albert escape and gesture for them both to sit.

Manika takes her own seat across the divide of her desk and begins to assess what faces her. Albert has also seen more than 50 years, is tall and large, and breathing heavily. Manika can almost hear the wheezing of his chest and feel the discomfort of his shallow breaths. They look an oddly contrasting pair, but both clearly in need.

“So how can I help you…mmm…the two of you?”

A small pause and Albert’s wife, whose name, Manika discovers, is Mary, lets fly.

“It’s Albert, it is. I can’t sleep because he wheezes. He wheezes because he can’t breathe properly. He can’t breathe properly because he has asthma, and he has asthma because…”.

Almost at the same time as she says the word asthma, the drift of stale tobacco from Albert’s clothes, reaches Manika’s edge of the table and then….she sees, for the first time a date in her head, very connected with Albert, and this date is only nine months away. It’s Albert’s calling card, his days are rather numbered and as always happens, Manika faces the shock of knowing someone’s fate, and knowing that she has to preserve this secret, to protect herself from the impact of it and take the situation forward.

Manika needs a few moments to gather her own composure, to remain stable and keep control, so she makes some notes and lets the silence sit and lets her pulse rate at least level out.

As much as she would like to use Mary as his interpreter, Manika knows that at some point, she needs to reach Albert. She decides to keep it formal. For now, she will play the role of the “kind prosecutor”. She needs to drag forth but the simplest of information via some binary questioning. She calculates that he will not yet willingly tell her the story, but on the other hand he looks unlikely to muster untruths.

“Mr Biggins, is it true that you could be sleeping better than you currently sleep?”

“Mmmm” says Albert, hands together, head lowered again.

Manika glances at Mary, she nods… that’s definitely a yes from Albert.

“Mr Biggins, do you believe that your problem is your asthma?”

“Mmmm” Manika knows what this means, but to build her rapport she glances again at Mary, gives her a smile of encouragement and she nods, quite vigorously, her eyes lighting up.

Here she goes, pushing now into darker territory….

“Mr Biggins, do you smoke….. cigarettes?”

Silence.

Mrs Biggins, nods almost imperceptibly, torn between truth and betrayal.

Manika already has all the information that she needs, there is nothing more to ask. What she needs now…. is a plan.

She thinks that she has to go for the jugular.

She grasps the moment, as, for the first time Albert glances up at her. There is a sad desperateness in his eyes, mixed with fear.

This is her chance and she takes it.

“Mr Biggins… do you… love your wife?” She stretches this out.

An unbearably long and awkward silence of tension ensues, now it’s Mary’s eyes that turn downward and Mr Biggins just stares at Manika, like a rescued dog, seeking the end of its suffering.

His head shakes slightly, and Manika notices the beginnings of a tear appearing from the corner of his left eye.

That’s good enough, that’s very good, in fact.

“Mr Biggins, thank you very much, you may go now, and I will talk with Mrs Biggins about her sleep problem”.

As if released from prison, Mr Biggins rises quite quickly, turning away from his wife, dabbing his eyes with his handkerchief and after a quick shuffle, closes the door behind him.

Mary did not see the tears, but Manika did, and they mean that she can smile deeply at her and convey something of the love that she knows he feels for her.

“Mary, we need a plan, and I think I know what we can do to improve your sleeping, but I need your help. This is how we are going to begin, and we don’t have time to waste…..”

Manika’s Plan – Episode 6 -Albert

Previously in Manika’s Plan:

Manika has an appointment with Albert. His wife Mary, actually booked the appointment for him. Albert is not in good shape, long term smoking and respiratory issues. Manika sees Albert’s “due” date , only nine months remaining for him, he’s still in his fifties , she’s shocked. She has to deal with Albert’s “closed shop” and Mary’s tired anxiety. A tear reveals the truth. Manika needs a plan. She enlists Mary as the key to Albert’s healing. Not much time left.

It was Wednesday afternoon and Manika had asked for Mary to come in while Albert was still at work in the docks. Ostensibly, she had said that she wanted to help with her inability to sleep, and that was true, but Manika really wanted to address the source of the problem, which was not Mary, but Albert. His constant wheezing reduced her sleep to intermittent intervals and when Manika asked if she could sleep further away from him, she shuddered at the thought, saying that she could not let him down. Manika didn’t start to question that.

“Mary, for how long has Albert been smoking and how heavily?”

She sighed deeply and folded her arms.

“When he was younger, he played football, not professionally, but at a good amateur level, but when he was 26, he broke his ankle in a tackle and that meant that he could not play again at a serious level. We had just married and this hit him really hard. His club just dropped all interest in him and made no effort to support him psychologically. It wasn’t long after that he turned to smoking. Over the years he then tried to quit three or four times, but by the time he was forty, five, he was on about twenty a day and that’s how it continued. Since he was fifty, five years ago, I began to notice his breathing problems as well as a weight increase, as if each problem compounds the other. There’s no pleasure for him in the smoking, it’s just a habit that has gripped him”.

“And what about your relationship with Albert, how would you describe that?” Manika asked, carefully.

“Not so good, he’s often in a bad mood, because of his breathing, and that gets me down too and there’s no real break from it. I wake up tired.”

“I understand that. You know what, Mary, I don’t think he’s unhappy with you at all, in fact I know that the opposite is true”. Mary picked her head up quickly and quizzed Manika with her eyes. “How do you know?” she said.

“Just trust me, it’s true, he’s far more disappointed with himself than he is with you and that is what’s blocking him from you, that’s what we need to unlock.

I need to give you some homework to do, will you do that for me?” She nodded reluctantly, and Manika could see that half of the solution here was with the thinking as well as the doing.

“What I want you to do is to try to help him find a motivation for change. A motivation that can be or that can become stronger than his heavy habit.”

She rolled her eyes.

“Mary…. we have to believe, me and you at least, that he can find something solid. I know he’s blocked to change right now, and it won’t be easy for him to move, but we can try to help him find the solution, he won’t take it from anyone else. We cannot change him, he can only find the will within him to make his own changes.

So when it feels right, I just want to give you some ideas for questions to ask him, and they won’t seem like much in themselves, but they are just like seeds that we need to plant and then keep them moist.

“I’ll try” said Mary.

“I think the timing is critical, before you ask these questions, they need to feel like natural questions that won’t spark his suspicion, and he needs to be in the best mood possible. Can you think of any times when he is going to be happier, most of all?”

“Oh yes”, Mary jumped in. “Around 5.00 pm on a Saturday if Arsenal have won, then he is really alive and joyful for at least a few hours”

“Well there we are, try it then. These are the questions, I think that two are enough:

What is it that you miss the most, Albert?

What would you really like to change?

Mary’s eyes lit up for the first time. “It’s Wednesday today, I will check when Arsenal have their next game and will hope it’s not a difficult match!.”

“Yes” Manika said, looks that we, ladies, both have to take an interest in the fortunes of Arsenal Football Club”.

Give me a call on Monday, before 9.00 am and tell me what happens….

Manika’s Plan – Episode 7 – Albert

Previously in Manika’s Plan:

Manika arranges a private conversation with Mary to address her sleep troubles, which stem from her husband Albert’s chronic smoking and health decline. Mary reveals Albert’s emotional spiral began after a football injury ended his athletic hopes, leading to a long term smoking habit. Manika gently guides Mary to help Albert rediscover a personal motivation for change, suggesting she ask him two key questions when he’s in a good mood, ideally after an Arsenal win. Mary agrees, feeling a spark of hope for the first time and must call Manika.

“Mary, is that you? Good, so I see that Arsenal played at home and managed to win in the last five minutes. So, any luck with Albert and the questions?”

It was a good sign that Mary had called when they had agreed. Increasingly, in Manika’s career of dealing with patients and people in general, she was always wary of gaps between what people said they would do and what they actually did. It was a common syndrome and in her own head she used to refer to it as the “Mind the Gap” syndrome or in doctor’s unofficial shorthand “MTG”.

Sometimes, people don’t even realise they have a gap, some ignore it and others expand theirs , it often widens but rarely narrows. Manika has to keep a sharp eye on her own MTG too. It can erode or destroy trust instantly.

“It was hard” said Mary, “because it was1,1 till almost the end and the excitement of the winning goal gave him a coughing fit. It was like the hot water boiler was exploding and this dampened the immediate impact of the win.

But after about 15 minutes, I was able to ask him some questions while I was making him a cup of tea”.

She had jotted down the questions and then also his answers. He was now sitting in his arm chair, smiling and gazing at the ceiling and Manika could see him re, living the last minute Arsenal goal. Mary knew that this was the moment to strike.

She passed him his cup of tea and asked:

“Albert, dear, what is it that you miss the most?”

Answer , “Time… time…. I wish I could go back in time and not have started smoking. I should have been a drinker instead….” Not often did Albert joke like this, dark as it was , but he was quite cheerful.

“And what would you really like to change?”

Answer , “Do you know what, Mary? I would love to be able to run, or just to jog for five minutes without being out of breath. I was always running as a kid and then training daily with Enfield or just on my own, jogging along the canal paths and through parks, until the Millwall game.

Albert always referred to the day of his football accident as the “Millwall game”, the end of his football career, during a match against local rivals, Millwall’s second team.

Manika was a bit excited by these responses. “Mary, that’s very good, do you realise that?”

“What do you mean?” she said.

Manika replied: “He has given us, albeit unwittingly, due to the late goal, opened the window all but briefly into how he feels and maybe, just maybe, we have a hook of a solid motivation. What I mean is, he is firstly acknowledging to himself and to you, that he regrets smoking. Ok, we already know that, but it’s still an opening up, but even more importantly, he is giving us a way forward.

Now we just need to help him build his motivation to jog, that’s all”.

Manika could hear Mary sigh in heavy disbelief at her “misplaced” optimism.

“Let me ask you some questions to see if we can exploit this in the next few minutes before I start surgery at 9 o’clock.

Who or what could stimulate Albert to start exercising and using what trigger?

Did he ever want to stay in the football world, even after MAD?”

There was a pause, whilst Mary drew on her memory.

“He did toy with the idea of becoming a coach for a youth team, because that was what one of his close friends did, who had also become injured. In fact, that old friend is still a coach, and he’s the same age as Albert.”

“Are they still in touch?”

“No, Albert fell out with him. He became very negative, and I think he was unable to cope with how his friend had transitioned into a new role. They haven’t spoken for years.”

“Maybe it’s time that they did. Let’s see what we can do. What was his name?”

“Geoff Bridges.”

“Ok, let us both think about it and see what we can figure out. Well done, Mary, good job.”

Manika had a funny feeling that she had another Bridges on her patient list, she checked it out. It was a Lucy Bridges, but it wasn’t clear if she was a relative, and Manika couldn’t really breach patient confidentiality by asking her. A week later, she called Mary.

“Did you find out anything more about Albert and Geoff Bridges”. Mary sounded down.

“Albert told me that they had had a major falling out, about 5 years ago, when Albert’s breathing worsened. Geoff had a go at him and criticized him for not quitting the habit. Albert was hurt and jealous, hung up on him, and that was that.”

Manika checked the file on Lucy Bridges and saw that she was supposed to come in for a follow, up checkup on her last visit, but hadn’t yet done so, so she asked Jane, the practice receptionist, to set up a session. Ten days later, Manika met Lucy Bridges, a young mum, with a noisy three, year, old and just as she was leaving, Manika asked her: “Do you know of a Geoff Bridges, he’s an amateur football coach? He lives in Newham.”

Lucy paused at the door and scrunched her forehead in concentration, Manika’s heart sank a little.

Then her look brightened as she focused.

“I think he may be a cousin of my mum, but I am not sure , why?”

“I am in need of a football coach, and he may be someone who can help or recommend someone , can you ask your mum, and you could just let Jane know at reception, that would be so good, thanks.”

Two days later, Manika came into her office to find a stick, it label on her desk from Jane, “Geoff Bridges , 07760…12”.

Manika immediately called Mary. She was pleased but hoping that Manika would call him, but she explained that she couldn’t start to intervene in this way. She had done what she could, partly by good fortune and partly with a touch of detective work.

“You are going to have to ring him, Mary.”

“I’m scared to.”

“I know, but you need to find the courage, for Albert and for your family.”

To be continued….

Manika’s Plan – Episode 8 – Albert

Previously in Manika’s Plan:

Mary uses the emotional high from a football win to connect with Albert, who opens up about his regrets, especially smoking and losing his ability to run, after a football injury. There is a chance for change by reconnecting Albert with his old friend Geoff, now a football youth coach. After some detective work, they track down Geoff’s relative and obtain his number. Mary is urged to make the call, despite her fear, for Albert’s sake.

Mary came home from work, plumped her bag down in the hallway, and walked into the lounge. What she saw shocked her. Albert was sat on the floor of the lounge, with his back against his armchair, staring in front of him.

“Albert, what on earth are you doing? Are you okay?”

Albert looked up slowly at her and said, “I’m okay. I’m meditating. And that’s all.” Albert went back into his pose.

Mary stood there in disbelief, staring at him and wondering quite what was going on. “Well, when you’ve finished, come to the kitchen. I’ll make you a cup of tea and maybe you can explain what is going on.” And off she went to the kitchen.

About five minutes later, Albert appeared, with a strange, detached demeanour, but somehow with an element of unusual calmness about him, and he sat down at the kitchen table.

“Geoff Bridges called me,” he said.

“What?” said Mary.

“He called me at work this morning. He must have had my number from before. And he told me that he’d had a dream about me. That’s all he said. He just said, ‘I had a dream about you last night after my niece mentioned your name’.

And in the dream, you were fully dressed, in a kind of long coffin like leaky box made of boards. So like a coffin, but not a coffin. A series of boards fitted together the length of a coffin, but not perfectly sealed. And you were in this sort of coffin box, floating down the middle of the River Thames in the centre of London. Floating quite high in the water for some reason, but nevertheless floating down the river inside the box. And the boards on the top were not totally tight, so there was a tiny bit of light and air inside this box.

But you were stuck there, wearing your work suit, floating down the river. And at some point, the River Thames became just a large weir, and you disappeared over the weir and fell away into the distance. And that’s all I remember.’”

Albert picked up his cup of tea and sipped it.

“So, what was that all about?” said Mary.

Albert said, “I think it was a message, a warning, a signal that maybe I need to do something. And after that message, which wasn’t very pleasant, I thanked Geoff. That was the end of the conversation”.

“How very strange.” whispered Mary, clutching her teacup with both hands.

Then, during my lunch break, I found some guidance on the internet on meditation. Because I thought that if I want to change what I do, first of all, I have to change what I think about.”

Mary was quietly flabbergasted, but also quietly encouraged.

“So what’s meditation as far as you’re concerned, Albert? I have never heard you speak of this in the 43 years that I have known you.”

“Well, meditation is not what people think it is,” said Albert slowly, sounding as though he was some sort of expert on the subject. “Meditation, most people think, is about clearing the head of thoughts. To have no thoughts and just be sitting, thinking of nothing. But actually, meditation is not that at all.

And by the way, Mary, I smoked nineteen cigarettes today, not twenty. And tomorrow, I shall smoke eighteen and not nineteen.”

“Oh my goodness, Albert, what’s happened to you?”

“I think, Mary, Geoff’s phone call, Geoff’s dream, is a message to me that I need to change something. Otherwise, things are just going to get worse and worse. So that’s what I’m doing. I’m trying. In fact, I’m not just trying, I am just doing it, reducing my smoking. And I am starting to meditate. And in a couple of weeks I will be able to explain to you how the meditation works. Maybe it will be useful for you too.”

“I’d like to know, Albert. Of course, I’d like to know. Of course, this is a good thing. I’m just a bit shocked. In fact, I think that I am so shocked that I am going to have another cup of tea”.

A bit later, Mary felt she had to leave a message on Manika’s phone.

“Doctor, I came home tonight and Albert was meditating on the lounge floor, having been called directly by Geoff Bridges, who told Albert about his dream of seeing Albert floating down the Thames in a sort of coffin, and now he has also started to reduce his smoking by one cigarette per day. I don’t really understand anything about what’s going on, maybe he’s gone mad, and after all this, I had to have two cups of tea, but anyway, see you Monday.”

