Erica Kaye, MD, shares her family's journey to becoming physicians and how meaningful connections have deepened her understanding of her role in caring for patients. This is part of an ongoing series.
Question: You grew up in a family of physicians. Can you talk about how they framed your decision to become a doctor?
Answer: My full name is Erica Carmen Kaye, and I was named after my grandmother, Carmen Jimenez. Carmen was born and raised in a poor rural community in Canovanas, Puerto Rico. She dreamed of becoming a physician in the 1930s, at a time when there were barely any women in medicine — and three decades before a medical school even existed on the island. Through sheer grit, ambition, and bravery, Carmen fought her way to the United States to fulfill her dream of becoming a physician. She doggedly sought out the few existing scholarships for Puerto Rican medical students, applying every year until she received a full scholarship to enroll in the Medical College of Virginia, now part of Virginia Commonwealth University.
She started medical school in the 1940s, at a time when only 5% of medical students in the U.S. were women. The Medical College of Virginia had just opened its doors to women when she arrived, and she was one of only three women in her medical school class. When she graduated, Carmen could have remained in the U.S., practicing medicine and raising her family stateside. Instead, she and my grandfather chose to return to Puerto Rico, and my father grew up in San Juan.
In Puerto Rico, my grandmother again found herself as a lone woman in a fiercely male-dominated arena. In the face of racism and misogyny, she commanded respect and demanded that others meet her incredibly high standards for the provision of equitable, compassionate healthcare. She was passionate about medicine, and she fought desperately hard for her patients, with all of her grit and heart.
My father also went into medicine, pursuing scholarships to study at Johns Hopkins and ultimately becoming a medical oncologist and basic scientist in cancer biology. I am a third-generation physician, and grateful to my grandmother and father for role modeling the power of perseverance, empathy and passion. These values served as the formative guideposts of my career.
Q: What prompted your focus on improved doctor-patient communications?
A: On my first overnight hospital call as a third-year medical student, I was shadowing with an overextended, stressed surgery resident. He received a page, skimmed it, and told me, “The path for Mrs. X in Room 3 shows metastatic colon carcinoma. You speak Spanish, so can you go tell her?” The look on my face must have demonstrated my horror – so he added, “Just tell her that she has stage IV disease and that we will place an oncology consult for tomorrow. Gotta run to the ED.”
With a wave over his shoulder, he disappeared. I will never forget walking into the patient’s room and seeing the faces of the patient and her husband – waiting, wide-eyed with anxiety. I had never given bad news to a patient or family. Haltingly, I shared the information and tried to answer their questions as best I could, recognizing how wholly inadequate all of my responses were. They were so grateful, and their gratitude only deepened my shame, because I was acutely cognizant of all of the ways that I had failed them.
I became very close to this family, and I walked alongside them in their medical care across the following year until the patient went home on hospice for end of life. I have spent a great deal of time reflecting on the moment when I first met them, as they waited terrified in their post-operative hospital room.
In medicine, we place a great deal of value, as well as time and energy, on teaching and acquiring the requisite skills– e.g., taking a nuanced, targeted history; performing a thorough, thoughtful physical exam; curating a comprehensive differential diagnosis; performing various procedures. For each of these skills, we require participation in didactics, followed by supervised practice. The “see one, do one, teach one” philosophy towards mastery of a skill.
Yet in the context of difficult communication, these steps are often passively overlooked or even actively discounted. When I was in medical school, many people told me different versions of the sentiment: “Either you are inherently good at communicating, or you aren’t.” And for those without innate communication skills, there was a sense that it couldn’t be taught. But I have realized that this could not be further from the truth.
Communication is a critical skill, just like any procedural skill. It deserves the same level of specific instruction, supervised observation and practice as any other medical skill. With didactics, mentorship, and dedicated repetition, communication skills can be developed and honed. My experience with sharing bad news that first time was traumatic and it will remain imprinted on my heart forever. But it also sparked my passion to pursue a clinical and research career centered in the study of communication.
Q: What have you learned about connecting with patients and families you wish you’d learned earlier?
A: This is a fascinating question. I recently authored a reflection piece in JAMA about my long journey toward learning how to navigate the intersection of faith and medicine. I wish I had experienced these lessons earlier in my career. I’m sharing the link, as it is difficult to paraphrase the paper and capture its full message: https://jamanetwork.com/journals/jama/fullarticle/2761092
The most profound way we can serve our patients and families is by investing effort in creating meaningful connections. Bearing witness to suffering, showing compassion, simply being present – these are powerful gifts that can bring us closer to faith. I realized that faith is less about what we know or in whom we trust, and more about the “inevitable product of shared wonder in the face of the indescribable” – and that the privilege of caring for a patient and family is sacred.