Kaytee Welsh, MD, associate director of Emerson’s pediatric hospitalist program, was shaped by trips during college to India with a retired surgeon, during medical school to rural clinics in Nicaragua and, during her residency, to Botswana — places where physicians toil with few resources. In caring for patients and families on Emerson’s Wheeler 4 floor and at Spaulding Rehabilitation Hospital, where she spends half her time, Dr. Welsh is sensitive to the role that mental health plays in the hospital setting, especially when families are struggling to cope with caring for a chronically ill child.
What drew you to practice as a pediatric hospitalist?
I like general practice, so it was hard for me to pick one area of medicine. I was interested in all of it. So hospitalist medicine worked out well for me. When I was in medical school, I realized I enjoy being around kids. They tend to get better, as opposed to adults, many of whom get to the point where they are just healthy enough to leave the hospital. Kids really get healthy again.
You need to care for the parents, too, and the community pediatrician is typically involved.
I like working with parents, despite the fact that you are taking care of them as well. When a delivery isn’t going as expected or when a child has been in a horrific accident, we see every kind of attempt to cope. Some families are anxious, some are angry, and some are scared; you have to learn how to support them.
For example, if a parent is so anxious that they can’t think, you have to keep going over the same thing — explaining it again and again. And I like the involvement of the child’s pediatrician because I like working on a team, running ideas off people and problem-solving that way. That’s how we work at Spaulding, where the team often includes a physical therapist, occupational therapist, speech therapist and case manager.
What kinds of cases do you see at Spaulding?
We see a lot of traumatic brain injuries; once they’ve been through the ICU and have stabilized medically, they come for their long-term rehab, which may be three or four months while they learn how to walk, talk or swallow again. We see kids who’ve had stroke, brain tumors removed and orthopedic procedures. The experience we have at Spaulding definitely helps us at Emerson.
Your pediatric patients at Emerson represent a very different population.
Yes, in the winter we see a certain amount of RSV [respiratory syncytial virus], which often requires oxygen but needs to run its course, along with pneumonia and gastrointestinal problems that require IV fluids. We also see mononucleosis in teenagers and random conditions such as pneumothorax and metabolic disorders. When kids who have asthma need medication at home more frequently than every four hours, they should be admitted. Today there are a number of different treatments we can offer them.
Everyone in our group loves working with families and taking on difficult cases, along with bread and butter pediatrics. Families know that we will call in someone for a consult or refer the patient when that is needed.
Children don’t expect to be in a hospital, and some are not equipped for the experience.
We consider their developmental stage and get on that level. That means sitting on the floor with the child or, if they are talking quietly, talking quietly back to them. This gives them control over how things are going, because they may feel overwhelmed.
The Pediatric Intervention Team (PIT) creates an environment where the child feels we understand them. The PIT also supports the family, often serving as translators by rephrasing things if they feel the parents don’t understand what is going on: “So, Dr. Welsh, do you mean that....” It’s wonderful.
What do you enjoy when you have time off?
I love yoga and anything outdoors, such as hiking. We have a cabin in Maine where we spend time during the summer. Anything that gets me moving is relaxing. We went to Costa Rica last winter, and we took our son to Brazil. My husband has family in Mexico, so we visit there, and my son is in a Spanish-speaking daycare. Before I was married, I traveled a lot — to Nepal, Thailand, China and Japan. Our kids have their passports, so we’ll keep traveling.
