Being Brand New

Being Brand New

Some folks graduate from clown school with a costume, a character, a name, a shtick that feels right to them, and off they go. And others—well, I remember how it was for me. On my first day at the hospital, and, honestly, for the first year, I was on sensory overload. There was so much to take in at once: the sights, sounds, smells of the hospital, being behind the nursing stations and passing out candy to the doctors and nurses, pushing the clown cart down the hall and greeting visitors, both adults and children, and finally, visiting a patient in his room. One minute I would be “out of clown” answering a nurse’s question: How long have you been a clown? The next minute I would see a child coming down the hall toward me, and I would be “in-clown,” whipping out my shy puppet friend, Loopi. And a few minutes later, I would be standing at the threshold of a patient’s room. As I had seen my mentor do, I would half-bow toward the patient and make an open handed gesture from my heart while asking if this would be a good time for a visit.

We are told in clown school to “read” the patient and the room in order to determine what that patient wants or needs. I discovered that making the judgment call takes practice because inside, every fiber of my new being was yelling, Okay, Clown! Do something funny. Say something brilliant. Show your stuff. I found that approaching the patient slowly was one of the hardest things to learn. In hindsight I’d suggest, think of approaching on a sigh instead of an exclamation. Do not ask, How are you? You might comment on something in the room: flowers or a stuffed animal or the patient’s view from the window. My mentor sometimes offered to have a column outside the window removed if was blocking the view. Or you might call attention to a prop you have: a stuffed animal, a clown stethoscope, a feather duster. Try to be make frequent eye contact. Remember, the patient is also sizing you up to see what kind of clown you are—boisterous, practical joker, even scary? The patient has had no forewarning that a clown is coming, has probably never met a clown in the hospital, if at all, and furthermore, is not feeling his best self. And you are getting a chance to see if the patient wants to play, or watch, or maybe just talk to you, or go to sleep, or maybe he has just had surgery and it hurts his incision to laugh—you never know.

At first, my clown character felt rather flimsy. It was a big surprise to me that my “audience” gave me ideas to build on. Heart Throb has bright orange curls. “Hi, Carrot Top,” one man said when I entered the room. That gave me an idea. I told him, “Yes, you’re right! My hair is orange, because ever since I was a child I’ve been addicted to carrots.” A woman I passed in the hall said, “You must be young; I don’t see any grey hairs among the orange.” As the weeks went by, I started writing down people’s humorous remarks so that I could select the ones that fit my developing character and use them as my own.

Still, I felt stiff and awkward. I was very grateful to be making visits with my mentor, an experienced clown. I was aware of being in the world in a brand new way. And of making mistakes. Once my mentor suggested that I “stock” the aquarium in a patient’s room.
Having seen him do this before, I placed a tropical fish sticker on the patient’s I.V. bag. When we were back in the hall, my mentor said gently, “You put the fish on the bag upside down.”
Trying to be cool and imaginative, I answered, “Well, sometimes fish like to swim upside down!”
“The only time that happens is when the fish is dead,” he answered.
“Oh, dear!” is all I could think of to say.
I’ve been a clown for five years, and I still make mistakes. You really can’t help it. There are times when I don’t know what to do or say. What is required is complex, and it changes with lightning speed. However, more often than you could have imagined you will bring joy and gentleness into the hospital world.

Here are some overall tips: start clowning as soon as you can after training ends while your enthusiasm is raging and before whatever confidence you have gained fades. Find a mentor whose style works for you. Try to sign up for a regular schedule, once a week if you can. Try different venues. Do you prefer the nursing home or the hospital? Children or adults? Practice your magic, or juggling, or puppetry at home. Read a training book: The Caring Clowns by Richard Snowberg or The Hospital Clown by Patty Wooten and Shobhana “Shobi” Schwebke. Or read the on-line training manual at our website: www.caringclowns.org. Keep a journal of your visits. Join a local clown club (called a clown alley). Take an improvisation class. Do whatever you can to build your confidence in the joyous and loving clown that is being born. As the French poet Paul Valery said: “The master has provided the spark, it is your job to make something of it.”

Improvisation with a partner

"Yes, and . . ." is a technique taught in Improvisational Theatre classes. The idea is to create a very brief scene together. Whatever your partner says, you receive as a gift and must respond to enthusiastically by saying: "Yes, and . . ." which means that you will add some detail to build a scene.

