When Manpreet Singh, MD, was growing up in the 1980s, her family was often told to expect her sister's premature death.
Singh's younger sister, Kirat, was born prematurely with Down syndrome and congenital heart disease. Although surgery when she was 3 repaired one part of Kirat's heart, the operation could not fix the large hole between her heart's lower chambers because of dangerously high pressures in her lungs.
Her doctors said she wouldn't live past age 5; then, when she was doing well at 5, that she wouldn't survive to turn 10. And so on.
Kirat did not die.
"As I grew up, I often wondered what made Kirat so resilient, and why her doctors weren't more hopeful about her outcome," Singh, now a child and adolescent psychiatrist at Stanford Children's Health, writes in an opinion piece published recently in JAMA.
In addition to remaining in good health, like many people with Down syndrome, Kirat, now 39, has always had a zest for life; she is exceptionally kind and very social, Singh writes.
Kirat's unflagging ability to be hopeful -- and how this intersected with their family's interactions with her doctors -- inspired Singh's medical career.
"My curiosity about Kirat's vulnerabilities and resilience led me to pursue a career in child and adolescent psychiatry, where I developed a focused interest in pediatric mood disorders," Singh writes in the piece. She continues:
"I was drawn to this field both by our limited understanding of the etiologies of depression and by my desire to instill hope in patients who feel hopeless. The underlying basis of hopelessness is still not completely understood, but the consequences of not recognizing it can be life-threatening."
While Singh was establishing herself as a clinician and scientist who specialized in understanding the origins of hope and hopelessness, Kirat continued to thrive. She passed milestones that had once seemed unimaginable, including becoming a beloved auntie to Singh's children.
Then, shortly after Thanksgiving last year, Kirat's health suddenly worsened; and she was hospitalized in Southern California. Singh then found herself in a new role as caregiver at her sister's hospital bedside.
"I became her 24/7 bedside physician advocate, interacting with the medical team, interpreting the medical lingo for my family, and relaying countless prayers from around the world encouraging a speedy recovery," she writes:
Kirat's empathy, in turn, inspired her medical team to become deeply invested in her care. Every time she underwent a procedure (PICC line, phlebotomy, X-rays), she asked her caregivers how they were doing, graciously blowing them kisses and telling them she loved them.
In the piece, Singh details Kirat's hospitalization and recovery, including challenges that had more to do with logistical frustrations than medical science, such as getting home oxygen set up before Kirat was discharged from the hospital. The experience made Singh feel even more empathy for her own patients -- especially those who lack the resilience, hope and loving support that her sister enjoys.
Now home and doing well, Kirat continues to surprise her doctors, who have given her a new prognosis:
"They predicted that Kirat would not likely die from heart failure, but rather from other routine age-related problems much further down the road," Singh writes.
Images courtesy of Manpreet Singh. In the top photo, Singh and her family members gather in her sister Kirat Singh's hospital room. Pictured are Ganeev Kaur Chadha, from bottom left, and Himmet Singh Chadha, Singh's daughter and son; Singh, her sister and their mother, Baljeet Kaur Singh; Singh's husband and their daughter, Mandeep Singh Chadha and Kirpa Kaur Chadha; and Singh and her sister's father, Pashaura Singh.