(to be continued……)

Manika’s Plan – Episode 9 – Albert

Previously in Manika’s Plan:

Albert, rattled by a haunting dream relayed by Geoff Bridges about him floating down the Thames in a coffin like box, decides it is a warning to change his life. When Mary comes home, she finds Albert uncharacteristically meditating and calmly announcing his plan to cut down on smoking, leaving her stunned. As Albert explains his newfound determination, Mary struggles to process the sudden transformation. In her confusion, she leaves a worried message for Dr. Manika, unsure whether Albert’s change is inspiring , or a sign that he’s lost his mind.

The door to Manika’s surgery clicked shut. Manika stared at it with a broad smile on her face and giggled for a second. Albert had just left and whilst slowly closing her door had waved his hand over the top of the door, like two little puppets waggling their legs.

Two years had passed since Manika had met Albert. Two years ago, Albert had been overweight, a habitual smoker, depressed, without meaning or purpose in his life. When she met him, Manika had seen nine months written clearly above his head as his life expectancy. Not only that, but she could foresee the increasing illness into which he would sink in those last nine months.

But look what had just happened. Albert had just told Manika one of his favourite jokes, tripped jauntily out of the surgery, and in one hour would be training the under, nine football team at his local club. She finished her concluding notes, knowing that Albert would not be back in her surgery for years, if not decades to come. Manika had written down his new “Sell by” date, and all we can tell you here is that it gave Albert a prediction of a vital and positive outcome for many years to come.

Still, the smile stayed fixed on her face. Her heart was filled with quiet joy, she understood deeply why she had become a doctor. This was someone who had been battling to breathe 24 hours a day, who had overcome those challenges and become, in every way, a new person, or maybe more accurately had simply found who they were supposed to be.

She re, opened her diary on the page where she had closed it, and flicked back to the beginning of her conclusion.

What were the lessons learned?

He had a loving wife, Mary, but Albert had become isolated, isolated inside his own head, incapable of breaking out of the cycle of negative thoughts. He could find no reason, no source of strength to break free from those damaging habits. But underneath, both his wife and Monika knew there was something, something deep in his subconscious that could be awoken. And they had found it. Football, and an old friend.

These two things together were just enough to give Albert a spark of hope, to nudge him toward believing there was something still worth living for. And so his bumpy journey had begun. His mind had grown curious again. His spirit started to awake.

He gradually moved from twenty cigarettes a day, gradually cutting down, one by one. Yes, there were a couple of setback days when Arsenal lost on a Saturday, understandable, really. But over two or three months, Albert managed to reduce his intake to five cigarettes a day. Giving up completely was a bridge too far at first. He needed a replacement, not a vacuum, and found it in two things: chewing gum and coffee. It wasn’t perfect, but honestly, far better to be chewing and sipping coffee than hacking up a lung every morning.

Mary was much happier cleaning away abandoned coffee cups and peeling off occasional blobs of chewing gum from the kitchen bin lid than cleaning out the filthy, rancid saucer of cigarette butts on the kitchen window sill outside.

By leaning on those two crutches of support, he gained enough strength and finally broke away from his dependency. Within a month of stopping smoking, four months since meeting Manika, his breathing eased. His walking improved. And, almost unbelievably, he took up meditation as a daily ritual.

For Albert, meditation was simply breath work: four seconds in, four seconds hold, four seconds out, four seconds hold , box breathing, as he called it. Four minutes in the morning, six minutes in the evening, which sometimes stretched to ten minutes before or after an Arsenal match. On some days, he did nothing at all, but gradually, over several months, it became a habit.

Of course, he was at first embarrassed about this. In his mind, meditation was the preserve of a cave living Nepalese guru on a Himalayan mountain top, not an ex dock worker from East London with a beer gut and a questionable passion for football. But Monika understood perfectly how powerful breath work could be, and she encouraged him every time.

She also supported his understanding of meditation.

“Albert, it’s not about trying to clear your mind and think of nothing, it’s about sitting calmly, relaxing, slow breathing, eyes closed. Then allow your mind to wander where it wants, letting it go off course and then gently realising that it’s gone off and then quietly inviting back to the source of the music or whatever the source is. And it’s like going to the gym, Albert, the more you do it, the easier it becomes, the better you are at it, but take it slowly and be patient.”

Albert used it to go to sleep also, Mary bought him some headphones, and he played his meditation music each night after he had given Mary a gentle hug and wished her good night.

Along with better breathing, more walking, and his new meditation routine, Albert felt stronger week by week. With Mary’s steady support, he adjusted his diet, after studying how to eat better. Less bread, fewer potatoes, pasta out, rice nearly gone. He took Monika’s advice, it was simple but effective:

“Think what your grandmother would have eaten (less the bread) , meat, fish vegetables, and if she was lucky, some fruit.

His weight came down.

Within six months, Jeff Bridges, who had been quietly keeping tabs through Mary, gave Albert a call.

“Albert, we’ve got a problem,” Jeff told him. “We’re losing our under, nine coach in six months, and we need a replacement.”

That was enough, Albert could feel that deeply as his staircase of further improvement to really gain some positive meaning to life.

That conversation gave Albert a six, month goal to get himself fit. Geoff set Albert a bar that was quite high:

“If you can run a mile in under ten minutes, and then within two minutes of finishing tell me a joke that makes me laugh, you’ve got the job.”

Challenge accepted.

Albert hit the canal, the park, the staircase, anywhere with a gravity challenge and chance to step out, back to training. At first, he could only walk, but by month four, he was jogging half a mile without stopping, building up his endurance. Eventually, he passed the mile and joke test with ease, surprising even himself, as well as Geoff and Mary.

For a man who had once coughed his way up a single flight of stairs, running a ten, minute mile was practically a minor miracle , though, of course, Albert wouldn’t have put it quite like that. He would have said it was“not bad, for an old smoker.”

(End of Albert’s story)

Manika’s Plan – Episode 10 – Marjorie

Previously in Manika’s Plan:

Albert, done and dusted, a new chapter follows. And by the way, Albert’s Under-10s football team is doing well.

But we move on, and Manika is going to be stretched in a new direction, pushed outside her comfort zone, and is going to have to make difficult professional and deeply personal decisions. It gives me goose bumps just thinking about what is to come, so we better get going.

The door to Manika’s surgery clicked open. It was Marjorie. Marjorie was an attractive, lively 38-year-old, wife and mother, whom Manika had known since Marjorie had been pregnant with her only child, who was now a boy of ten years old, Marcus. Manika had not seen Marjorie for nearly six years, because she had not been ill and neither had her son and there were no vaccinations due. Marjorie had missed her last smear test appointment, due to ‘pressure of work’ and never followed it up. Manika had seen Marjorie’s lifespan date then, six years ago and again now, and there was nothing to worry about. Marjorie was set for a long, extensive life span, or was she?

Marjorie was the office manager for quite a large accounting firm in central London, and her responsibilities ranged from hiring and firing receptionists, booking Michelin chefs to come in to prepare Board lunches, to ensuring that the coffee machine was not raided of beans by the cleaners during their night shift work. One night, she had slept under her desk in order to catch them red-handed.

“Marjorie, you look very well and have barely aged a day since I saw you last,” said Manika, in truth.

‘‘Thank you, Doctor, but maybe you need to see one of your colleagues to get your eyesight tested.’’

It was the same Marjorie, punchy, fun and never slow with an answer.

“So tell me this, I see from my notes that three years ago, we had a ‘‘no-show’’ from you for your smear test at 35 years and not a whisper from you since. You told our receptionist, Ann – ‘work pressure.’ when she called you. Just how bad was this work pressure?’ asked Manika.

Manika’s facial expression remained smiley and positive, but she swivelled her sitting position slightly, which Manika did not fail to notice.

“Doctor”’ she said, while she threw a carefully placed carefree glance at the ceiling, ‘‘if I remember correctly, on that very same morning, I had booked a critical hairdresser’s appointment with a close friend, who had some very hot gossip for me, and at the same time, we both had a 10% discount for making a dual booking during a low demand period. In the battle that played out for hairdressing and gossip versus smear test, Sasha, the hairdresser, won.’’

‘‘I see’’ said Manika, somewhat lost for further words. ‘’Well, hmm, so, well let’s book you in for next Wednesday, during your lunch break, and you really try hard to make it. Deal?’’

And with that, Marjorie swished back out of the room, allowing the door to clunk slightly more loudly and harder than it should have.

On the next Monday morning, early, before the Wednesday booked Marjorie smear test, Manika received a call from Ann at reception. ‘Manika, Marjorie is here and wants to know if you can squeeze her in before nine, she is acting a bit disturbed, even for her’.

“Okay, send her in, I have about 7 minutes, let’s see what’s going with her.’

Almost at the same moment, Marjorie both simultaneously knocked and crashed into the surgery and plumped herself heavily on her chair.

“I hope it’s cancerous, I hope it’s so cancerous that it’s straight to stage 4, Do not pass go, and we’re done and dusted and Iam off to meet the main designer before the end of the month. That’s how it is, doctor, that…is…how…it…is.’’ She was almost shouting,

as she thumped her fist on the table five times with each of these last words.

Manika, forever the professional, calm on the outside, but gripped by slight stomach uncertainty, decided to stay quiet, observing Marjorie from head to toe, and waiting to see what else was going to come pouring out, before any questioning would begin.

Her normally cheerful healthy looking face, was red and blotchy, she had clearly already wiped her eyes of any traces of mascara, her attractive long brown hair had been partially brushed, and she was sitting, her body tense, leaning to one side, with her fist still set on the table. There was silence for half a minute and then began the trickle and the stream of tears, the liquid release of pain.

Manika was used to tears, trained and practised in not letting these intimately expressed raw emotions touch her own heart. She needed to stay totally in control and be ready to start catching the fall-out, asking the right questions and starting the repair. She waited patiently, while Marjorie sobbed, wiped, blew, breathed unevenly and sobbed yet more.

“Ann, you are going to have to delay the 9 o’clock by 10 minutes, ok? whispered Manika to Ann.

The sobbing softened and for the first time in three minutes, Marjorie looked Manika in the eyes and Manika saw such pain of suffering that she bit her lip.

“Marjorie, I am really sorry, but I need to see another patient now, but I want you to wait so you can tell me what’s going on”.

She awoke in mind, voice and strength:

“There’s no need for me to wait, because I can tell you now in less than one minute…”

(To be continued…..)

Manika’s Plan – Episode 11 – Marjorie

Manika glanced at her watch, nodded and waited for this explanation.

It exploded out of Marjorie in a mad rush.

“I choked on my latte this morning. My dear husband, Paul, told me that via social media, specifically meaning YouTube, that six months ago, he came across a former student of his, a woman, by the way, who now lives in Australia, and who is one decade younger than me, with whom, he has explained, that he has a connection, whatever that means – I didn’t want to hear any more and left the house”.

Manika was waiting for more, but after a pause, it was clear that that was it. Marjorie had blurted it out in less than 30 seconds and was done.

She stood up and walked out, and the door slammed.

Manika gathered her thoughts and tried to ground herself.

“I am a GP, I am trained to look after my patients for certain physiological aspects, to examine them, assess them and to decide an action plan for their symptoms. I am neither a psychologist nor psychiatrist, nor do I aim to qualify as one of these. Marjorie is physically healthy, she is having a bad day, and that day will end and being as she is, she will move on from this, with or without her husband. It’s all quite straightforward, if emotionally painful”.

There was one thing though, thought Manika, Marjorie is maybe not going to make her smear test on Wednesday, and that is my concern. Manika moved on with her daily appointments and tried to let Marjorie slip into the lower levels of her thoughts.

It was Tuesday afternoon.

“Ann, please will you check that Marjorie has received her sms reminder about tomorrow’s smear test, thanks.”

Ten minutes later, Ann forwarded an sms from Marjorie, which read:

“The only reason that I will go for the smear test is in the huge hope that it promises a cervical cancer diagnosis that gives me 48 hrs to live, 48 hrs, I need, so at least I have time to get my hair done for the last time before I cross over”.

Manika sighed, “Oh Marjorie, for goodness sake”.

Then Ann called Manika:

“Marjorie wants an emergency appointment during lunch on Thursday.’’

“Ann, I can’t do that, that’s not how it works, the results of the smear test will be known Monday, and I am not prepared to see her before then and then only if there is anything wrong. So do your best to explain that gently.”

Ten minutes later, Ann forwarded another sms from Marjorie:

“If I don’t get my emergency appointment, I will dress up in black as the devil incarnate and stand outside the surgery entrance and shout – ‘death meets all who enter here’ and that’s a promise! And by the way, I will take the whole day off work and someone else can order more blasted water bottles for the office and be nice to the Michelin chef”.

Manika smiled; at least there was a sliver of black humour buried in the depths of her anguish.

“Ann, tell her that she can write to me, that’s the best I can do, she can send me an email, give her my work email. I can only hope that when she has to compose her feelings in writing, it might help her to slowdown, calm down and think about what she is saying.”

The sms stopped flowing, at least for now.

Each time that Manika logged on to her email, she first glanced a little nervously at the bold font messages at the top of the Inbox. It was coming, this email, it was just a question of time and would be a top priority for the hurting sender to fire it off.

However, the days went by. By some miracle, Marjorie had attended the Wednesday smear test, the result received Monday was clear; this was now nearly a week since the requested Thursday emergency meeting.

Part of Manika said, maybe the problem is solved, they have talked it through, she just had an awful initial and exaggerated emotional reaction, it’s not an issue, her husband is still on side and, we can all relax… Nevertheless, a part of her felt that this was not the end, but it was the weekend and on leaving the surgery on Friday afternoon, Manika felt light and free.

Little did she know what would be waiting for her on Monday morning.

(To be continued…..)

Manika’s Plan – Episode 12 – Marjorie

Previously in Manika’s Plan:

Marjorie burst into Manika’s office, venting about her husband’s connection with a younger woman in Australia, then leaves abruptly. Over the next few days, she sends darkly humorous but alarming messages about her upcoming smear test, hinting at despair. Manika tries to manage the situation professionally, relieved when the test results come back clear and things go quiet. But as Friday ends, she feels it’s not truly over, unaware of what Monday will bring.

On Monday morning, Manika breezed into the surgery at 0830, greeting and exchanging weekend headlines with Ann before heading for her office. She had forgotten about Marjorie, the weekend had been a distraction, she had travelled away with her husband, Ravi, to the South Downs, and they had walked and walked in nature.

She opened her PC and logged into email.

Right at the top of the Inbox, she read the apocalyptic bold header line:

Mar….S…[email protected] “I sent this at 0840 this morning, so that this is the first thing that you will see, but go and get a cuppa first..”

Manika felt her cortisol rise, she stood up and headed straight for the kitchen, to get some chamomile tea.

Five minutes later, she opened the email. She whipped her eyes across and down the lines, both trying to grasp a sense of the message and the energy, but also avoiding being sucked into the emotional details. It seemed a long email, but had been written with structure and editing. She felt some relief; it looked like not so much a desperate ranting, but a very personal letter of facts and feelings, with some of Marjorie’s dark humour hanging in there. Feeling calmer about the situation, Manika felt she could leave it and deal with the rest of her inbox quickly before her 9 o’clock start.

But this Monday turned out to be so busy. By the end of the day, she had won no free time to return to Manika’s email, for which she knew would need at least two or three read throughs, so she decided to print it off and take it home, not thinking what she was doing.

She was taking this letter into her home time. That was something she had agreed with herself, and with her husband, Ravi, that she would not do. Work is work and home is home. But, she had broken this rule unconsciously and in doing so had crossed a barrier. Would she regret that?

That evening as she lay in bed, she took up the printed letter, which was about three pages long, and she started to read.

“Dear Doctor,

Thank you for agreeing to read this.

I had already ordered and paid 24.99 for my devil outfit online, delivery tomorrow, but I managed to cancel the order when you allowed me to write. It’s a shame, as I was thinking of wearing it in the office the next time I need to do a sleepover, in order to scare the nighttime pilferers, of our consumable items. The coffee beans still get raided occasionally.

I know full well that my private business is not your professional business. I am physically healthy, for the moment. But I can tell you this much…..my physical health, for which, you do bear some professional responsibility, as you know very well, is very much determined by my mental, psychological and emotional health. Let’s call them my thoughts and feelings (T&Fs).

So my argument is this, which I think is brilliantly logical. If you can help me with the T&Fs, then together, as a team, we can prevent them from manifesting into physical problems, thus saving you, me, and the wonderful English National Health Service, valuable time, money and resources.