For example:
The nurse clown says, “Dr., I understand that you were called in for an emergency surgery this morning.”
The Dr. clown says, “Yes, and I removed a defective funny bone.”
Nurse says, “Yes, I heard, and I wondered if that is an inherited condition?”
Dr. says, “Why, yes, it is. In fact, I now have a collection of defective funny bones in my tent back at the circus. Would you like to see them sometime?”
The nurse could end the scene with her next line or just by rolling her eyes at the doctor.
Or the doctor could end the scene by switching the focus back to the patient. “How’s your funny bone today?”

In a hospital, while visiting a patient, just 4 –5 lines can be enough of a scene. Once you get good at the game, you can drop the words "Yes, and" after the first few lines and just respond in that spirit.

Remember, you have to listen carefully and play moment to moment. Every response is accepted and built upon.

Don’t be afraid to pause and think. Silence is a very dramatic tool. You can even scratch your clown head or pace before answering. With practice, you will be amazed to learn that there is a part of your brain that knows how to do this work quite well.

Last week my partner and I met a patient who played the "Yes, and" game with us without realizing it. As we were passing down the hall, a woman sitting beside the patient’s bed invited my partner and me into the room. “Come right in,” she said. “My husband is blind, but I’m sure he’d like a visit.”

Her husband was wide-awake, sitting up in bed. Turning his head in my direction, he nodded in enthusiastic agreement.

“Thank you,” I said, going over to stand right beside him. “Good Morning. My name is Heart Throb.”

“How do you do,” he responded in a deep, cultured voice.

“I’m sorry that you can’t see me because I am movie star beautiful! I have shining orange curls. Big brown eyes. A red heart on each cheek. A red heart on the tip of my nose. And I even have heart-shaped lips.”

He laughed, and his wife said, “It’s true, Charles, she does.”

“And this is my partner, Dr. Wiggles.”

“Yes,” Dr. Wiggles added. “And underneath my baggy yellow pants, I’m wearing red boxers.”

The patient nodded and laughed. Leaning sideways toward us in a gesture of intimacy, he asked, “Are you two married?”

“Well,” Dr. Wiggles piped up. “I asked her, but she hasn’t answered yet.”

“Yes, that’s true, Sir,” I explained, “Wiggles lives in a plain old brown tent. You see, I’ve always dreamed of living in a white tent with lavender ties.”

“Hmm.” The gentleman brought his hand to his chin, index finger pressed against his lips, thinking. “You know, I happen to be an expert on marital affairs.”

“Oh, Goodie. Would you help us?”

“Yes, Yes I will. Does Chuckles ever talk about wanting to move?”

“No. He’s a happy-go-lucky sort of guy. It’s part of what I like about him. I’m a bit of a brooder myself.”

“Hmmm.” Silence followed while he gave the matter his full consideration.

His wife was looking at him as if she were falling in love with him all over again. “Charles is a professor. He’s a great problem solver,” she said.

Charles sighed. “Well, my dear. Let’s face facts. What we have here is a brooder and a doodler.”

“Oh, my gosh. You’re right. You really have a way of getting to the heart of things.”

“And, I’m wondering: Have you thought of compromising?”

“How in the world could we do that?” Dr. Giggles asked.

“Well, what about starting out in a beige tent?

“ A beige tent. Of course!” I cheered.

“Of course.” The patient offered a graceful, thin hand, and we shook hands all around, with the wife joining in.

Holding on to my hand, the gentleman said, “You helped me, too. I’ve been here for ten days, and the doctors can’t find out what’s wrong. Every day they put me through another test of some sort. Everyone who comes in the room wants to stick me with a needle or prod me. Except for you two, that is.”

“Oh, dear.” I held his hand another moment. And then, reaching into my pocket, I said, “I have something for you. Here’s a red, heart-shaped sticker to remind you of our visit. It says, ‘I met a clown today.’ ” I pressed it into his fingers.

Raising both hands to his forehead, he applied it exactly in the middle. “How’s that?”

“Perfect.” I answered. “You’re perfect.”

Take A Breath and Trust

Last Thursday, as I left the ICU Unit, where I had been offering the nurses a treat from my bedpan filled with candy (a process I call “feeding the troops”), I heard a woman’s voice calling to me.

“Clown, Clown, come back.”

I turned around to see a tall, stately woman rushing after me.

“Oh,” she said, “I’m so glad I caught you. Would you please come visit my husband? He’s been a clown for 30 years. His clown name is Freckles.” Her words were rushing out. “He’s in a coma, and he’s dying, and I know it would mean so much to him if you would visit.”

