Dr. Raj Panjabi, a physician who spends his career treating patients with serious illnesses, admits he failed to recognize the critical warning signs in his own daughter, Karuna, due to a psychological phenomenon known as normalcy bias. This cognitive bias leads individuals to expect that current conditions will continue indefinitely, causing them to dismiss early anomalies as temporary or inconsequential.
For the first year of Karuna’s life, Panjabi described a period of profound joy. Her older brother Abhay encouraged her first steps, while her younger brother Sohaum played with her affectionately. Their mother, Amisha, appeared exhausted but deeply fulfilled. However, months after her first birthday, Karuna began rejecting solid foods, sticking primarily to olives, rice, and lentils. Panjabi initially attributed this to typical picky eating behavior common in toddlers.
By her 18-month checkup, medical graphs indicated her weight had fallen below that of 97% of children her age. Although pediatricians recommended nutritional interventions, including PediaSure and increased formula intake, Panjabi remained optimistic, believing she would eventually catch up. Instead, her condition deteriorated; she became irritable, stopped eating nearly all foods except olives, and began exhibiting signs of extreme fatigue.
By September 2019, caregivers at her daycare noted that she preferred lying alone in a corner rather than engaging in activities with other children. When Panjabi observed labored breathing, he sought medical attention, and a pediatrician initially diagnosed pneumonia. Five days of antibiotics yielded no improvement. Shortly before Karuna’s second birthday, swelling appeared around her eyes, and her eyelids accumulated fluid. Despite these alarming symptoms, Panjabi resisted taking urgent action because his parents had traveled from North Carolina to celebrate the milestone. He chose to light the candles and cut the cake, suppressing his fears.
The following day, an urgent clinic visit led to a chest X-ray at Boston Children’s Hospital. The results were devastating: Karuna’s heart was more than double its normal size, and her lungs were filled with fluid. For Panjabi, a specialist in heart disease, the diagnosis was immediate and terrifying—his daughter was in heart failure.
Researchers note that gradual crises often go unnoticed until they reach a
The scene with the birthday cake absolutely shattered my heart. It is heartbreaking to think about the choice he made to wait.
This makes me wonder how often systemic biases delay diagnoses in general. It feels like we are too quick to accept the status quo until it breaks.
Normalcy bias is such a common trap. I bet many doctors in different specialties would have fallen into the same pattern with their own kids.
I find it hard to believe a heart specialist missed the swelling around her eyes. Isn’t that a classic sign of heart failure?
As a parent myself, this is genuinely terrifying. It is so easy to rationalize away warning signs when we want to believe everything is fine.