So right now, these T&Fs have taken off, sailed up the creek, flown over the hills, beyond the mountain and are now far, far away, out of control. And it’s not clear to me, if and when they are coming back home.

Doctor, do you want to know how far away they have travelled? These feelings of mine. Just try and imagine the real gap between the membership of my gym and the chance of me actually turning up there to ride the exercise bike. It is huge, that’s how far away I am from myself.

Each night lasts forever. The demons are banging their drums and painting mad pictures on the inside of my head. I would have more peace inside a rotating cement mixer. My bedroom and my bed have become my prison, I’m locked in with my inmate who comes to bed after me and wakes up after I have got dressed.

He seems to occupy the furthest strip of the bed from me, he smiles in his sleep, and he emits occasional wind noises from both ends of his body. Once upon a time, these sounds were quite endearing or at least tolerable, but now it’s like white noise torture as part of some interrogation training..punishment, night after night.

If I do drop off to sleep, which I must do, it’s a couple of hours at most, before I am staring at the ceiling and practising twenty-four different sleeping positions, trying to find the one that gives me some peace and none do”.

Manika’s husband grumbled about the bedside light – he was trying to fall asleep. Manika’s head was wide awake, so she decided to skip straight to page three and the final sentence of the email.

“So the big question, Doctor, is a very simple one –are you going to help me? Yes or No?”

…..(to be continued)

Manika’s Plan – Episode 13 – Marjorie

Previously in Manika’s Plan:

After a peaceful weekend away, Dr. Manika returns to work to find a deeply personal but unexpectedly well composed email from Marjorie, an energetic patient teetering on emotional collapse. Manika has broken her own rules by taking it home. As she reads in bed how the email spirals through humour and heartbreak, Marjorie ends with a stark, urgent plea: “Are you going to help me? Yes or No?” Manika is left wide awake, holding the question, and its weight, in the dark.

“No improper emotional relationships with current patients.” Manika’s husband, Ravi, was angry at breakfast the next day. Taking an exaggerated slurp of his coffee, he fixed her with a stare.

“It states quite clearly in the General Medical Council and British Medical Association guidelines – you should not have an “improper emotional relationship” with a patient.

So what do you think you’re doing, Manika? You’re putting your career at risk by getting so involved with this woman. You should never have brought her letter home, never sat up late reading it, letting it fill your head. Why did you even allow her to write to you in the first place?

She’s not medically ill. Physically, she’s fine. Don’t risk your job by drifting into this emotional spider’s web. You’re meant to be discreet, professional, independent, and emotionally detached. It may not help the patient, and it certainly doesn’t help you.”

Manika heard it all. It felt like being pushed underwater. Of course, he was right. She knew he was right, almost right, because she knew she was helping Marjorie and what made it worse, she knew in her heart that she could help Marjorie come out the other side in one piece. But what was she supposed to do now?

“Send Marjorie away,” her husband pressed. “Call her. Sit down and tell her you can’t receive any more emails, you can’t write back, and you certainly can’t meet to discuss her personal issues. Refer her to a specialist, a psychologist or whoever, that’s your medical duty.”

“That’s not what she needs,” Manika thought and sat in silence, staring out of the window into the back garden. “She just needs someone to listen, and then she needs some guidance. And I think I know what the problem is… I think I have a solution for her.”

Her husband shrugged at her silence and pensive look.

“It’s up to you. But I see red flashing lights. She’s volatile, from what you’ve told me. What if she goes on social media? What if she writes to the BBC, or the NHS? What if she puts on her devil costume and stands outside the surgery? She sounds the sort of… person, who would actually do that, from what you say”.

Manika thought that he was going to call her a‘nutter’.

“You should have thought about all this before you even started with her, Manika. And by the way, I should know nothing about your patients – that in itself is a breach of doctor – patient confidentiality”.

Manika was stuck. She left the house full of worry, weighed down and isolated by Ravi’s words, words that were common sense, legally correct, and actually in her best professional interests. She was torn and it hurt.

But she had more than an inkling of what the problem was. And knew that there was a solution. But the path ahead was potentially dangerous, and she had to think carefully about how she was going to manage it.

But eventually, Manika decided she would write back to Marjorie, for the first and last time, trusting that Marjorie would maintain the confidentiality of the communication.

Dear Marjorie,

I apologise. I’ve crossed professional boundaries. I have to pull back. I could be professionally disciplined for the way I’ve been behaving, and I can’t continue like this. I hope you can find a solution to your problem. I’m sure you have close friends you can talk to. If you wish, I can refer you to a care professional who can help you work through what you’re going through. I am really sorry not to proceed further.

She read it twice. She pressed send.

Guilt came first. Then a small, cold burst of certainty. This was the correct thing.

Marjorie went quiet, for a good while.

Days passed. No reply. No calls. At work, Manika kept focused on keeping a heavy case load.

In an attempt to reduce the worry, lower the cortisol level, to sleep better, she took to exercising at her gym in a more disciplined scheduled way. It also gave her more time to think on her own, without Ravi being too close at hand.

Ravi also knew that having very pointedly raised his concerns, he now had to pull back and let Manika deal with the situation, and support her, but their recent confrontation had led to a small dent in their relationship.

Manika needed some space, some exercise and a chance to think. She took off to the gym, where they had a family membership, that mostly her boys used. She hadn’t been for a couple of months, but now felt the time to release some tension. She took the bus, arrived, changed and had been on a cycle machine for about seven minutes, plugged in to a podcast when there was a …

to be continued……

Manika’s Plan – Episode 14 – Marjorie

Manika was on a cycle machine at her gym, plugged into a podcast,

….there was a tap on her shoulder.

“I thought you never went to the gym” said Manika, shocked and alarmed to be disturbed.

It was Marjorie.

“It’s my first time, that’s how bad things are. I have been paying the subscription for eight months, but I had to google the place to remember where it is.

Look, doctor, I just came here to escape, I had no idea that you would be here.

It’s just that my bedroom feels like a sleep deprivation cell, my husband treats me like I am some sort of neutral business colleague, he’s in another world, in deep connection with Australia.

And before you say anything, I understand that you can’t help me, that it’s professionally incorrect and so on. I do get it, so don’t get any more involved, I will work it out, and I don’t need any psychotherapist digging into my distress”.

And with that, she moved off to start a mat exercise, deliberately around the corner and out of sight from Manika. But Manika could still spot her, via one of the many massive gym mirrors, she was lying on her front on the mat with her head on her hands.

Manika carried on her exercise mechanically, with no focus, enthusiasm or effort, occasionally glancing at the mirror, the words of the podcast now drifting straight through her head. After a few minutes, she noticed that Marjorie was still just lying on the floor face down, and seemed to be sobbing into her hands. Marjorie’s figure contrasted so sharply with the rousing fast beat music, pulsing round the gym and the movement of the gym’s fit young, regular visitors.

Manika got up and went to the gym reception desk:

“Look, I’m a doctor and I have a situation where I just need to talk to someone here in private, is there any room, anywhere that I can use for 30 minutes or so without being disturbed? There’s someone who’s distressed that I need to talk to”.

“Not really, but you could use an empty storeroom, if you want, here’s the key, it’s the second door after the toilets, it may be a bit smelly, but it will be private”.

“Thank you very much, pse can I also have two bottles of water”.

Manika approached Marjorie, who was still face down on the floor.

“Marjorie, come with me now”. Manika ordered her.

She responded, but laboured to get up, her hair bedraggled and her face blotchy, wet and red, not the first time that Manika had seen it so.

A few moments later, Manika and Marjorie, were seated, on a bench, next to each other, in a dank gym store room, with dull lighting and the door locked, each with a bottle of water. This was going to take time, and Manika knew that. And there was no going back now. Her husband’s words echoed dimly in her mind, but now she was on a mission and there was no stopping.

Marjorie spoke up, she was more or less emotionally exhausted, but her keenness to be listened to was still stronger than the fatigue.

“I do everything that I can think of to keep him as happy as I can. I have fun with him. We have fun together. I look after him. I buy the clothes that fit him and suit him. I can see when he needs new underwear, and I just buy it and put it in his cupboard, and he says, ‘Thank you for buying me new underwear. I like them.’

You know, so we have that comradeship. We have that deep and trusting friendship. We care for each other, we look out for each other. We trust each other.

And now he’s just saying, through his behaviour, it’s not good enough, because he’s found somebody special. He’s withdrawn and become minimalistic in his communication, and I feel like I irritate him just by being at home with him. I feel that I have just failed.

It’s so annoying, and upsetting, because almost every night, he is up late chatting to her, openly, he doesn’t hide it, he just goes into a downstairs room, shuts the door, and chats. If I want to, yes, I can go and overhear what he is saying, but it’s just so scary and unsettling. Then he comes to bed late, because of the time difference, and goes to sleep immediately, almost with a smile on his face.

I pretend to be asleep, or when it’s worse for me, I tell him that I can’t sleep because I am sh*t scared about what is going to happen to me. He doesn’t try to shore up my fears and doesn’t seem to care about how I feel. All he can say is that he feels that his connection with this person is so strong and feels like nothing else he has ever felt. I am so desperate for a hug or just a hand on my shoulder. Oh my God, Manika.

I found somebody with whom I have a connection, that’s exactly what he says”.

“So what do you think he means exactly? What is this connection”?

“He’s gone all spiritual about it. He says that he can feel her moods. She’s in Australia, and he’s here, so the time zones are so different that often when one’s asleep, the other’s awake, and when one’s awake, the other’s asleep. So they only have a few hours at the beginning and end of each day when they’re both awake, but he says that during that time, he can often sense physically and mentally how she’s feeling.

I can choose to probe into the relationship more, and one part of me is desperate to understand the detail of what is going on between them, and the other part of me is so frightened that I just want to run away.

And the other day, for example, he said she had severe period pains, and he could feel an aching pain within him, in his lower stomach. He said that he felt a physical pain in his own body, and so he called her. Would you believe it? He called her, and she confirmed that she was having really bad period pains. I mean, how do you explain that?

What about my period pains? If I ever have them again! When will he ask me next?

So that’s what’s going on. And so, I thought we were having a great time. I thought we were together. I thought we loved each other.”

Do you love him?

“Yes, I do.”

“What does that mean for you?”

“Well, it’s what I have been talking about, isn’t it? It’s that very comfortable feeling of togetherness, of commitment, like there’s a balance, isn’t it? It’s how I look after you, you look after me, you care for me, you love me, I love you, and that’s how it is. You want to be with somebody, you want to care for somebody. You feel drawn together, comfortable and not bored with each other.”

“Marjorie, I understand all that, and it has clearly worked for a long time, but I am not sure that it’s enough”.

“What do you mean? I really don’t understand that…”

Manika’s Plan – Episode 15 – Marjorie

Manika said: “He’s found something which he feels is very special, and he’s found something which is on a level that’s difficult to comprehend.

He believes that he’s found connection, and you have been living with attachment, that’s the difference.

But do you know, there is a solution”. Manika tried to end on a positive note, but Marjorie was nowhere near.

“Oh yeh. I can think of solutions, but they involve a long solo car drive, a few whiskies, a steep cliff, a wooden box and some teary-eyed funereal singing.”

“Marjorie, stop it. I don’t think now is the right time or place to go into this any more. You are not in solution mode yet, you are in grieving mode, and you need to go through that before you can do anything else.

It feels like you have lost Paul, and maybe you have, but it’s not at all certain to me. But if you have lost him, you have to remember this. You have not lost your son, Marcus, stay close to him, spend time with him. Give your love to him.

But most importantly, don’t beat yourself up, don’t think that you failed as a wife and a person, just because of what has happened with Paul.

Above all, understand that before you can deal with Paul, you need to deal with yourself.

You need to stop berating yourself for failure and remember to accept yourself fully for who you are right now. Imperfect yes, but still very lovable, by you. It doesn’t mean much and won’t sink in now, but when you’re exhausted by grieving and feel you’ve reached the worst point, then you can start to re-build”.

Manika was still in full flow.

“And one more thing, let’s just be practical, Marjorie, I am, ostensibly, at least bending, if not breaking the rules of doctor-patient ethical relations. Look at us, sitting in a dingy store room at the local gym, hidden away, clutching our bottles of water.

But I have made a decision. I am going to help you, but only on my terms”.

For the first time, Marjorie looked at her with faint hope, and at the same time tears again welled up, and her water bottle cracked loudly as she squeezed it involuntarily.

“My terms are this: no phone calls or visits to the surgery, no emails. This is my mobile number, stick it in your phone, but not as Dr. or Manika and don’t ever ring me unannounced. When you do call, let the screen say “Zara customer service” or something like that. Only text me, and only if something changes from the arrangement that we make now. This has not been a bad place to meet, but we can’t use it week by week. And I am Dr, not Manika, OK? Let’s try to keep some semblance of a professional relationship.

I will SMS you a time and place where we can meet and talk at least forty-eight hours before we meet, and it will only be in the evenings. Ok?

Much as it will be tricky for me, I am going to tell my husband what I am doing, because I will not lie to him about where I am going and whom I am seeing. Up to you whether you tell Paul, but I also suggest that at the very least, you do not lie to him, even if you don’t tell him the full truth. Do you agree to the terms, Marjorie, I am deadly serious about what I’ve just said?’’

“Yee…s.” Was all that she could manage, and she struggled with that.

Manika, still in full control and beginning to feel that they were at last dealing with the fundamentals, paused and then, slightly melodramatically said:

“And remember this, Marjorie, in your very darkest moments, when despair has gripped you, and you feel there is nowhere to go, the tank is empty and there’s nothing left, remember this, just three letters, PKO”.

“PKO?” Marjorie looked puzzled and for a moment distracted from her suffering.

“Yes, PKO. When life is at its worst, in England, when disaster has struck, when the team has lost, when you are knocked over, there is always, always one solution.”

“What on earth are you talking about, doctor?”

“PKO.

Put the Kettle On! – just go and put the kettle on and have a cup of tea. So use PKO, anytime you need it, it helps. I used it when I saw your email, it was my last PKO moment”.

Marjorie almost smiled

Manika gave her a high five, battling the urge to give her a hug.

Then there was a knock on the door of the store room.

To be continued….

In a fitness centre store room, Manika tackles Marjorie’s emotional collapse. Despite her bleak suicidal musings, Manika anchors her with compassion, urging her to grieve, reconnect with her son, and stop blaming herself. Breaking professional boundaries, Manika offers support on strict terms, a turning point in their relationship. With “PKO: Put the Kettle On”, she leaves Marjorie with a glimmer of hope and a cracked smile.

(Ed. PKO is a very British thing, its original cousin, is the now massively over exploited WWII poster, “Keep Calm and Carry On”)

“Marjorie” – Episode 16

A male voice, one that Manika recognised from reception, said, “Are you alright? Have you finished? I’m ending my shift now, and I need the key back… and the room.”

“Let’s go,” said Manika.

The two of them stood up, went back to the changing rooms, and got dressed. Marjorie tidied herself up, and they parted ways at the entrance to the gym. Manika watched Marjorie as she trudged towards the bus stop, still looking like a forlorn figure, worn out by her suffering.

Manika decided to speak to her husband, Ravi, as soon as she had eaten. She had come home drained and hungry, and the idea of stress killing her appetite didn’t appeal to her.

After dinner, she said, “Ravi, just sit down. I need you to listen to me, just listen, please, until I’ve finished. OK?”

“OK.”

Ravi plopped himself down heavily into his armchair. He was nervous. The memory came rushing back to him. The last time she had spoken to him like this, she had big news. He hadn’t forgotten that conversation from over twenty years ago.

“Ravi, sit down. I need to talk to you.”

“OK. What’s happened? Is it bad news? Are you alright?”

Ravi was younger then, more easily shaken, and Manika had decided to tease him.

“Ravi, I need to tell you something. Something that’s going to change your life and mine for many years.”

“What?”

“I think I’m pregnant.”

“No! Really? Are you serious? Manika, that’s wonderful!”

Ravi had jumped out of his chair and hugged Manika, carefully, as if she were already carrying something precious.

“Yes, it is. And do you know what? There’s even better news.”

“What’s that? Twins?”

“No, Ravi, listen, I had the DNA checked. It’s you. You’re the father.”

Ravi had stopped, stared at her, then burst out laughing.

That was then. As he remembered that moment, only seconds passed before this one began.

So he braced himself.

Manika explained to Ravi about unexpectedly seeing Marjorie at the gym, and everything that had happened. She watched him carefully as she spoke, sensing his reactions and waiting for objections.