“Of course.” I said. “Thank you for asking me. Lead the way.”

When we entered the darkened room, his wife went to his bed, and touching him on his arm, said, “Dear, there’s a clown here to see you.” And then she moved behind me and sat down.

The patient’s eyes were closed. His mouth was open and a tube protruded. In fact, a labyrinth of tubes and equipment surrounded him. His breathing was labored and noisy.

Let me pause here to say that as hospital clowns we are schooled to focus on the patient’s eyes when we enter a room, to try and read what the patient may be feeling—fatigue, boredom, fear, or anger— in order to determine what we can do to help. I am accustomed to looking past medical apparatus and into the patient’s eyes.

In this case, he was not capable of giving me a cue. I felt afraid. What could I possibly say or do?

In those seconds of doubt, I heard the voice of my clown teacher saying, “When you enter a room, take a deep breath, not from up high in your chest, but from way down low in your belly. Let your belly go soft and expand like a balloon. Then exhale slowly. As you are exhaling think of how glad you are to see the patient. And trust that an insight will come to you.”

I took a deep breath. To my surprise, these words came. “Hello. My name is Heart Throb. I am a clown with orange curls and hearts on my cheeks. I know that you have spent your life giving laughter and love to hundreds of people through your clowning. Today I am here to return that love to you. So you will feel surrounded by love.”

The man let out a breath that sounded like a growl.

From over my shoulder, his wife said quietly, “That’s the noise he makes when he wants to let you know he hears you.”

I nodded my head and turned to her,“Do you think he would like it if I sang him a song?” I asked.

“Yes, definitely,” she answered.

I sang words my mother used to sing when I was sick. And then I said my goodbyes.

Walking down the hall, I asked myself what I would want from a fellow clown if I lay dying?

I decided whatever inspiration came from a deep breath and a loving heart would be a comfort.

What is a Hospital Clown?

“A clown is a poet who is also an orangutan.” I don’t know where I first heard this statement, but it has stayed with me.

At first, I took it to mean that a clown must be creative and as agile as an orangutan. Then I did a little research.

Orangutans are large, gentle, intelligent apes that live mostly in trees and swing from branch to branch using their arms.

Inventive, they have been known to use found objects as tools; for example, they use leaves as umbrellas against the rain. They also use leaves as cups to help them drink water.

As the hospital clown “swings from room to room,” she applies her wit to found objects. She places a fish sticker on an I.V. bag, turning it into an aquarium. Or if the patient is about to leave the room for a walk with his I.V. on a pole, she may say, “Oh, I see you are taking your girlfriend, IVY, for a stroll.” If the patient is sitting up in bed, breathing through the mouth into a plastic cylinder with mist coming out of it, she may ask, “Say—Is that a Cuban cigar? How are you getting by with smoking in the hospital?” If she sees a triangular handle hanging from a bar over the patient’s bed, she may ask, “Hey—are you practicing acrobatics to join the circus?” For a patient waiting to be taken downstairs for an x-ray, she may offer to do a cat scan right then and there, in which case she will pull a cat mask out of her bag, put it on, and scan the patient head to toe. She applies her orangutan curiosity to everything she sees.

It has been said that a poet is one who is gifted in the perception and expression of the beautiful. I would add that a poet also sings in the dark times. We think of poets as being creative dreamers who are driven by a need to share their thoughts.

Enter, the hospital clown. This clown has a need to share love and smiles. As she goes room to room at the hospital, she has no idea what she will discover: a man without legs, a woman suffering from Alzheimer’s, a happy patient who is going home, a patient who thought he was going home but who is being transferred to a nursing home, a patient who has been waiting for too many hours for surgery, one who has returned from surgery and is still medicated, a deaf patient, a blind patient, a gentleman sitting in his chair doing cross word puzzles—well—you get the idea. In each patient she meets, she perceives beauty. That’s the poet in her.

Most people, in the course of their daily lives, do not meet orangutans, which are endangered, or poets, who are thriving, or clowns who practice their compassionate antics exclusively in hospitals.

What if I Fail?

