The author at work.

“Wow! You were so kind to that little boy!” a paediatric resident told me with a saccharine and insincere tone. I was a third-year medical student, and she’d pulled me aside after she’d witnessed me giggling and zipping trucks along bedrails with a patient. I was also a 25-year-old woman who lacked a professional filter.

“Why wouldn’t I be kind?” I blurted out. My voice mirrored my grandmother’s.

I don’t remember if the child was experiencing a specific ailment commonly coupled with his Down syndrome, such as leukaemia or a structural heart or digestive condition, or if he was hospitalised for a typical paediatric problem like asthma, appendicitis or some accidental injury. What I remember is the resident’s eyebrows arching and her lips pursing. I realised too late she’d expected me to just say “thank you.”

I trained my eyes on the tiny plastic frog dangling from her stethoscope. The amphibious toy meant to distract children while she auscultated their hearts and lungs couldn’t distract me from the sound of my pounding heart. We stood silently facing each other in the hospital corridor, until I heard the little boy’s Tonka truck clank to the floor. Saved by gravity, I pivoted back into his room to pick it up with echoes of my grandmother’s yelling buzzing in my ears.

Twenty years earlier, my grandmother Yetta reprimanded me and my cousin for tumbling headfirst down the half-flight of carpeted stairs in her split-level house, wearing the smocked Polly Flinders dresses she’d bought us. It would take me another 20 years to understand that my grandmother’s reprimands captured her purest expression of acceptance toward my cousin Becky, who has Down syndrome.

My grandmother’s words bit the air: “Rachel, Rebecca, stop it!” She was a staunch woman with curly jet-black hair who audited taxes for the IRS while raising three boys and running a luncheonette with my grandfather. She had zero tolerance for nonsense.

“Sorry, Granny,” I said.

“OK, Ede,” Becky said.

Eight of her grandchildren called her Granny, but not Becky.

“Not Ede. Granny,” my grandmother would chide.

Always, my cousin smiled. “No. Ede.” Becky never explained why she used this name.

And always, my grandmother smiled back. Their lighthearted refrain was a familiar script interjected between my grandmother’s complaints about the way my grandfather chewed everything he ate and how long it took him to do his daily crossword puzzle.

Rebecca Fleishman (left) and the author in Lake George, New York, in 1980.

Becky was a year older than me. We spent our elementary school days playing hide-and-seek with our brothers, middle school swimming in her parents’ backyard pool, and high school changing into team swimsuits in our school locker room. My grandparents eventually moved to Florida while Becky and I were still waving hello to each other across our school cafeteria.

When Becky and I finished high school in the late ’90s, she moved to California with her mom and stepfather, and I moved to New York City for college and medical school. While I spent the bulk of my time in libraries, Becky completed vocational training and then worked at a bowling alley, and our grandmother discovered email. She sent Becky countless messages from her handle, GranEde, and Becky always replied.

I hadn’t meant to be rude by rejecting the resident’s compliment, but my actions didn’t feel praiseworthy or even unusual. The world I knew before medical school was the one modelled by the adults who’d raised me. I’d always known that people with Down syndrome have distinct physical features — what the medical literature calls “stigmata” — and a propensity for certain health conditions and disabilities, but I had never witnessed how they can be subjected to harassment, humiliation, mistreatment and neglect, both in hospitals and outside them. I’d come to learn that “stigma,” a concept put forth by Erving Goffman, encompassed “disgrace attached to a particular condition or trait.” I’d never perceived Becky as stigmatised because our family did not isolate her.

For decades after high school, Becky and I were mostly out of touch. I asked family members about her. I liked her Facebook posts. But my strongest connection to Becky was through my grandmother. When I flew to Florida for visits, my grandmother, in between digging through the sale rack at Bloomingdale’s and instructing the deli workers at Publix about the proper thickness of turkey breast slices, gave me the scoop on Becky. She........

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