When she finished, Ravi said, “Well… I suppose if you really did bump into her at the gym, when she’d said she’d never been before, even though she joined eight months ago, I could see that as a sign you were meant to meet her. But even so, I still think you have to be careful with her.”

“Thank you,” said Manika, and gave him a hug. She sighed with relief at his calm and understanding reaction. It was also the hug she had wanted to give Marjorie. He hugged her back with effort, because he knew she needed his support now more than ever.

The next morning at the clinic, Manika’s phone buzzed. It was Marjorie. She had sent a very long text.

The day was packed with patients, so Manika left the message unread until the evening. When she was finally free, she made a cup of tea and sat down, trying to prepare herself for whatever Marjorie had written.

The message read:

“Dear Doctor,

After I put Marcus to bed last night, I asked Paul to sit down for a proper talk, so I could finally understand what’s going on. It’s so painful not knowing why he’s changed. At least he agreed to speak. I cried the whole way through, and he stayed distant, no affection. He was cold… but at least I got some answers.

He said it all started three months ago with a dream. A dream about Christine.

Christine was his economics student ten years ago. She’s from Australia. Paul lectures at the University of East London. Back then, she was a bright undergrad who later became a postgrad. She finished her master’s degree with another lecturer, and they only met occasionally for coffee. He swears nothing ever happened, and I believe him.

She went back to Australia. Apparently, she’s the kind of person who takes over any room she’s in.

She was an only child, with demanding parents. Her dad travelled a lot for business, and her mum worked full-time. She’s been married and divorced twice, with one son.

Back to the dream. Paul said he was standing next to a carousel at a nighttime fairground. It was spinning fast, the colourful horses and riders just blurs. He stared ahead. Then the ride slowed and stopped. On the horse in front of him was Christine. She got off, gave him a hug, and walked away. That was it.

After the dream, he looked her up online. She’s very active on social media, posting financial advice to loads of followers in Australia. She runs her own company, teaches courses, gives private coaching — all about making money, building wealth.

He contacted her, at first anonymously, in a public forum. She replied. They moved to private messages, started texting, and eventually chatting.

So I asked him, what is this about? What happened to us? What did I do wrong?

He said his connection with Christine feels different. It feels powerful. He said they argue, they talk deeply, and yet there’s something between them, a bond, a deep feeling. Because of that, he feels disconnected from me. He said he never felt this kind of connection with anyone else. He told me that talking to her makes him feel his full worth.

So thanks, Paul.

I asked what happens to me and Marcus. What about our family?

He said Christine is divorced, and has a ten-year-old son, but she barely sees him. The father has custody. That’s strange, don’t you think? Paul says he doesn’t know what it means.

She’s free. She can do what she likes. But Paul is my husband. He’s a father. He can’t just walk off into the Australian sunset, can he?

I feel lost. Abandoned. Cheated. I’ve done nothing wrong. I’ve always supported him, loved him, taken care of him, spent time with him.

Now I lie awake at night with an ache in my chest. I stare at the ceiling light, and it looks strange and distorted in the dark. I can’t stop looking at it. I hear every noise. I hear his slow, calm breathing, knowing who he’s dreaming about.

I wake up exhausted. I go to work. I smile and pretend everything’s fine. It’s like gentle torture.

Sometimes I wish I could float away in a hot air balloon with Marcus and find the version of myself I’ve lost.

I asked him if he wants a divorce. He just stared at me and said nothing.

What do I do?

What do I do, Doctor? I can’t go on like this.

Manika’s Plan – Episode 17 – Marjorie

Previously in Manika’s Plan:

Manika confronts her husband Ravi about reconnecting with Marjorie, and is relieved by his measured, supportive response. Later, Marjorie sends a raw emotions text revealing the bumpiness of her marriage: her husband Paul has emotionally detached and formed a deep bond with a woman from his past, leaving Marjorie feeling invisible, abandoned, and spiralling. Her message ends with a cry for help, asking Manika what to do next.

Manika had read but not replied to Marjorie’s latest message, but the next morning, a Saturday, she handed the phone to Ravi, who sat back slowly with his coffee and stared at it for a long time.

“She’s built her happiness around what she receives from him,” Manika said quietly. “And it worked, for years. There was a kind of emotional trade happening, love, attention, care, companionship, and she gave back as much or more. But now the deal has collapsed, because he’s giving it somewhere else.”

Ravi nodded. “He’s tuned out. Moved to another frequency. And no matter how hard she turns the dial; she can’t reach him any more. It’s long wave versus VHF.”

“It’s not that she doesn’t love him,” Manika added. “But it was never unconditional. It was based on a balance. And the moment he broke that balance, she lost everything, her security, her reflection, her sense of worth. What should she do?”

“Put the kettle on,” joked Ravi, naughtily.

“Come on, Ravi, don’t be flippant.” said Manika.

“There’s only one thing to do,” Ravi said. “Let him go.”

That evening…

They prepared for bed and while Manika was cleaning her teeth, the phone buzzed again, another SMS from Marjorie, Manika got into bed and read it out.

“Paul has just told me, God bless him, just before I try to sleep, that Christine is coming across to Europe in eight weeks’ time, to Basel for a financial investment forum, at which she is to be one of the speakers.

I blew up and bellowed at him that he better go and see her and not come back until he has sorted out what he is going to do. I can’t stand this waiting game, being stuck in limbo, existing and breathing, not sleeping. I can always change all the locks on the house while he is away.”

The SMS continued…

“You know, Doctor, this is about as much fun as cheering on a love story that ends with your own heartbreak.

So, he has agreed to do it and has told her. He has booked his miserable self into a hotel in Basel and can meet her at some point during the conference and then at least I will know where they stand, where they sleep etc and therefore where I should not be standing, sitting, breathing, or anything else.

I am so tired; like a dried-out shrimp. It’s like waking up with a heavy hangover every morning, and wondering why there was no party the night before.”

Eight weeks later…

Paul left; the car disappeared out of the drive. No real, warm goodbye. Just a half-wave and a hug for Marcus.

Marcus then went and helped himself to some cereal. He looked up when Marjorie came into the kitchen, his spoon halfway to his mouth.

“You okay, Mum?”

“I’m fine, sweetheart,” she said. “Just a bit tired.”

She sat beside him and watched him eat, letting the quiet sit between them. There was something about watching your child go about the ordinary that made the extraordinary feel both cruel and far away.

“When I went to the bathroom last night, I heard you sniffing and so I came closer and I heard you crying,” Marcus said quietly.

She reached out, touched the back of his head and pulled him gently toward her so their foreheads touched.

“I’m sorry, love. I didn’t mean to wake you.”

He stayed there, close to her, and said softly, “I miss Dad too. But I love you. It’s going to be okay.”

She held him tighter than she meant to. That kind of squeeze where you are trying not to fall apart.

With Paul now gone, she walked through the house and opened the bedroom windows wide, let the air come in properly. For the first time in weeks, she could choose which side of the bed to lie on.

And for a moment, it felt like something, space maybe, or just air.

But that was short lived.

In her mind, Paul was already with Christine. She saw them together in the images she didn’t want. She imagined them walking by the Rhine, talking, holding hands. She had seen photos of Basel online, so her mind filled in the background. Stone bridges. Cafés by the river. And them. Sitting close, knees touching under the table.

She stood up and left the room, just to stop seeing it.

That first night, she cried quietly, under the pillow to stop the sound. The second night, Marcus came in without saying a word. Climbed in beside her. Warm in his pyjamas.

“I miss him too,” he whispered.

For two more nights he came in like that. Sometimes talking, sometimes silent. She felt his small breathing, the weight of his body next to hers, and the warmth of it was the only real thing she could hold.

Then Paul came back.

He looked tired. And something else. Not guilty exactly, but thrown.

“Did you see her?” she asked, when Marcus had gone upstairs.

He shook his head.

“No. She didn’t show up. She kept delaying, she was always busy, her phone engaged or not answering. She said, maybe, on the last day. But she stopped replying. I waited around, she never came.”

Marjorie sat very still, shocked.

“You went all the way there and didn’t see her at all?”

“I waited as long as I could. There was no point staying longer.”

It took a few moments for that to land.

She didn’t feel relief. Not even satisfaction. Just confusion.

It didn’t feel over. It just felt… delayed.

Three days later, she saw his iPad light up with messages. The previews showed names she didn’t recognise, but the company was Christine’s.

Later that evening, Paul told her.

“They offered me a job. At her company. Sydney-based. It’s the kind of role I could do in my sleep.”

“Are you applying?” she asked, although she already knew the answer.

“I did. Just to see.”

Of course he did.

What followed was days of questions, documents, more emails. And then something shifted.

“She’s playing games,” Paul muttered one night. “The process makes no sense. Every time I finish one step, she adds another. She’s not serious. Or she is, but only when it suits her.”

They argued. She didn’t go downstairs, but she heard them. Paul’s voice rising.

Accusing. Angry.

Then silence.

Marjorie didn’t ask him what happened. He didn’t offer. But the sulking returned. The unfinished sentences. The heavy footsteps around the house.

A few days later, out of nothing but morbid curiosity, Marjorie started watching Christine’s conference videos online. Financial panels. Interviews. Speeches.

She was striking, that was clear. Charismatic, confident, fast-talking.

She didn’t smile much. When she didn’t like a question, she narrowed her eyes and waited. You could feel her control even in the pauses.

Marjorie watched her for a while, then closed the video.

She knew for the first time that something was not all well with Christine, not at all well.

Christine had become less of a threat, and was more of a person with serious issues.

“She’s not magic,” she whispered to no one. “She’s just a woman who gets off on being wanted.”

Later that night, in the darkness, she asked Paul again.

“Do you still want to go?”

To be continued….

Paul’s answer was silence, a twist of his body away from her, a sigh of suffering, and then just silence.

Four days later, Marjorie texted Manika:

“Paul explained to me that he applied for the damn job and was then asked a whole load more supplementary questions by her staff, to which he replied, and then more questions followed. After a week of this, he just felt that he was being led down the garden path and told Christine to stop messing around. They had a hearty row, which I could hear upstairs from his study, and now they are not talking to each other. And Paul is sulking worse than Marcus when I found Haribos underneath his pillow.”

Manika shared the text with Ravi, who read it pensively and said:

“She has to start with herself. Just to deal with herself.”

The next day at nine o’clock in the evening, no SMS, but a call came through from Marjorie with no warning.
It was a desperate call that Manika knew she had to answer in full. She had known it would come one day. This was going to be a breaking point, a depth of sadness that had knocked her.

“I have to go, Ravi. I have to go.”

Manika put on a coat. Marjorie had asked her to meet outside the park, it would still be open at this time of night. There wouldn’t be too many people around.
She headed out toward the park. As she approached, she could see Marjorie standing, clutching a handkerchief to her face.

As they entered the park, Marjorie began:

“I don’t understand. On the one hand, they’re still in contact from time to time. On the other hand, she seems to have lost patience with him. She seems to be so self-centred and damaged. On the one hand, she’s asking for him to be with her, she says that she loves him, and she acts like they are already together, and yet, remarkably, she behaves so unreasonably.

She’s so demanding. She’s so selfish and self-destructive.

Not only that, but she has these real narcissistic tendencies.

I’m so tired. I’m so exhausted. So is Paul. I don’t know what to do.”

They walked deeper into the park. Marjorie began to recall the last conversations she’d had with Paul, and it was clear he was lost too. He’d applied for the job. He’d replied to follow-up questions. He’d provided all the answers that were asked of him in a timely, well-considered way. Before that, he’d travelled to Basel to meet her. It was Christine’s idea, and then she denied him.

It was a key moment.

Manika looked at Marjorie’s tired, sad, lined face and said:

“Marjorie, it’s time. You know that. It’s really time now.

Remember I told you some weeks ago that there is a solution?

Well, there’s still a solution, the same one I had in mind then, the one you weren’t ready for.

Let’s see if you’re ready now.”

No reply. No reaction. No response from Marjorie.

“You really have to let go.

You really, really have to let go.

Let go of him. Let go of the pain. Let go of the rejection.

You have to stop thinking badly of yourself.

You have to remember who you are.

You’re Marjorie.

You’re powerful. You’re strong. You’re fun. You’re attractive. You’re intelligent.

You can do many things. You can create many things.

People like to be with you.

And if he doesn’t want to be with you…..let him go.”

Marjorie slumped onto a bench. She put her head in her hands.

She cried.

She cried her heart out for twenty minutes.

Manika sat with her, this time with her arm around Marjorie’s shoulders.

And after twenty minutes, Marjorie slowly looked up, painfully, at Manika and said, very softly:

“I am okay, aren’t I, Manika?” she asked pitifully, like a little lost child.

“I am okay, aren’t I? There’s nothing wrong with me, is there, Manika?”

“No. There is nothing wrong with you.

The only thing you need to do is to remember who you are, and to accept who you are, and love who you are.

Who you are now, not who you can become.

You don’t need anybody else.

You don’t need to be made complete by anybody else.

You are complete.

You are whole.

And the problem is that, for too long, you’ve just not thought about that, because you’ve given yourself, parts of yourself, too much of yourself, to somebody else.

And he was doing the same to you, genuinely. But because he switched his attention somewhere else, you’ve collapsed. Because you don’t love yourself.

You look to him for your validation, and your validation has to come from inside you.

Because you are enough.

More than enough.

And you need nobody…nobody at all, to make you who you are.

You are enough, my dear Marjorie.”

“Yes. I am okay. I think I’m okay,” whispered Marjorie.

She raised her body and sat upright for the first time.

Took a huge breath and sighed deeply.

This breath was somehow one of renewal, a first positive renewal, and the sigh was the first full start of the release of the pain.

They sat in silence for another ten minutes.

Manika knew that the worst was over.

Now the real Marjorie could awaken and start to take back control.

It wouldn’t be quick, but they would look back at this moment as the end of the lowest ebb of sadness.
“Yes. I am okay,” said Marjorie again, with more certainty.

Manika gently squeezed her shoulder and stood up.

“So go home now, Marjorie. Go home and think about who you really are.

You are the Marjorie who manages stuff.

The Marjorie who camps out under her desk to catch nocturnal coffee bean thieves in the office.
The Marjorie who is ready to wear a costume to protest outside my surgery.
The Marjorie who now knows where the gym is, yippee, Marjorie!

Maybe go away somewhere and be on your own.
Go walking somewhere. The South Downs are beautiful.
Go walking. Go talk to yourself.
Go hug some trees.
Go get yourself in order.

You don’t need anybody else.
You are everything that you need to be.

So go and do that, Marjorie.

Go and do it as soon as you can.”

Marjorie sobbed, but she was smiling.

“Yes. I think it’s time.
It’s time to stop this.”

Manika said:
“Accept yourself for who you are now, this messy, chaotic, chewed-up you.

Yes, that’s who you are going to love.

Just start being kind to yourself, forgiving, and accepting, everything.

Tell yourself, constantly, honestly, that you are enough.Your brain believes what is repeated.So now, this is about you.

Then you can release him.”

“Yes,” said Marjorie slowly. “Once I release him, I’m free. Really free.”

To be continued…
In two weeks – be read to meet Dan, in a new adventure roller coaster, who pushes Manika to new limits.
Did you know?

Previously in Manika’s Plan:

Marjorie rebuilds herself after emotional collapse, shedding old habits and dependence on Paul to become confident, self-contained, and self-loving.
She redefines boundaries, embraces independence, and channels her growth into helping others, even launching a small online community.
Months later, fulfilled at work and expecting another child, she reappears in Manika’s life transformed, calm, strong, and finally at peace.

And here comes Mr. Dan Keegan…..

“Good morning, Dr. Kundu.”

It was Dan.

Dan strode, almost bounded, into Manika’s surgery. A big man, aged 52, with a wide, permanently red cheeked, rounded full face, smiling brightly. He was on time and plumped himself heavily into his chair. Manika eyed the chair’s structural integrity with mild concern.
“So, Mr. Keegan,” said Manika. “Good morning. What is it that I can do for you today?”
“Well, Doctor, I haven’t seen you for many years, as you know, and everything’s been fine.”
But just as he said the word fine, Manika saw it.
Clear as a date on her wall calendar:

The date.

The date that Dan would cross over.

