A matter of counselling

Dr Sunil Kumar GuptaBy Dr Sunil Kumar Gupta, Sr Consultant and Chief of Head and Neck Medical Oncology Services, RGCI


Dear Doctor, I have undergone a long bout of treatment in cancer treatment. Success is  eluding, time is running out and my days are limited. I am not destined to live for long but I
have a wish to see my grandson before I leave this world. Please save me for some time to fulfill this little vision.

Shashi Prabha, 60 yrs old Hindu female was pessimistic about life and living but was resolute in one dream – to catch a glimpse of her grandson who was expected in two months. She was suffering from advanced ovarian cancer and had been treated with chemotherapy and surgery to no avail. There was minimal response to the treatment. Clinically, progression of the disease with ascites and unable to walk for last one month and repeated abdominal fluid tapping was done to relieve the pain abdomen and respiratory distress.

She came to Rajiv Gandhi Cancer Institute and Research Centre as an emergency patient and was admitted to ICU as critically sick patient. She had features of intestinal obstruction (bowel) with massive fluid in the abdomen. Added to this was persistent vomiting with poor general condition for more than a month due to poor oral intake.


I began with counselling and gradually inculcated optimism and positive approach towards life. Pros and cons with reality of the disease were explained to the family members who were turning positive despite negative ground realities. She was inspected by the surgeons in consideration of bowel obstruction but could not do anything due to advanced dissemination ( they simply opened and closed the abdomen).

Good counselling, timely approach, optimism and certainly the determination helped her to emerge a winner.

In the beginning she was on supportive care and ones her general condition improved she was plan to give low dose single agent chemotherapy after written consent from family. Pros and cons were outcome of treatment discussed with the family.

Gradually she responded and her fluid dried in the abdomen. The family developed tremendous faith in me and the line of treatment offered.

Gradually, her general condition improved and she was doing her day to day routine work. We planned to give combination of chemotherapy to get the maximum response. Subsequently she received combination of chemotherapy and her condition improved. The initial crisis had just ebbed to an extent when hernia surfaced and she was advised hernial surgery which she refused. She wanted to see her grandson in her laps and for this reason she refused the incisional hernia surgery. Soon she presented herself with pain abdomen and bulge of bowel from incisional hernial site with inflammatory changes at the local site.

Again counselling, we came to her rescue and she agreed for incisional hernial surgery. Following her successful hernia operation she is now out and about in the playfield with her grandson. Her life is now normal for more than a year.

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