At the end of a day of clowning at the hospital, I am often amazed at how many times I have visited patients who were initially glum but by the end of the visit are laughing or singing. This turnabout I attribute to the largesse of the human spirit as well as to the art and playful spirit of clowning. But it does not always work this way. Sometimes a patient glances out into the hall and looks quickly away, pretending not to see me. Sometimes a patient will make eye contact, frown, and shake his head to make it clear he does not want a visit. At times like these, I am reminded of the advice of Richard Snowberg, founder of the world famous school for clowns at the University of Wisconsin-La Crosse and author of the book The Caring Clowns. He says, “Caring clowns distinguish themselves from other clown entertainers in their need and willingness to accurately assess the needs of their audience and meet those needs—no more and no less.” If the patient wants less of me, I keep moving. I admit I feel a smidgeon of rejection. Inside a caring clown, there’s a friendly puppy that wants to play with everyone it sees.

Occasionally, someone other than the patient will invite me into a room. Last week, a nurse asked me to visit a patient. “The man in 232 really needs cheering,” she said, with a catch in her voice. “He’s a sweetheart.” She knocked on the patient’s door, and in a cheerful voice, addressed an older man sitting in his recliner, which was tipped way back, a pillow propped behind his head. “Look,” she said, “There’s a visitor here to see you!” She ushered me over and then quietly left the room.

The gentlemen opened and closed heavy lidded eyes. Deep grooves turned down from his mouth as if it had been locked into a position of sadness for a long time. “My name is Heart Throb,” I said softly. His eyes opened and closed. “I’m just going to dust your TV for you.” I ran my green feather duster over it for a bit. His eyes, a worn blue, focused for a second on the TV and then closed. I thought he saw me, but I couldn’t be sure. “Well,” I said, going over to stand beside him, “I’ll be going now. I hope you will remember that a clown brought you love today,” and I touched the top of his hand lightly. It seemed to me that the tension in the muscles around his eyebrows relaxed.

In the hall, I thanked the nurse for asking me to make the visit, and I said I wasn’t able to cheer him. She nodded her head to say she understood and went off to see her other patients.

At home that night, writing in my clown journal, I kept wondering what else I could have done. Maybe I could have sung to him. Or played the little music box I carry in my bag. As I sat there thinking, a rule we learned in clown school came back to me: Never touch the patient without asking permission. Remember, the doctors and nurses will be coming into the room all the time to perform medical procedures. Your job is to honor the patient’s need for privacy and personal space.

Was it possible that he didn’t like my touching his hand? Yes, it was. Or maybe, the non-invasive touch was a relief. Perhaps it registered as love. I have no way of knowing. As a caring clown, I’m not going to reach every patient. And I’m not always going to do the perfect thing. That’s okay. It’s part of the job. It never keeps me from looking forward to my next chance to visit patients.

Accepting Death

I knock on the open door of a room where  a gentleman with curly white hair is sitting in the chair beside his bed. He holds his shoulders pressed back as if he wishes to maintain proper posture.
Or perhaps he is one of those people who possesses a regal carriage.

"Well, well, what have we here," he calls out to me.

"Oh, I'm just stopping by to make sure you are having fun!"

"Right. I'm regaled with pleasure. Come in. Aren't you a breath of fresh air, my dear. What ever is that contraption hanging around your neck?"

"Oh, this? This is the high powered stethoscope I use to listen to patients' hearts. I'm a heart specialist."

He sits up even straighter in his chair and places his hand on his chest. "Capital. No one has listened to my heart today."

"Great," I say, going over to his chair. "This stethoscope has some of the same technology they used in the space shuttle so it's very accurate." I place my red sink plunger on top of his hospital gown on the side of his chest. "Now just breathe deeply." I listen. "Oh, wow.This is amazing. Could you take one more breath so I can hear that again?"

He obliges, leaning his ear to that side as though he might be able to listen in. Drawing back, I say, "Your heart sounds great, PLUS, there is something very unusual about it. Gosh, this is so rare. I've  only had this happen one other time in a thousand cases."

"What is that?" He is looking at me with raised eyebrows and clear blue eyes.

"Your heart is singing!"

"Ah, yes," he says, nodding, not surprised.

"Did you already know you have a singing heart?"

"Well, I don't doubt it, that's all. Because I am a singer. I sang in the choir for fifty-two years."

"Really! Do you feel like singing something for me?"

"Certainly, I'd be charmed," he says and closes his eyes. In a sweet, strong tenor, he sings, "Ave Maria," his voice full of chapel light.

"Oh," I say, clapping, "that was beautiful. You really are a singer. Do you perform for audiences?"