She stopped listening to his words and took an unplanned breath. Not deliberately, it just happened. The air seemed to pull back from the room as she looked at him: this large, cheerful, bright-eyed man in front of her. Obese, yes. Flushed. But open. Warm. A man who meant well.

This is a challenge, she thought. This is a real challenge.

“I’m sorry, Mr. Keegan. I lost my concentration for a second there, got distracted – could you repeat what you said?”

Dan was speaking unnaturally fast, almost gabbling his words.
“Yes, Doctor, of course. I’ve…I’ve…I’ve been having some odd sensation in my chest, very odd, a sort of uneven heartbeat that’s been happening over the last month or so. I ignored it for a few weeks, but it keeps tapping gently on the wall of my chest, so I just thought I’d come and check with you.

I naturally turned to Doctor Google first, as I am sure you often do, he winked heavily, and I noted that “atrial fibrillation” popped up. “Afib”, doctor, that’s probably what you call it, in the trade, so to speak. But I’m not really sure if that’s it”.

Dan, still gabbling away at speed:

“I mean, I am a bit overweight, Doctor, as you can see, but my father was too, and he lived to a ripe old age. And his father, as well, survived the war. So genetically, I don’t think I’m predisposed to any serious issues.

My kids do give me a hard time because I can’t play around with them as they would wish, but what I can’t do with my body, I make up for with my mouth.

Eloquence on demand, that’s me…..But, it’s my wife, Tessa, in particular, who has asked me to have a check-up. Just to establish where I am, and where I may be going and if in doubt, why not?

Manika tried to stay on track, still in recovery from what she had seen in her mind’s eye.

“Can you tell me more about the exact feeling you’ve been having, Mr. Keegan? The one in your chest, when did you first notice it?”

“Hmm. Let me think. When was it, I’d say, maybe three, four weeks ago? I was sitting at my desk, mid-morning, bit of spreadsheet warfare, nothing too emotional, and I suddenly felt this sort of… I don’t know, like my heart did a little drum solo. Not painful. Just weird. Unscheduled.”
Dan smiled.

“At first, I thought it was indigestion, or maybe the morning coffee was a bit too enthusiastic. You know when your stomach and your heart start having a conversation, and you’re not sure who’s saying what?”

“Did it stop straightaway?”

“Yeah, after a few seconds, maybe half a minute. Then gone. Bit of a whoosh. I thought: well, that was strange, and got on with my day. It didn’t happen again for a bit.”

He paused and glanced at her, to check if she was still listening, she was, intently.

“Then, over the next week or two, it popped up again. Not every day. Just enough for me to notice, mostly when I was still. Reading, or working, or trying to go to sleep. Lying on my side, sometimes I’d get this flutter.
Like a moth caught in a lampshade. It’s hard to describe, Doctor. Not pain. Just… not right.”

“And during the day? Any shortness of breath?”
He shrugged lightly.

“Well, yes, but I mean, I’m a big lad, as you can see. Getting breathless on the stairs isn’t exactly breaking news. But now and then, yeah, I’ll walk fast across the car park if I’m late, and I feel like I’ve gone up three floors.”

He paused momentarily.

“Again, I’ve always put it down to, you know… the unholy trinity, beer, belly, biscuits. But it’s been a bit more noticeable lately. My wife said she heard me breathing like a walrus with asthma, in my sleep. I told her it’s just deep rumbling contentment.”

He smiled again, but this time it faded a touch quicker.

“I suppose it’s… happening often enough now, such that it has stopped being so much fun.”

“All right,” said Manika, her voice gentle, but composed.

“Here’s what we’ll do, Mr. Keegan. We’ll schedule you for some tests, just routine ones, to start with, all here at the surgery. We’ll take a blood panel, do an ECG, check your blood pressure, urine test etc. A basic tech check, really.

It’ll take about an hour. I know you work at the school, so if you can be available next Wednesday afternoon, I can fit you in then. I think we should do this as soon as possible.”

“Yes, Doctor, I can make Wednesday next week. That’ll be fine.”

“Good,” she said, smiling, though her mind was already turning inward, to the work ahead.

Because she had seen the date.

And, if nothing changed, at aged 52, Dan Keegan had less than nine months to live.
………(to be continued)

Manika’s Plan – Episode 2 – Dan Keegan – “The Wrong Trousers”

So Dan had arrived for his Wednesday check up and Manika saw him before he went off on the round of tests, with Margaret, the clinic nurse. He had arrived thirty minutes late, looking uneasy and unwilling to take off his coat and with a carrier bag, which he placed under his seat opposite Manika’s desk.

“I am so sorry, doctor, I suffered an unfortunate incident at work just before I was due to leave school to come to see you.”

Manika simply paused to see if he wanted to reveal more of the issue, in case it was health related. Dan obliged, gushing forth with his story.

“Today has been a challenge, of course, from the moment I rolled out of bed, thinking – great, it’s medical day today, so nothing to eat until after 3.00 pm – that’s headline shocker news for my stomach; to be in solitary confinement for most of the day.

So after my delicious breakfast cups of water juice, I arrived at school, approached my work station, and without any warning, as I plonked myself down at my desk, the right outside trouser seam of my suit, exploded with a loud rip, from my hip right down to my knee.

This pair of suit trousers was, admittedly, always a touch slim fit, but this morning, for some reason, my right leg was hungry for air beyond my trousers.

I took refuge under a blanket, just as the Headmaster called me to do a budget review, which I had to decline, or else I would have been walking down the corridor wearing a grey oversized floppy skirt.”

Manika tried to picture the scene and couldn’t resist smiling at the image.

“This required some emergency repair work from my secretary, God bless her. So I regret that I come to you late, with elevated blood pressure, no doubt, and with some nonmedical wobbly stitches holding me together, and my trousers are still very much in intensive care, doctor”.

Manika composed herself.

“Ok, Mr Keagan, so let’s get started. So, can you confirm that you haven’t had anything to eat or drink this morning or this afternoon?”

“Yes, that’s most regrettably correct, doctor, it’s been driving me insane and that’s why I have brought some resources with me. As soon as I have given liquids, I will need to absorb solids, or else I will pass out”

“Could I just have a look at your resources, please?”

Dan unhesitatingly opened the neck of the Tesco bag with his two spade like hands, to reveal several packs of sandwiches, two packets of salt and vinager crisps, Coca-Cola and a Snickers.

“Ok, well, we will do the blood and urine samples first, then you can have a bite to eat, and then you will do waist and BMI measurement, height, and a questionnaire that covers some basic mental health screening, mood, stress etc. and the lifestyle review.”

So off went Dan, in his coat, shielding his right trouser leg and sheepishly clutching his carrier bag.

The date that Manika had seen on his first visit, hadn’t changed. Dan had just less than nine months to run.

A week later…..

Manika had specifically asked for Dan’s results to be processed as an emergency priority, Dan was unaware, and thought that the National Health Service had just been very efficient. He was now seated in front of Manika, hands folded together.

“So, Mr Keegan, I have your check-up results here, and I would like to go through them with you”.

Dan smiled nervously, as if he was about to be read his end of term school report as a rebellious teenager.

This is what Manika read before her:

Weight (kg): 120
Height (m): 1.75
BMI = weight / height² = 120 / (1.75)² = 39.2

🔺 BMI: 39.2
⟶ Category: Obese Class II (Severely Obese)

“Mr Keegan, the news is not great, medically, you are classified as obese class 2, first by the BMI test, which we know is not a perfect measure of healthy weight, because some people are very heavily built with muscle and still deemed over weight.

But I think you will admit, if we are both being honest, that muscle build up is not so applicable with you.”

Dan flexed his arm, and raised his eyebrow in mock questioning.

“But secondly, if we also take into account the waist/height ratio, we still have the same result. So without going through all the other factors, we can just say that the weight issue is a pressing challenge, Mr Keegan.”

“Certainly was on my trousers, this morning” mumbled Dan.

“Would you mind if I ask you some questions?”

Dan gave a weak nod.

“Tell me, please, what do you think your body’s been trying to tell you lately?”

“Well, definitely to buy a larger suit size, at least in the trouser department.”

“Anything else?” said Manika.

“Not really, I mean, it is what it is and always was be.” Dan was bravely attempting to laugh off the situation.

“When you think about your health five years from now, what concerns, if any, come up for you?” Manika queried.

“None at all” said deadpan Dan.

“Why not?”

“Well, I believe that you should live life only in the moment, and not focus on the past or on the future. If you focus on the past, you live with guilt and regret and that causes depression, and if you focus on the future, you seek unrealistic goals, and you create anxiety about not being able to fulfil them.”

“Ok, I understand the logic of that, but how, then, is your present looking to you?”

“It’s pretty good. I wake up each day, I have my family, I have my job, my friends in the pub, I am pretty much happy with life.”

Manika probed again. “Has there ever been a time when you felt better in your body, more energy, more in control?”

“Well, of course, I am no longer in my 20s, 30s, or even 40’s – I am now just over halfway through the match, in the second half of the game, not running around like in the first 45 minutes, not tackling and tracking back as I used to, but I am still scoring goals and winning games.

He paused awkwardly while he reflected on what he had just said.

“Of course, I can’t actually play sport at the moment, unless I am in goal.”

Manika’s thought weighed heavily on her:

“Dan, If you only knew how deep you are into injury time, of the last game of life.” But what more could she say.

“Two more questions, Mr Keegan, and then you can go”.

“If someone you cared about were in your shoes, what would you want for them?”

Dan grabbed temporary false freedom from the discomfort of Manika’s questioning.

“Daily slices of warm, oven fresh, white, sourdough bread, liberally spread with demi-sel Normandy butter and organic English strawberry jam…..oooh”

“I think you’re being flippant with me now, Mr Keegan.

“Sorry, doctor. I would just want them to enjoy themselves and seek to make themselves and those around them, happy”.

“Ok, last one.

On a scale from 1 to 10, how important is it to you right now to feel more in control of your health?”

“I honestly think that I am in total control. I may not be controlling in the best possible way, but my control is full, I have control, Captain.” Dan was still dipping into his humour bank, which was emptying rapidly.

Manika thought, “maybe I didn’t phrase that last question correctly”, and he squirmed his way out of it, but on the other hand, many times had that question been answered in a balanced and thoughtful way by other patients.

Then the thought just came to her, not to spar with Dan, but just to align with him.

“Actually, Mr Keegan, one more question that’s literally just popped into my head.”

The more, the merrier, Doc”, Dan immediately realised that that was a tiny step too far.

“Doctor, sorry.”

“Mr Keegan, answer me this, if some potatoes, rice, bread and pasta happened to knock on your front door, quite late on a Friday night, what you say to them?”

“Ooh, now you’re talking, doctor. Come in guys, let’s have a kitchen party, how long can you stay for and can you invite any other friends.?”

He paused for a micro-second, building a picture in his mind, and then let fly, with full enthusiasm.

“Fry those potatoes, pudding that rice, butter that bread and boil up that fresh pasta.”

“I thought so” added Manika, quietly. “Thank you, Mr Keegan, that’ll do fine”.

Manika bid farewell to Dan and called in her nurse, who had previously run the tests with Dan.

“Margaret, could you come in, please, when you have a moment, I want to ask you about how it was with Mr Keegan, when you ran his tests, last week. I want to confirm something with you”.

(to be continued)

Manika’s Plan – Dan Keegan – Episode 3 – “Full denial”

“So Margaret, you’ve seen and heard it all, tell me what you think about Dan Keegan. He denied all my questions. What was he like with you?”

Margaret was a very experienced, no-nonsense nurse, who did not suffer fools.

“He is in possession of a rich library of excuses for his guilty self, for everything. He told me all about his plans for the summer, his BBQ patio, his younger years, his future dreams and his prowess in the kitchen. He didn’t stop talking. I wondered if he had trouble at home with his wife and kids not wanting to listen to him.

But what was interesting was, that no matter what subject he started on, like a boomerang, it almost always returned to the magnetic subject of his love for food.

For instance, he talked of his plans over the long school break to construct a wooden patio in his back garden. He described the stages of construction in detail, but in the end, the aim is to put a BBQ unit in there so that he can cook. And of course, most importantly, to eat there, and, it was most important for him to have a little fridge built in, so that he can keep his home-brewed beers chilled without having to go back into the kitchen.

So I understand, doctor, that he is in full denial of his current medical state and of his potential future condition. I would say, looking at his baseline bloods, that he is heading for a red flashing light, and he is already on full amber. Once he’s done the ECG to check his AF (atrial fibrillation), we will know more.”

“Yes, I have booked him in,” said Manika, “but he’s going to have to wait three weeks.”

“You know what, Margaret, if there was a debating society which happened to propose the motion, “Could obesity be harmless?” And if, for some bizarre reason there was someone needed to speak in support of the motion, then It’s Dan Keegan that you would want speaking for you.”

Meanwhile, back at home for the weekend, Dan had to deal with Tessa, his wife, and the kids. Evie, his teenage daughter, had requested a family meeting, which meant that there was a point of contention to be resolved. Someone was heading for a grilling, without a BBQ. In earlier years, family meetings were called by Dan or Tessa to deal with the kids, but now they were called by the kids and his wife mostly, to deal with Mr. Dan.

Evie, was sixteen, studying in the same school where Dan was Bursar and she was principled and punchy. Her younger brother, whom she regarded as a slouch, was twelve-year old, Leo, who was quiet, liked cycling and was due to join his dad’s school the following September.

Tessa worked as a chemist, dispensing subscriptions, and actually knew Manika, via that route, as her chemists was near to Manika’s surgery and often used by her patients. Tessa, was patient, diligent and hard-working. Being able to live long term with Dan, was strong evidence of that.

Dan and Tessa had met on holiday when Dan was in his early forties and she in her late thirties. They had unpredictably somehow jigsawed together. She had taken a risk on his happy-go-lucky approach to life and he had admired her solid reliability.

Evie had requested and was now chairing the meeting, which took place around the kitchen table. It could not convene until Dan had filled his huge coffee mug and clattered some chocolate digestives onto a dinner plate, that was not placed centrally on the table.

Evie had briefed and lobbied her mum and Leo, beforehand in order to make sure that she knew their view, and so when it came to the family vote, she had a pretty good idea how strong her hand would be on the matters raised.

“Dad”, said Evie, “there are four items on the agenda for this meeting and three of them concern you.”

Dan was dunking his first biscuit, trying to hit that sweet spot of soaking as much of the biscuit as deeply as he could for as long as possible, without the lower half breaking off and requiring an immediate emergency spoon air sea rescue operation.

“I am all ears, my dear.” said Dan, cheerfully, already nibbling his second biscuit, having smudged out the table drips from his first with his fist. Tessa saw and was used to it all.

“It’s about the upstairs toilet”. Dan’s cheer evaporated and he looked uncomfortable, partly because he knew what was coming, and partly because the thought clashed with the sight and taste of his chocolate digestives.

The Keegan semi-detached household offered a communal toilet and bathroom upstairs and another toilet downstairs, primarily for guests, and for when the other was occupied during the morning rush hour.

“Dad, when you go to “talk to a man about a dog” (family code for toilet No.2s), you quite often forget to make use of the brush and/or the spray, and it’s pretty disgusting on quite an industrial level. Plus the toilet seat itself now has quite a large crack near the hinges, it’s been totally stressed out…..by you.

Dad, like it or not, you are a repeat offender and in spite of warnings at the last two family meetings, you have not responded. Therefore, I have a proposal to put to the vote. My proposal is that from now on, Dad will only use the downstairs toilet”.

“Oh my God”, blurted Leo, “all my friends use the downstairs loo.”

Dan felt some angst rising within him, this was a bit much, to be banned from his own upstairs toilet.

“Look, guys, this is unfair, and radical, …..I have another suggestion”.

Dan scrubbed around for a fairer solution. He lost his forth biscuit into the lower depths of his coffee mug and didn’t even notice. But suddenly, his face lit up.

“I tell you what, team. This is my idea. I will pay a fine if I neglect to scrub then whoever has to clean up, receives the fine payment”.

“How much per fine?” asked Leo, immediately, seizing the business opportunity to supplement his pocket money.

Dan had to think quickly, with all three of them, locked visually on to him, spotting any facial weaknesses. Leo was tense, on the edge of his seat. Dan’s strength was his quick maths, and he ran through the process.

“Ok, average 1 deposit per day 5 days a week, maybe 15% increase at weekends and holidays, that’s up around 30 deposits per month. With a 80% clean up rate, that would mean a 20% forget rate, so possible 6 fines per month.

Ok, I will pay 1.50 per fine.”

“Deal”, shouted Leo loudly, as he jumped out of his chair. Tessa looked away and Evie put her head in her hands. But in the end, Leo got the vote and spent the next month, whenever possible, waiting for his dad to complete, to check the status of the ceramics. This triggered Dan and helped bring down hygiene failures to under 5% and so Leo eventually gave up his guard duty outside the bathroom.

The rest of the meeting covered less controversial subjects: late night fridge raids by Dan of food that “belonged” to other family members, incorrect colours of clothes in dirty washing baskets (Dan and Leo) and lastly, Leo’s screen time.

Both Dan and Leo escaped further punishment, but needed to adjust future behaviours. The meeting closed, Evie published her minutes of the meeting summary on the family What’s App group.

Tessa and the kids had either left or were on their way out of the kitchen. Dan went to stand up and quickly sat down again, a major flip of his heart beat grabbed his whole attention. He felt light-headed and a bit dizzy. His coffee cup was empty, save the sludge of a drowned biscuit and so was the plate of half a packet of chocolate digestives, but his mind filled with fear.

(to be continued…..)

Last week in Manika’s Plan:

As Dan Keegan brushes off medical concerns with deflections about BBQs and beer fridges, experienced nurse Margaret sees straight through his denial, warning that he’s already in dangerous health territory. Meanwhile, at home, his daughter Evie leads a blunt family intervention on Dan’s hygiene habits, resulting in a bizarre but effective toilet-fine system enforced by his son Leo. Just as Dan thinks he’s off the hook, a sudden dizzy spell and heart irregularity strike, hinting that denial won’t protect him much longer.

Manika’s Plan – Episode 4 – Dan Keegan – ‘‘Heartache”

In front of her, Manika had Dan and Dan’s ECG results, together with the consultant’s opinion, and she had decided to lay them out as directly as she felt professionally able to do. She had to trigger a positive response from Dan. Which mode would Dan be presenting today?

He sat before her, smiling, as usual, but his smile was a little too wide and a touch of incoherence hung between his mouth and the look in his eyes. The mouth attempted a good yes, but the eyes failed to support.

“Mr Keegan, I have your ECG results here and with them the report of the consultant, and according to his analysis he recognises the symptoms of atrial fibrillation, AF, or Afib, if you prefer to call it that.

As I think you are aware, from your own Dr Google, this means that the electrical pulse that should fire your regular heartbeats, is doing so irregularly and this is causing you problems. And if I understand correctly, the occurrences are continuing with the same type of regularity. Is that true?”

Dan nodded.

“So I want to lay out what I see for you. It seems clear, so far, that the main cause of the AF is your excessive body mass.

It should be under 90 kg and it’s nearly 120kg. So we can skirt around this fact, but it is inescapable that you really need to accept that you need to lose a good deal of weight, and pretty quickly. If not, and maybe in any case, you will need to have an operation to relieve the AF, but if the fundamentals don’t improve, you can be back in the same situation within a few years”.

If for decades, Dan had been some kind of spaceship, freely orbiting the earth without resistance, forever circling, gazing down and waving, with a smile, at his planet, Manika could now see that he was beginning to re-enter the earth’s denser atmosphere and the pressure and heat was growing rapidly…but she felt the need to press on.

‘‘Your heart is under considerable strain on a continuous basis, and that increases the risk of some sort of adverse cardiac event”.

Dan had been avoiding Manika’s look during this speech, his hands were locked together, with his thumbs rotating awkwardly around each other, and almost intangibly, back and forth, he was rocking in his chair.

“Mr Keegan, may I try and tell you what I think is really happening? Would you mind if I paint a picture for you?”

Now that she knew that Dan’s defence had fully broken, Manika was trying to tread very gently, and to seek Dan’s permission for what she was about to say next.

“Er..yes, doctor, go ahead. Let me be a blank canvas.” he said dryly and quietly.

“Are you sure?”.

“Yes, I’m sure, paint away, I trust the artist”.

There was no bluff smile any more, there was a hunched up, big, scared man, ready at least to hear, if not yet ready to swallow, totally, the bitter truth.

Manika spoke very slowly and quietly, in short phrases.

“I believe, that you know, deep down, that you need to take urgent action. You should, not just to go on a diet, not just to stop consuming Snickers and crisps, also not to suddenly start jogging and so on. We have to have a deep habit change. Your habits have formed your behaviours, and your behaviours are who you have become today.

I can well imagine that you are suffering. You have now suffered from the first persistent signs of AF, and before that, no doubt, from the physical challenge of being so heavy, the strain of body movement, the poor sleep, getting up in the night and so on.”

Dan said nothing, his eyes were slowly drifting around the room.

“So you know your daily suffering.” It wasn’t a question, but Dan nodded very faintly, his eyes dropping to settle on the tiled floor.

“But the thing, Mr Keegan, is this, if we look ahead, to where you will be in two to five years time – I really don’t know what we will see”.

Manika, knew, of course, what she would see, down to the week, month and year, and it wouldn’t be a Happy Christmas this year for Dan’s family.

Also, she knew well that for 25% of all registered heart attacks, the victim had no further suffering beyond the moment of the event, because life ended there and then and Dan was clearly sitting in that group.

Dan remained fixed, except for his rocking, his spade like hands still locked together.

Then, in a quiet, subdued voice, his gaze still focussed on the floor, he said slowly:

“So we need a DHC.”

“A what, Mr Keegan?” said Manika, struggling to follow Dan.

“A DHC, a Deep Habit Change….so doctor, if I have understood you correctly, you think that I am walking on an ever-growing thinner tightrope, in army boots, two sizes too big, three hundred feet above a snake-infested jungle, wearing a blindfold and with my hands tied behind my back?”

“Well, I am not sure that your hands are tied, but other than that, I think you have got the picture.”

Dan stopped rocking and remained silent, deep in contemplation and then gradually, his posture came alive, he looked up at Manika directly and put his hands on his legs, arms straight, and filled his huge chest with air.

“I will do it for my kids and my wife, I will make change, you’ll see, I don’t care how difficult it’s going to be, but I will do it.”

Manika smiled at him. “That’s the spirit, there’s only one sensible way forward, you know that. I have here some ideas, guidance, whatever you want to call them. They may help you,” and she handed him a pamphlet.

“Thank you, doctor, for painting the picture. I see “The Scream’’ by Edvard Munch.’’

(to be continued…)

Manika’s Plan – Episode 6 – Dan Keegan – ‘‘WTP’’

Back at home, Dan had sat Tessa down and shared all the details of his doctor’s appointment. She sat, grim faced, gripping her coffee mug with both hands throughout his reporting, but she had been surprised by nothing that she had heard. She was at least relieved that her husband, and the father of her kids, was, at last, showing some signs of taking responsibility for sorting out his health.

“Better late than never, Dan.”

“I am calling a family meeting, I need to tell the kids what’s going on…carefully.”

Without referring to all the details of his meeting with Manika, Dan announced to the family that he was making plans for a project. He had decided to call it – “The Wrong Trousers Project” or ‘’WTP’’ for short. He wanted to use the embarrassment of his trouser split at school to be a trigger for action.

“Dear Team, I have a new project.”

Dan had developed his own analogy for his situation and his actions, and he decided to focus on the junior member of the family to make his point.

“So, look Leo, we have a car, right? And it needs regular servicing and good quality fuel to keep it running. And without both, eventually, what’s going to happen to this car, Leo?

“It’s going crash.”

“Well, hmm, let’s say, at least, that it’s, eventually, going to run less smoothly and may break down. And I have been told by my doctor mechanic, so to speak, that I need to improve the fuel quality and the servicing of my two legged car, in others words, my body. So in order to do that, WTP will help me to make those changes. Everything will be gradual. Week by week, eat more vegetables, fewer carbs, more fish, chicken, less red meat.

I will weigh in twice a week minimum, daily would be good, if I don’t obsess too much about the figures and just take the trend”.

The children reacted in their own ways.

Leo worried that this meant that he’d enjoyed his last Big Mac Drive Thru’ at the local Shell garage and Evie was full of teenage scepticism, but also grateful for any change that led to less anxiety.

Dan waved Manika’s pamphlet, that she had given him, and explained that it contained the secret of healthy living.

Apart from Leo, they became rather curious to read Manika’s pamphlet.

“Dad, what about a system of fines, if you break the rules in the pamphlet.”

Leo was keen again to cash in, after the failure of the previous WC revenue stream opportunity.

“Leo, good business thinking from you, as I would expect, but there are high risks here, that I don’t think that I can afford to take. I can’t afford to lose weight and bankrupt myself at the same time”.

He continued reading from the pamphlet:

“Yes, I will try to avoid any arguments or heated discussions in the evenings. Let’s agree that if we need to have tricky discussions, try to finish them by 8.00 pm and then agree a truce until morning”.

Everyone nodded at that one.

“Keep the bedroom cool, warm duvet, ventilated room.

No screen work one hour before bed and keep the lights dim, all evening if possible, after 8.00 pm, are you listening, Leo?

If I get desperate for food, I will have scrambled eggs, or some natural nuts, salted or raw, walnuts, almonds best, then cashews and peanuts”.

He carried on reading from the pamphlet:

“Main things to limit or remove: out with bread, pasta, rice and potatoes and all fruit juices and steer clear of porridge and processed seeds in general. Do not cook with sunflower oil, use olive oil or butter on a low heat.

If I get the shakes because of sugar withdrawals, I will go for fruits and if I go for fruits, I go for berries, like blueberries, raspberries (frozen or fresh), plus some Greek yoghurt, and if I must, one teaspoon of honey or sugar”.

“Or two or three or four” tempted Leo.

“No, Leo, that’s not how it will be. Dear Team, I give notice now that I am assuming control of a couple of kitchen cupboards (as already marked with green stickers, see over there) and at least one shelf of the fridge. I want to move the processed foods out of my cupboards and off my shelves.

Maybe we can’t get them out of the house or the kitchen because of you guys. But just don’t buy any more chocolate digestive biscuits. Pamphlet says: buy 75% or more cocoa content dark chocolate, it’s not bad at all for you, a couple of squares a day, squares, not bars.” said Dan, talking to himself.

“So you know, I am going for a Mediterranean type diet, keep it simple, I will go for foods that I like, I won’t force myself to eat broccoli, if I don’t like it because it won’t be sustainable”.

Dan felt, inside, like he was at the receiving end of a firing range with pamphlet bullets of nutritional goodness being fired at him incessantly. Each restriction made him wince inside.

“Now that is over, there is some other news. Item 2 on the agenda. I know that we all have bicycles, but Evie and Leo, your bikes are now both a bit small for you, correct?”

“Yes, dad” they both replied.

“So this is the plan. Leo, you will have Evie’s bike, Evie, you will have mum’s bike, mum you are without one, for the moment, but you hardly use yours anyway. And I have invested in a new bike, as part of ‘’The Wrong Trousers Project’’. Come out to the garage and see my beauty!”

They all trooped after Dan into the garage and there was a gleaming new bicycle.

‘’But, dad’’, exclaimed Leo. “It’s an E-bike.”

“A what?’’ said Tessa.

‘’A pedal-assist electric mountain bike, Mum. It has a battery, so that whenever Dad needs to go uphill, he can switch to battery power.’’

“Yes, it’s an E-bike for the WTP and not only that’’, said Dan excitedly, ‘’I have bought a multiple bike carrier frame that fits the back of the 4×4, so that we can go biking… this weekend, all three of us and mum can go and visit grandma.”

So that was it.

‘’The weather forecast is good, we will spend one night in a B&B on the South Downs, and we will do some serious cycling. I am going to pack the car tomorrow night and yes you can both have a go on my bike, once we find a big open space, with no obstacles’’.

The children were both impressed and uneasy. It was a beautiful bike, but they smelt a trick.

The following evening Dan packed the car, the kids had rearranged their weekend plans and Tessa had happily fixed it to go and visit her mum. Tessa had noted, positively, Dan’s reference to needing to cut down on alcohol, but when she put Leo’s clothes rucksack next to the tailgate of the SUV for Dan to pack, she noticed, partly hidden under Dan’s North Face coat, a five litre plastic bottle of Dan’s organic home brew.

‘’Dan, why are you taking home brew on the Wrong Trousers weekend cycling trip?”

Without thinking, Dan retorted:

‘’There’s no pub for miles….”and then he stopped and realised his mistake. “Well, it’s just for emergencies, you know, you never know’’.

‘’Give it to me now, Dan. No beer on the weekend, it clearly conflicts with the WTP.

“Oh, ok’’. Dan had been thwarted.

Dan had a long way to go, with his cycling trip, his WTP and his general thinking, but off they all went.

On the Monday evening after the cycling weekend, Evie called a family meeting. Her main aim was to officially complain about the events of the weekend. Her mum had been on a shift at the chemists Sunday, so had missed out on the news on their arrival back home.

“Mum, I want to let you know about Dad’s tactics over the weekend. First of all, he chose a really hilly start on the first morning, which was exhausting for Leo and I and he just turbocharged his way up the hill and sat at the top waiting for us to climb it. And…as soon as we arrived, he wanted to set off again”.

Dan objected.

“I needed to test the battery capacity on that first hill to make sure that it met up with the spec of the bike. You are fit kids and I could see that a short rest was enough”.

Evie was not going to be put off by her dad’s interventions.

“And then we went down the hill, and he thought that that would charge his battery, but it didn’t …and then halfway up the long slow second hill, the battery died, and guess what….he couldn’t cycle and keep up with us and had to walk, and we were ready to ride.”

“Listen, my bike weighs nearly 25 kg in all and with my weight, that’s pushing 145kg up a hill. Do you want me to have a heart attack or what?”

“Ok, listen”, said Tessa. “Let’s call it a draw. And next time, Dad, let the kids agree the route with you beforehand.”

Monday night was Dan’s “gym night”.

He drove to the gym in his a 4×4 Toyota Prado. Why this car? Because it was one of few cars that he could get in and out of. He overcame gravity to climb in and gravity helped him flow back down out of it.

If you had asked him:

“Well, you know I had to get something big enough for the kids and the camping holidays.” The Keegans had never been camping and such an event was never in Dan’s plan.

Monday night was Dan’s symbolic gym night, drive there, sit around and drive home. At least he had stopped going to the pub afterwards as part of his ‘‘cooling down’’ session. As he drove home a classic song came on the radio, “Hotel California’’..’’you can check out anytime you like, but you can never leave…’’ Dan felt trapped and his chest was tight.

Manika’s Plan – Dan Keegan – Chapter 6 – Public Speaking

On the way home from the gym, Dan’s chest was tight, but he had lost over 2.5 kilos in two weeks. It was Evie, who was to dominate events in the Keegan household over the next few weeks.

On Monday evening, Evie came home with details of the school public speaking competition. It was an annual event with students eligible to take part from the fifth grade and above, a total of around 240 students.

It took place at classroom level first as a preliminary round, and then the class winners proceeded to the finals, two weeks later, in the main school hall, to which the whole school and parents would be invited. The participants were to give a two-minute speech, on any subject that they wished to speak.

Evie said, “I’m going to enter this competition because I like speaking, just like Dad, and I think I can do a good job, although the thought of standing on stage in front of more than 200 people makes me nervous”.

“So what subject are you going to speak on?” asked Tessa.

Evie replied, “I don’t know. I’m going to think hard about that because it has to be something that is natural to me and that I feel excited and passionate about but not too contentious or boring.”

The next morning, Evie came down to breakfast and said,

“I’ve decided the subject that I’m going to speak on – the value of friendship.”

Evie, like many teenagers, had already been through some tricky stages of relationship building. She’d fallen in and out of relationship with hormonally charged boys and one or two girls, and had learned something about herself in the way that these events had unfolded.

It seemed natural to her to speak about the value of friendship. In a world where social media encourages the individual to be better than, or happier, or wealthier, or more successful than their neighbour.

For the next month, she was to be heard locked in her bedroom, repeating and learning her two-minute speech. She made her notes, refined them, re-edited and improved them. She then practised speaking, played the recording back to hear how she sounded.

She played the recording back to her parents for them to give feedback. And she generally honed her skills professionally, in order to present these two minutes.

Two weeks after this was the class competition. And she came home bubbling one evening, saying that she’d won the classroom level vote and had been selected to go forward to the finals.

“Well done, Evie”, said Tessa. “Great job. Now, what about the finals?”