"Well, not since I fell ill." He shifts slightly in his chair, crossing one leg over the other. "I had some bad news this morning. Five doctors consulted, and they all came up with the same conclusion. I am going to die soon."

"No!" The word flies out of my mouth and my arms fall to my sides.

"Don't look so sad," he says, gently. "You're a clown."  

All week, I've been playing back this encounter in my mind, asking myself what a clown's relationship to Death is. As a hospital clown, I have been trained how to sit with a dying patient and breathe with him in his final minutes, if need be. I have been taught to listen, hold a hand, talk about it, or not talk about it, in general to be supportive of what the patient wants at that moment. I know that it is okay to cry with a patient.

Possibly what my gentleman meant when he said, "Don't be so sad. You're a clown" was that Death can't beat down a clown's spirit. A clown knows Death is always close by. If she chooses, she can cock her innocent head to one side and play in the face of it.


What happened next at the hospital was that having taken a deep breath, I said, "You know what?" I see your nurse in the hall. I'd like to call her in---to hear you sing something. And I'd like to hear you again. Would you mind?"

"Why, no," he said. "I'd be delighted."      

"You're Not a Real Clown"

Last Thursday at the hospital, as I pushed my cart down the hall in
pediatrics, a small boy, holding the hand of a young woman, came out of one
of the rooms to see me. His dark hair and thick-rimmed glasses made him
look like a small version of Harry Potter. Because some children are afraid
of clowns, I stopped and waved but stayed beside the cart instead of
approaching him.
Coming closer, the child pointed at my lime green scrubs, stating in a loud
voice, “That’s just a costume.” And pointing at the patches around my eyes,
“That’s just white paint. And that rabbit sitting on your arm, that’s a
puppet.”
I have to admit that in spite of attending six weeks of hospital clown
school where I studied the history of clowning, how to apply clown makeup,
create a costume, a clown walk, work with a puppet, do clown magic, develop
a character, incorporate methods of improvisational theater, and adapt
clowning techniques to a therapeutic setting—in spite of being mentored for
one year and clowning once a week for three years, I still worry that a
child will one day look at me and say, “You’re not a real clown.”
What am I dreading? I’m not exactly sure. I don’t want to feel like an
imitation of a clown. I’m aiming for a level of artistry where I am
thoroughly in my clown character, purely “Nurse Heart Throb.” But mine is
not simply an actor’s wish. I also aspire to honor the larger concept of
“Clowndom.” I want to please the Ethereal Clown Board, presided over by
Emmett Kelly, who will, when he looks down on me, elbow his buddies and say,
“Now there’s a real clown!” And by that he will mean that I am a clown from
the inside out, that I have the playful, loving, vulnerable, wonder-filled
instincts of a clown, that even if all I had for a costume was a red nose, I
would be believable.
And there’s more. Remember when you believed in Santa Claus? What if, when
you were a small child, sick and afraid, Santa Claus had come into your
hospital room, and instead of just dropping off a present, he stayed and
played quietly with you, made up a song with your name in it, maybe asked
you to help him do some magic? What if he listened to the heart of your
teddy bear with a North Pole stethoscope and said your bear was very, very
brave? Or put a fish sticker on your I.V. bag to turn it into an aquarium? I
want to step, however briefly, into that magical, healing space that
“believing’ creates.
Meanwhile, Harry Potter is calling us over . . .
“This is my son, Zachery, “ the young woman says, in a tone which suggests
that this little boy is a genius.
I bow to him. “How do you do, Zachery.”
Zachery glances past me at the cart, decorated with a large cardboard cut
out of a clown and bobbing helium balloons. He studies an array of objects
on the lower shelf of the cart.
“Would you like to try one of those?” I am about to offer a rubber reflex
tester that makes the sound of breaking bones upon contact with an arm, but
he chooses a magic wand.
“Bow,” he commands, waving the wand at me, and, of course, I do, as low as I
can go.
“Turn around three times,” he says, and I obey so fast that I stagger
dizzily into the wall. Zachery hoots in delight.
“You know, Sir Zachery, you really are very good with that wand. I wonder if
you’d like to wear a red nose?’
He nods yes, and I give him a sponge nose, which he puts on.
“And now,” he says, walking over to his mother, who has been watching him in
silent adoration, “ I am going to turn you into a cat—a nice cat, but
still—a cat!”

Watching Zachery wield his magic wand, I was reminded that the goal of
hospital clowning is to empower others. However and whenever that happens,
magic is in the air.