In the finals, you were allowed to use the same speech as you made for the classroom, which was the obvious thing to do if you felt you had a very strong speech. But for those who thought they could improve on it, they would, or they could choose a new subject. It was entirely free choice.

So Evie decided just to improve and to refine the value of friendship. She felt that it had resonated with her and her classmates and would therefore touch the audience of both pupils and their parents.

So the evening of the event came.

Tessa was on duty at the chemist and no one could cover for her, but Dan said he would come along with Leo and the event was being recorded by the school. Dan, being Dan, had got the timing wrong and was over forty minutes late and arrived, just one speech before Evie was due to perform as the final speaker.

There had been eleven speeches so far, all of which were very competent.

Arriving late with Leo in tow, Dan opened the hall door to see it packed with students and parents. Evie was on the stage looking nervous. The only available free seats were now temporary wooden seats, which had been brought out of the storeroom to cover the unplanned high demand of the evening’s popularity. Dan and Leo moved towards the first two empty seats on the penultimate row.

The hall was mostly quiet, there was a pause between speeches, and people were respectfully silent before Evie took to the stage.

Dan targeted his wooden seat and lowered his bulk as carefully as he could, but….

(to be continued…)

Manika’s Plan – Episode 8 – Dan Keegan – Newton’s 3rd Law

Dan stressed and strained as he tried hard to make a soft, slow, moon landing on the wooden seat, but unfortunately for him, at 0.1 metres from a successful landing, he fired his retro rockets at full blast. He let rip, his derrière spoke, and every single person in the hall heard Dan’s klaxon call. It was like a bull bison calling his mates to join him.

Not only that, the rickety wooden chair on which he had tried to so delicately place his 120 kilos, was old and tired and shuddered under the weight such that Dan slowly, but completely, collapsed onto the floor, with Leo looking down in horror, both at the sound and sight of his rotund father splayed out below him.

(It would turn out that, later, the young and slightly disrespectful teacher of physics, who was sitting in the row in front of Dan and Leo, would always use the event to explain to his third grade, Newton’s third law of motion.

He was heard to have said:

“The downward force on the chair, exerted by the Bursar, exceeded the chair’s structural capacity to resist it, and so the chair, overwhelmed by the force, responded to the gravity, collapsing at all joints, to the floor, together with the Bursar, who continued the direction of his initial motion”.

There was silence for a moment, a few people stood up to see if Dan was OK and then one or two nervous laughs erupted. But once it was clear that Dan was not hurt, then a wave of laughter crescendoed, Dan stood up, red-faced, smiling hurtfully and deeply embarrassed and said: “Thank you, ladies and gentlemen”, after which, there was tension release and generous applause.

Evie had gone pale on the stage, as if frozen by the trauma of hearing the explosion, and then seeing the collapse of her very own father, the school bursar, the financial director of the school, known to all present above grade 4.

Evie was beckoned to the microphone by the teacher time-keeper.

“Evie Keegan, the value of friendship.” He announced. There was a murmur of laddish humour from 5th and 6th grade boys.

Each speaker was allowed to indicate when they were ready, and the clock would then be started once they gave their nod. Anyone exceeding their two-minute time limit was automatically disqualified, that was one of the rules of discipline for the speakers. The timekeeping teacher was looking heavily at Evie, awaiting her signal to start the timer.

Evie stood on stage in front of the microphone in total silence, staring down into the hall as if bewitched and paralysed by the event that had taken place. The timekeeper coughed as if to remind her. But it was another full ten seconds before Evie’s facial expression changed. She dropped her head, nodded and began to speak.

“Family challenges – Evie Keegan” she began quietly. Dan, now on a metal chair, and Leo, looked at each other incredulously.

She had totally abandoned her prepared text. She was going to wing it with an absolutely unprepared speech. Even twelve-year-old Leo knew nearly all the words of “the value of friendship”, by heart.

Evie began as she saw the timer go to 1:59. She took a deep breath, blocked out everything and everyone and went deep inside herself.

“I take more hassle than I oughtta, it’s me… Evie, the Bursar’s daughter
Look in the mirror, splash the water, the fun of life lives ever shorter
Like a lamb to the slaughter, where the hell are my supporters?

(First cheer from the 5th form)

No half chance, not even a quarter, this whole damn life is out of order.

Every day, we play this game, no strength left, to fan the flame
No one knows, we hide this pain, spinning round, drives us insane
You don’t need to know our names, ’cause we kids, we’re all the same
(Huge cheer from all kids)

In this circle we remain, no rest, no break, we feel just blame.

At night, online, we share our grief, one to one, we find relief
Morning comes, it’s a thief, the night was kind, but all too brief
For my rights, I beg belief, they crash like waves upon a reef
We look up high to our chief, but hope is crushed just like a leaf.”

The clock was on one-forty, but Evie wasn’t watching it, she was rapping her heart out.

“Too proud sometimes to show a tear, but trust me, pain is always near
Who is there? Who wants to hear? This fear I hold is crystal clear
It’s shouting loud inside my ear, but will it fade, or disappear?
But when it breaks, it’s crystal clear, we rise, we shout, we’re going to cheer!”

Evie shouted this last line, punching her fist high and firing up the whole hall.

2.03

Everyone stood and cheered, kids and parents, the kids were shouting and the parents warmly applauding. Evie beamed, bowed, waved and smiled.

The clapping lasted over a minute, Dan and Leo, from the back, were shouting “Bravo”.

Eventually, the Head teacher, Mrs Patterson, rose and called for calm.

The timekeeper, the rule loving, Mr Arnold, pointed to the clock and mouthed to Mrs Patterson the word “disqualified”. The first few rows of students caught wind of it, saw the clock at 2:03 and started to boo very loudly, and the booing soon spread throughout the hall.

Mrs Patterson, her arms extended, appealed for calm, and then explained that the judges would need at least five minutes to consult. She led them out with all the contestants to the library next door.

Slow hand claps started in the hall, with no one of real authority ostensibly in charge, the students were now empowered and the tension rose. Evie sat back down on stage, her heart racing at what she had just peformed, she could not believe it.

After four minutes, the Head teacher emerged leading out all contestants and school judges and called for quiet again.

“Ladies and gentlemen, boys and girls, the judges and contestants have all quickly come to the conclusion that there are official winners and an unofficial winner”.

The official three winners, in first, second and third place, were quickly announced, politely congratulated and applauded, but the impatience for the unofficial winner was running around the hall and the positive tension still buzzing.

Soon, all were seated, and Mrs Patterson stood up.

“What we know tonight and what we have witnessed is a remarkable performance of spontaneous rapping, completely unrehearsed, by fifth former, Evie Keegan. Such a bold and inspired move”.

Huge cheers and whistles.

“As a result of this memorable moment, which we will never forget, we have decided to launch a new school annual rapping competition, which will start next year and will be named the Evie Rapper competition”

Loud shouts of “yes!, Evie!”

The evening drew to a close and Dan, Evie and Leo had finally said goodbye to the last of the admiring students and congratulating parents and theirs was almost the last car remaining outside the school.

Dan sighed heavily, he was worn out, they all were. “Well, Evie, what a performance. You blew my mind and Leo’s”.

Evie looked at her dad, paused and said:

“Well, it’s all because you blew your bum, didn’t you, Dad?”

They all laughed, all together, as one family, longer, louder and closer than ever before.

(to be continued….)

One month after when Manika had sent Dan off with the pamphlet, he appeared again in front of Manika, like a plaintiff on probation, reporting to a court magistrate.

Dan began, earnestly:

“Well, doctor, I have worked hard on my eating, drinking and exercising discipline. Hoping very much that I have not put on more muscle than I have lost fat.”

“That is a low-risk hypothesis, Mr Keegan” said Manika. ‘‘Muscle mass needs weeks and months to build up and days and weeks to fall away. But I do note that your weight is down by over 4 kg, as you said, so that is a decrease of 3.3% in body mass. It’s a good start, Mr Keegan, just keep going. Let’s see you in another month and aim for at least another 4 kg reduction.”

Dan left. A few minutes later, Manika went to the bathroom and as she was washing her hands and looking into the mirror, Manika saw something extraordinary happen that she had never experienced. In her mind, as clear as crystal, she saw a banner of Dan’s cross-over date, but it also had a time.

The date was today and the time was within the hour. Dan was headed to cross over in less than sixty minutes. Manika’s heart leapt. “Oh my God,” she said out loud to the empty surgery office. She threw down the paper towel, leant over the sink, avoiding the sight of herself in the mirror, and bit into her hand as she started to think and her mind raced to understand the magnitude of the challenge that she suddenly faced.

This man, who had just left her office, whom she had come to know as an honest, good, caring, loving person, was going to have a massive heart attack within the next hour.

She zipped through the scenarios. He had come to her by car, and it was his lunchtime but he had not had lunch before he saw Manika. So whatever he was normally going to do in the next hour, being Dan Keegan, he was definitely going to eat. But where?

“Ann, is Mrs Keegan at the chemists today? She is…. ok. I am asking you to lie to her, in an emergency situation, I will explain later. Just tell her that her husband left something important at the clinic, and we need to return it to him and only to him.

And then ask if she knows whereabouts he normally has lunch, somewhere between the surgery and the school. Maybe a pub, but we need to know, and then I need to find him. I will drive myself but stay in touch with me and be ready to call 999, when I ask you. Just don’t ask me any questions, just do exactly as I say, thanks. And Ann, try and rearrange my next two hours of appointments and have Barry cover for me, if possible.”

Manika grabbed her coat and car keys and ran out of the surgery. Ann had never seen this before and knew something very grave was going down.

Ann called Manika back just as she was getting into her car.

“Manika, Tessa said that he can go to at least two or three places for lunch” and Ann listed them.

“Two pubs and a cafe, or…’’ she said, “he may have gone back to school to eat”.

In any case, Manika needed to head towards the school area, where all of these places were located. Already twelve minutes had passed since she had seen his final deadline.

She hit the lunchtime movement on the roads and was slowed painfully by the stop start of London traffic lights, roadworks and roundabouts.

Whilst she was driving and forced to follow the snail trail of cars, she took the opportunity to think through the scenarios. Probably the most likely scenario was a major arterial blockage, he would be down and gone almost instantaneously.

So, she thought, we will need a defibrillator and cardiac arrest team to be on the scene immediately that it occurs. If she waited until she found him and then called an ambulance, it would be too late. The response time could be ten to fifteen minutes, even though the nearest Accident & Emergency location was only two or three miles away.

Just then she noticed Walthamstow fire station ahead, she spontaneously pulled onto the small forecourt and hurried in to the main hall.

“Hello, I’m Doctor Manika Kundu, I am following a patient who I’m pretty sure is about to have a cardiac arrest, don’t ask me why. But, I guess you have a defibrillator and if you can, maybe you could lend it to me. Here is my ID.

“Tilly, go and get the boss. Hang on a moment, doctor, we will ask, Martin, our Station Commander”.

Martin appeared from the obvious place, in this older London station, sliding down his polished stainless-steel pole and landing lightly a few metres away. Manika glanced at her phone, it was now twenty five minutes since Dan had left her office.

“Hello, what can we do for you, doctor?”

Manika briefly explained the situation .

Martin said: “Look, understood, the good thing is that it’s not a peak call out period right now, and I have my response car which is parked out the back. It has a defibrillator and other kit. Where is the patient and why haven’t you called 999?”

Manika became a bit flustered: “Look, this sounds crazy I know, but there is no victim yet, and I don’t even know where he is, I just know, I really believe that this guy is going to go down very soon with a major cardiac event. I have three places to try to find him in the next thirty minutes, or it’s too late and so you either trust me on this or not.”

She could see that Martin had decided, the risks made it so, and Martin felt that there was something very honest and professional about this woman, doctor or not.

“Ok, doctor, this is what we are going to do. Tell us the three locations, we will plan the best route and then Tilly and I will go in my SUV on “blues and twos”, (lights and sirens) so just stick to our tail as close as you can, and we will be looking out for you all the time. Let’s have your mobile number, so we can keep an open line with you as we go.”

“Thank you so much.” Manika shared the locations of the café and two pubs, and they immediately said which they would go to first, knowing their local area inside out.

Manika got back into her car and waited for Martin and Tilly to appear in front of her in Martin’s marked London Fire Brigade SUV. She heard the siren of them coming round the back corner of the fire station, and she felt a small burst of hope not to be alone any more on this mission.

They headed off down the busy high street as all the cars in front bent out of their way to the edge of the road, creating enough space for Martin and Manika to pass.

Martin’s voice was unbelievably calm, logical and steady: “Doctor, when we get to each location, I will pull up outside, you pull up behind me and you and Tilly will go inside, check the premises and then return to the car. Tilly will have the defib. kit with him each time, so we don’t lose a moment, when we find him.”

It was Martin’s apparent firm conviction that they would find him that lifted Manika further, and she understood the powerful professionalism of this fire officer.

They arrived outside Dan’s preferred café, “The Copper Kettle” – they checked it, no Dan. Thirty five minutes gone.

(to be continued)

Last week in Manika’s Plan:

One month after his last visit, Dan returns to Dr. Manika Kundu, showing signs of progress, but as he leaves, Manika has a sudden, vivid vision that he’s about to suffer a fatal heart attack within the hour. Racing against time, she enlists her receptionist Ann to locate Dan’s possible lunch spots and pulls in the local fire brigade for emergency support. With sirens blazing, she and Station Commander Martin tear through traffic, checking each location with a defibrillator in hand. So far, no sign of Dan, thirty five minutes have passed, and the clock is still ticking.

Manika’s Plan – Episode 25 – Dan Keegan – The Nag’s Head

‘‘The next pub is “The Nags Head”, his wife said he liked it because it has a big garden out back, where he sits with his lunchtime beer,’’ explained Manika.

“OK, so let Tilly run in and check both the main premises and then the garden, we will be there in less than five minutes, if we maintain this speed. Are you doing OK, Doctor?”.

“Yes” said Manika, feeling far from OK, hanging on to the view of their blue light, a beacon of hope and the fading prospect of finding Dan still alive.

Three minutes later, they arrived at “The Nags Head” pub. Tilly grabbed the defibrilator and ran into the pub. Manika followed him. No Dan in the pub and in fact no one in the pub, not even the bar staff. They ran out into the garden and there was a crowd of people gathered loosely around someone on the grass. It was Dan.

Manika shouted: “He’s here, and he’s down already”.

Manika heard Martin radioing to Control:

“Control, from Charlie 1.”

“Charlie 1, Control, over.”

“Charlie 1, I am attending a suspected ACE (Adverse Cardiac Event) in the back garden of the Nag’s Head, 9 Orford Road, Walthamstow. Disregard any other calls made regarding this event, we are present and we will start CPR (cardiopulmonary resuscitation) now. Send paramedics”.

Martin turned his attention to the pub goers in the garden. Everyone, back into the pub, please, now!”

In the garden, Tilly and Manika had turned Dan onto his back and ripped open his shirt. He had been sitting at a wooden garden bench and table and had just rolled off the end to his right and onto the ground. The other pub goers said that it had happened about 2 minutes ago. Manika knew that they had to have started CPR no more than 4 – 6 minutes after the event, just to try and keep some blood flowing into Dan’s brain.

The landlord was moving everyone back inside the pub so that it was just Martin, Manika and Tilly, kneeling next to Dan.

His face was ashen white, his lips a pale, pale pinky blue, his eyes were shut, the tips of his fingers were just beginning to look a touch bluish and his chest was not visibly rising and falling.

Tilly had set up the defibrillator and Martin had arrived with an oxygen supply and applied it to Dan’s face, to allow him to be boosted with oxygen as soon as he was breathing properly, if he ever did.

They had been working for about seven minutes, with no major improvement in Dan’s condition, when they heard the siren of the paramedics arriving. They brought with them an intubation kit, IV drugs and a cardiac monitoring device. The pub goers had helped bring the trolley out through the pub and into the garden, and left it next to them.

Within 1 minute of arriving, the paramedics announced that they had taken over: “I’ve got it. Right, continuing compressions. Attach pads, Oxygen on, IV access. Stand clear…shocking and CPR carried on.

Two minutes later.

“Ok, he is stabilised, he is breathing, let’s get him on the trolley – you guys, come and help us lift”.

It needed six of them to lift Dan onto the trolley, and then they had to half carry it back through the garden, through the pub.

“Put that damn phone camera away!”, shouted Martin, raising his voice for the second time, as he followed the trolley out of the pub door and towards the ambulance.

Dan was in the ambulance and away to Whipps Cross University Hospital, A&E. Manika collapsed back onto a pub bench near the front door of the pub. She looked up, Martin was coming towards her with a drink in his hand, smiling.

“Here you are, doc. You deserve this, you managed to save his life, without any question. I have no idea how you knew that he was going to collapse when he did and how you managed to figure out where he would be and when, but you did it, somehow, truly amazing. I think that’s the first and last time that I have a callout like this one”.

Martin and Tilly looked unphased, like another day at the office for them, at the end of their shift, they both had a quick drink and said goodbye, asking Manika to let them know how Dan was.

Manika thanked them, emotionally exhausted and felt empty when they had left, they had such reassuring and overwhelming positive energy. They saved lives, probably several times a month, and probably much more often. Just heroes.

Manika rang Ann at the surgery and outlined the situation. She asked Ann to contact Tessa and tell her to go to Whipps Hospital, and told her that it looked like they had reached Dan just in time. Ann was lost for words as to the whole story, but at the end of the conversation, she just said “You’re an angel”.

Manika headed back to the surgery and somehow managed to process her remaining waiting patients. She felt dazed and disconnected from the banal reality of a baby with ear ache, kids with a cough and elderly folk with back pain.

It was four days later that she went to see Dan, when he had come out of intensive care and was in the high dependency cardiac ward. He had undergone an immediate coronary artery bypass grafting (CABG). The surgeons had taken veins from his leg and grafted them to bypass the blocked artery, restoring the blood supply.

His heart was restarted with electric shocks and medication. They wired his sternum shut and closed up his chest. After, he was transferred into Cardiac Intensive Care Unit, and he remained under observation for the next forty-eight hours, to see if his heart could sustain the rhythm without support, to confirm brain function and how his other key organs were coping with the stress.

“Hello, Mr Keegan, how are you feeling?” said Manika.

“Hello, doctor, I am sore and more, very sore here, like someone dancing on my chest in stilettoes,” he indicated at his chest with a slight movement of his left hand, “and my head is still occasionally floating around the room and beyond.

But I tell you what, doctor, I had a very strange experience in the garden of the Nag’s Head, I will tell you about it later. I went off to visit my maker and then came back. The staff told me it was called a Near Death Experience.”

“I think we all had a strange experience in the garden of the Nag’s Head, it will never be the same place for me again.” said Manika.

She sat with him until his family arrived and could see that they were still upset and concerned.

Manika said to Tessa: “Dan has been fortunate that he has not had secondary complications, so his first few days provide for quite an optimistic outlook, but we need to take it day by day for the next 2–3 weeks. He should be home in about a week, but he won’t be able to do much for several weeks, no lifting, driving nor work for at least six weeks”.

Manika left the family to see Dan on their own. As she looked back at Dan’s room – over the door she saw a new date, which gave her hope, it showed that Dan had many years to go, but the date kind of flickered as if the information was not yet fixed.

What was clear was what had happened to Dan’s body, but what would emerge over the next days, weeks and months were the changes in his mind, if any, the longer-term consequences of this life-changing moment.

(to be concluded….)

Manika’s Story – Post script – Dan Keegan – Episode 11

In the 6 weeks, since his heart attack, Dan had lost 6 kilos, without really trying, it was just the multiple effects of hospitalisation, intensive care, general shock to the system and gradual rehabilitation at home. So he was now down to 110 kg, from his pre-pamphlet days of 120kg. During the six weeks, Dan had consumed much reduced levels of sugar, compared with his normal Snicker, crisp, biscuit regime. This meant that he continued to lose weight and gained considerable satisfaction from this, only regretting that he had needed a heart attack to allow this weight improvement.

He was now able to move around physically quite freely, but he acted as though he was still fearful of overdoing a movement or gesture, so all actions were in a kind of semi-slow motion, whether walking, stretching to open cupboards and he occasionally placed his hand on his heart.

Manika was now seeing Dan as an outpatient and she knew that much depended on his ability to reset his habits and that would now be a real test. But after her third meeting with him, two months since his heart attack, she saw a date of death over his head that put him well into his seventies and for the first time in nine weeks, she heaved a huge sigh of relief.

Dan, who had been at home, recovering now for two months, had called a first family meeting, after his “Nag’s Head”, as the event now became known. He had discussed with Tessa what he had wanted to mention at the meeting, and they had agreed that he should say what he planned to say.

The kitchen table was occupied by Dan, Tessa, Evie and Leo, with all eyes and ears directed towards Dan.

“So look, team, I called this meeting, there’s no long agenda, but now it’s clear that I seemed to have survived my Nag’s Head pretty well, I wanted to share with you what I remembered, because it’s pretty interesting, or at least I think it is’’.

The kids looked at Tessa with uncertainty, but she calmed them with her hands and a gentle but sad smile.

‘’When my heart decided to miss a beat or fifty, I rolled off the end of the bench at the Nag’s Head, which of course, I don’t remember.

I have heard from Bill the Landlord, that the bench now has a little plaque on the side of it, which reads: “On this bench, Dan Keegan rolled over, but his pint survived.” Bill always had a dark sense of humour. He owes me a pint…of tomato juice, when I next go back to his pub.

Anyway, I wanted to tell you all what happened. I experienced what I now realise what some people call an out-of-body experience or an NDE – near death experience. This ‘dream experience’ that I had was so clear in my mind, that I can recall every detail and feel that I should share it with you, if only out of a sense of curiosity.

So this is how it went. One moment I am sitting with my pint and a packet of salt and vinegar crisps, waiting for my bar meal to be delivered, when…

I was standing in a brightly sunlit garden, with beautiful flowers, the colour of which I have never seen before. It’s impossible to describe the richness, type and variety of colours that don’t exist on earth, but that’s what they were. They were so bright and rich in colour, not even your day glow red lipstick comes close, Evie.

Then I looked around me, and by the way I was feeling so light and free and full of the deepest feeling of love that I can ever remember. Deeper even than when England beat France in the rugby last year, and that’s saying something.

Anyway, a group of people were in the background of the garden not that far from me and I could see and recognise many faces. Among them, I remember the pure joy of seeing my grandparents, who were just smiling at me and they looked young and fit, pretty much how I remember them when I was about your age, Leon. They were surrounded by some other Aunts and Uncles of mine, whom I also remember as a younger man.

Then a powerful looking, but handsome male figure with long hair and robes came forward and addressed me and asked me if I wanted to stay here or go back. I felt so full of love for the place and the people, I so much wanted to stay, but as soon as I was about to speak, I felt a strong pull, like a strong magnet in my heart, pulling me to go back, to be with you guys and to just come back and live. So I said, “thank you, but I need to go back”.

The next thing I remember sensing was the movement of the ambulance, the sound of the siren, the smell of medicine and the rocking around as we sped along to the hospital, but I couldn’t open my eyes”.

Tessa and Evie were quiet and tearful, Leo just grasped his dad’s arm. Dan continued.

“Listen guys, I owe you all an apology. I have been pretending for so long that everything was great, I have been ignoring the elephant dad in the room, I mean, my problem with eating and drinking too much of the wrong stuff. You guys have been watching it all, for years, I know. But I felt trapped in this body, trapped in my brain, trapped by my habits and behaviours, powerless to change.

I’ve been kidding myself. For example, the only reason we have the 4×4, it’s not to impress the neighbours, for status or safety, it’s just so I can get in and out of it. It takes me for forever to get in and out of mum’s car, as you know.

I don’t know if it goes back to my childhood, when I wasn’t good at sports, and I was always the last one to be picked for playground teams at school. I think that I thought that the only thing I could do was to make people laugh, so I focussed on that and hid my physical issues behind food. I believed that a big funny guy can still do well, and for years it did work, I suppose. Look, even mum agreed to sign a contract with me!

But there was always a day of reckoning, that I feared would come, but I had hoped it would never materialise. But now it’s come. The good news is that I now have a chance to get it right. I think I have been very fortunate.

I have no idea how Dr. Kundu found me when she did and how she had such help with her. She just said that she had a feeling that I was going to need help. So anyway, it’s a new life for me, new rules, same humour, but new habits. I won’t get a second chance, I’m pretty sure of that, but I tell you what, I really did love that garden of flowers….there must have been a really lovely pub nearby with some classic craft angel ale.

“Dad” said Evie, smudging her eyes with a tissue. “Stop it”.

And so it was that Dan Keegan needed a symbolic flashing red warning light, then a full knock down and roll over, and finally a celestial meeting to learn the lesson of life and reset everything.

“By the way, Dr Kundu told me that for 15-20% of people that suffer heart attacks, they just go down and straight to the garden in the sky, and get mowing heavens’s front garden, so I have really been given another chance, and I am not going to mess it up.”

A year later, Dan had made good on his promises, he was now under 90kg, and unrecognisable to people who knew him from more than two years ago. He had sold his e-bike, bought a normal bicycle and cycled with the kids and Tessa, who now had her own bike too.

Evie had just hosted the first school rapping competition, named after her and Leo was now at his dad’s school. Dan had had to undergo the major expense of refitting himself with new clothes, but Tessa had enjoyed buying him smaller sizes of everything.

As far as we know, Dan Keegan is a changed man. Let’s hope it stays that way. If we asked Dan to summarise his experience, without cracking a joke, he might say that:

“Your actions today determine the terms of a contract with the future, that cannot be broken or renegotiated’’.

What’s coming next?

“Good job there’s a doctor called Manika

There’s really not much that can panic her

She’s finished with Dan, but here comes a man

A knock on the door, it’s Peter Podmore”.

(to be continued…..)

It was early evening and Ann, the surgery receptionist, called through to Manika’s room just as Manika was about to snap shut her laptop and was visualising the cup of tea at home with feet up.

“Manika, I’m sorry, but you’ve got one more last minute appointment,” Ann said. “A new patient, Peter Podmore, just moved into the neighbourhood and registered with us last month, aged sixty-four, with a stubbed toe issue. He’s in the waiting room now.”

Manika sighed, set her pen back down, and straightened her desk. “Send him in, please.”

A polite double tap followed a moment later.

The door opened and in walked a lean, well-dressed man in a suit. He had that polished look and quiet confidence of someone who is naturally welcomed almost wherever he went. His brown leather shoes shone, his dark blue suit hung stylishly, and a rose handkerchief peeked neatly from his breast pocket. It could have looked slightly vain on someone else, but on him, it was quite classy. His face carried a healthy reddish glow; he looked way younger than his biological years.

“Mr Podmore,” Manika said, standing to greet him.

Just as she said his name she saw the date that he would cross over, which put him at sixty-five, hard to believe, less than twelve months from now, she thought, this is a fit man. And yet she knew that the information given did not come from her, and it had never yet deceived.

He smiled warmly and extended his hand. “Dr Kundu, thank you so much for seeing me at the last minute. Much appreciated.”

“Not at all. Please, have a seat and tell me a few words about yourself, Ann, the receptionist tells me that you’re new to the area.”

Manika had refined her “nice to meet you” requests over the years. She used to say, “tell me about yourself”, but surgery meeting times had become squeezed and, worse still, most patients forgot time when they were in flow state, talking of themselves and their issues. So now she leant on the word “few”. Peter took the cue and, crossing one leg neatly over the other, adjusting his cuffs, said:

“Well, we’ve just moved up from Hampshire. My wife’s an accountant with Ernst & Young, she’s been promoted from the Guildford office to a London branch. So we’ve rented out our place down there and taken a flat here.”

“Congratulations to her,” said Manika.

“Yes, thank you. It’s all rather new to us, but I can work anywhere, really. I’m a business consultant these days.”

“Is that so? What kind of consulting do you do?”

He smiled, pleased at the question. “I used to sell medical equipment, actually, in the former Soviet Union. That was my trade for years. But now I do more general business consultancy. Strategy, client development, a bit of training. I’ve always liked meeting and talking to people.

“Medical equipment, you said?”

“Yes, yes. Back in the day, I sold to Russian hospitals. This was just after the breakup of the Soviet Union, ninety-two, ninety-three. Quite an adventure, really. I was one of the first Western salesmen to go in. Russia was still deep in crisis; everything was in short supply, travel was erratic, tricky and chaotic, and deals were… liquid driven, if you understand.”

“That must have been fascinating,” Manika said.

He laughed softly. “It was. And hazardous. You could slip on ice, fall through rotten steps, be blocked by “Soviet” bureaucracy or trapped with vodka in a sauna.

Manika smiled at the image. “So, what brings you here today?”

“Well, doctor, I have been hearing strange alien voices in my head, telling me that I should wear pink.”

There was a short pause, while he fixed Manika with a stare, and then he laughed out loudly.

“No, doctor, sorry, I am messing around.”

Manika was slightly flustered and then quite amused. Peter then switched to the matter at hand, still with a wide grin on his tanned face.

“Stubbed my toe. Played it heavily into the door frame between the lounge and the kitchen, still unfamiliar territory, the new appartment, was just wearing my socks. The door frame won the duel. It’s been a week, and it’s still sore, still swollen. I can’t get my shoe on comfortably. So I wanted to know what’s the issue.”

“All right,” she said, rolling her chair back. “Let’s have a look. If you don’t mind, take off both shoes and socks so I can compare and just sit up on the edge of the examination table.”

He obliged, chatting lightly, as he did so. “I put on clean socks an hour ago, washed my feet, too. Thought it was the decent thing to do before inflicting them on you.”

“That’s very considerate of you, Mr Podmore. Not everyone does that.”

He grinned again as he casually hung his jacket on his, sat on the examination bed, swung his legs across onto it and extended them. The left toe was swollen, the skin stretched, a bit bit purple on the tip and shiny.

He carried on talking as she came over to the table, as though they had known each other for more than three minutes.

“Funnily enough, once, many years ago in Novosibirsk, I was in a Russian sauna, they call it a banya and, I slipped on a wet floor and cracked my thumb trying to break my fall. Same thing as now, really. Bruised, swollen, wouldn’t heal for weeks. Not the safest environment, a slippy Russian sauna.”

Manika leaned forward to examine his toe.

She ran through the check in her list in her head. There was local swelling, reddish-blue bruising around the joint. No fracture tenderness, no deformity. The skin was warm, suggesting inflammation but no infection. He reported a dull ache, worse in shoes, better barefoot. She noticed mild puffiness in both feet, perhaps circulation, perhaps the weather, but nothing alarming.

“It’s a soft-tissue injury,” she said. “You’ve given it quite a knock. There’s some deep bruising under the joint capsule, and that can take a surprisingly long time to settle. The bone’s fine, I can move the joint freely, and you can bear weight, so it’s just patience. Keep it elevated in the evenings, wear roomier shoes, and if it hasn’t improved in ten days, come back, and we’ll review.”

He nodded. “Good to know. I was worried I’d done something worse.”

“No, you’ll be fine.”

As he reached for his socks, he added with an amused glint, “You know, Doctor, in Russia they’d have told me to soak the toe in vodka for two hours and then stand in the snow for twenty minutes.”

Manika laughed despite herself. “I think we’ll stick with rest and elevation here, Mr Podmore.”

He slipped on his shoes, straightened his jacket.

”It’s a cultural thing, the banya, very Slav.

He hesitated at the door. “Just before I go, a quick anecdote. Once there were three top-flying American businessmen sitting in a sauna in New York. One of them had a brilliant idea. The other two said, ‘That’s amazing! Let’s go to the office, put it into structure, and work on it.’

“Meanwhile, thousands of miles away in Moscow, three Russians were in an office. One said, ‘I’ve got a really good business idea.’ The others agreed, and they all went straight to the sauna to work it out. That’s how the different cultures work.”

He laughed, the easy, confident laugh, of someone who’d lived between those two worlds and maybe still wasn’t sure to which one he felt more naturally belonging.

Manika replied. “That was fun, Mr Podmore, thanks, all the best to you, let me know how it goes.”

He inclined his head. “Goodnight, Doctor. Thank you again.”

When he’d gone, she sat for a moment longer than usual before writing her note:

Soft-tissue injury, right great toe. No fracture. Review in ten days.

Then she closed the file. A pleasant patient, charming, articulate. Nothing unusual.

Except that faint, uninvited thought again – only twelve months, way too early. Maybe it’s an accident, beyond his control, but then why do I see it?

(to be continued………)