Section 7: The Hospital Visit
Entering the Room
Similar to a circus or stage clown’s performance, and even a birthday party clown’s show, your caring clown visits should have a beginning, middle and an end to each visit. A caring clown visit starts even before a clown enters a patient or resident’s room. A puppet peering around a corner, a few silly giggles, or blowing bubbles are ways of introducing a clown visit. It is important that you seek permission to enter a room. This is one of the few moments when a patient or resident actually has control over his or her environment and/or situation. If a person says that he or she does not want a clown visitor, you must respect that and continue on to the next room. In his book, The Caring Clown, Richard Snowberg mentions that although knocking and asking permission to enter a room is not necessarily a funny action, this simple courtesy provides patients with dignity, a quality that is often lacking in a hospital or nursing home setting.
Sometimes it is not possible, or polite, to enter a room, even if the patient wants you to come visit. There may be medical staff present, or procedures and tests occurring at the time of your visit. It is OK to ask the patient if you can come back later, as long as you are certain to come back later. For example, you can acknowledge that they are very busy getting better and that you don’t want to interrupt, explaining that you were just on your way to polish your clown shoes. Then you can ask if it would be all right for you to come back and show off your shoes in a little bit.
Occasionally patients or staff will request your presence during a long or painful procedure. You can be a wonderful distraction. It is important for you to know yourself well before volunteering to help during a procedure. Some clowns are unable to do this and get weak in the knees. If you are one of these clowns, you can see if another clown is available that is willing and able to stand in for you. You could also provide a picture, game or toy, or an audiocassette of you singing silly songs for the patient to focus on during the procedure. Some clowns who have volunteered to help out during a patient’s long or painful procedure have mentioned that focusing on the patient’s eyes instead of on the equipment or needles has been helpful. Having a patient sing a song or tell a story also helps distract the patient and keep them focused.
If the patient does express interest, you should enter cautiously and slowly. In some instances, the person might not have understood that there was a clown coming to visit and could change his or her mind quickly, especially if he or she is afraid of clowns. If this is not the case, and patient welcomes the clown, you should take notice, upon entering, of what is in the room and what the patient/resident was doing when you entered. Often comments about the cards or flowers in someone’s room are a good way to start a conversation. Misidentifying something, calling the dog on a greeting card a giraffe, often grabs a chuckle. If you can not find anything in the room to comment on, you can comment on something you brought with you. By focusing attention on something other than the patient, you are delaying direct eye contact with the patient, allowing him or her to size you up and determine whether or not you are someone with whom he or she wants to interact.
Caring clowns do not start with the common phrase “Hi! How are you?” because of the medical environment. Caring clowns are there to entertain and bring joy. Shobi Dobi notes that breaking the “Hi! How are you?” habit was one of the hardest habits to break. She now introduces herself and freezes in a silly pose to allow the patient and/or family members to adjust to the surprise of a clown visitor and to allow her a chance to take a quick survey of the room and visitors. She mentioned that this quick survey of the room also helps her “to be aware of physical apparatus in the room (i.e., so I don’t step on their IV – I’ve done that, so you don’t have to!)” (Schwebke, 1995 p. 4).
Entertaining and Responding to Your Audience
A caring clown needs to respond to the individual as if he or she were healthy and in a normal environment outside of the medical setting. The clown visit is an opportunity for the patient or resident to escape from their current environment for a few moments. A caring clown is able to offer that mini-escape into fantasy and fun.
One way of doing this is to maintain eye contact. It can be challenging not to focus on the injury or medical equipment in a hospital room, or the physical disabilities of an aging resident of a nursing home, however, eye contact will help you see the person behind the physical or emotional problems. While most clowns recommend not focusing on the medical equipment in the room, some choose to briefly mention it to invite patient to talk about it, if he or she so desires. One clown asks children if they are super heroes because they are receiving super powers from their IVs. These super powers will help them grow stronger and more powerful. Regardless of whether you are a clown who chooses to ignore the medical equipment or to briefly mention it, you should remain open and flexible in case the patient needs to talk about it.
Focus on one person at a time. If you are in a room with a number of beds, make sure to visit each person and to focus on that person as if he or she were the most important person in your world at that moment. Of course, sometimes it can be fun to include the other people, or the person will invite the others to join in. That is fine, but be careful not to leave anyone out. This also applies if you are visiting a private room where the patient or resident has guests. You can play with the guests, but be sure to let the patient know that he or she is the reason for your visit. You came to see him or her and are excited that when you feather dust the room, you will also be able to dust those people sitting in the chairs. Sometimes, an elderly patient will have just as much fun watching you interact with his or her grandchildren as he or she would have interacting personally with you. Keep your eyes and ears on the patient for verbal and non-verbal cues as to how much time to spend interacting with the visitors.
Another way to help both the patient/resident and the clown escape from reality is through mutual respect. Snowberg mentioned that a patient would respect the clown who asked permission to enter the room and that the clown should respect the patient’s response whether it be a positive or negative response. I would like to add that by demonstrating respect throughout the visit, you are providing a much better opportunity for you and the patient to experience a positive interaction. An example of this respect would be for you to try to remain within view and to be at eye level. So, a clown who is not dusting the furniture, medical equipment or visitors, should try to sit down to be at the patient’s eye level if the patient is in bed or sitting in a chair. Bubbles can be blown and simple, small magic tricks can be performed sitting in a chair as easily as standing up. Do not sit on the bed or touch any areas that can not be seen. You never know what is under there.
Voice tone and volume are other means of responding to a patient that can serve as forms of respect. Unless it is your caring clown’s character to be extremely nurturing, terms such as “honey” or “dear” can be taken as condescending. Speaking caring clowns must take care not to be too loud or boisterous, yet be loud enough that their audience can hear them. Exaggerated facial expressions help emphasize a clown’s reactions.
Length of Stay
The length of stay in a hospital visit depends on what type of visit you are hoping to provide. As mentioned in Section 4 (Starting a Caring Clown Program), there are different types of visits. If you are following the circus clown’s community service visit, you should plan to limit your visit to three to five minutes. This allows you just enough time to spread joy and cheer and to dash out before you tire your patient out with your performance.
If you are there as a caring clown who plans to make a heart to heart connection, you need to allow yourself more flexibility. It may only take walking in the door to make a connection or it may take much longer. If a child is a bit shy, you could match their shyness and take baby steps into the room as you blow bubbles, lowering your eyes, because you are ‘too scared to look directly at the child. Once the child begins to reach for and pop the bubbles, you have likely made a connection, and your movements and actions can become less shy. Once the child tells you where or how many bubbles to blow, or asks to blow bubbles for you to pop, you have made a connection. Each patient, regardless of age, will require a different amount of time and energy in order to achieve a connection.
In a nursing home, again, you need to decide if you are going to follow the circus clown’s in-and-out method, or take the time to make a connection. Either visit is greatly appreciated, but if you want to make a connection, you should be prepared to slow down a bit, not necessarily because the residents are slower physically or mentally, but because nursing home residents often enjoy a lengthier visit. So, keep in mind that if you have two hours to visit, you may be able to see ten people, or you may interact with only two. Be flexible.
Exiting the Room
Sometimes your exit is caused by medical staff coming in to take care of the patient. Quickly excuse yourself and ask if it would be OK to finish your visit later. As mentioned before, it is important that you remember to come back later.
Sometimes exiting a patient’s room can be a challenge. This may be due to the patient not wanting you to leave, or you not wanting to leave the patient. In either case, at some point, you will need to leave the room. The nicest way is to leave the room with the patient smiling and laughing, but this is not always the case. Be careful about what you say, “See you later!” might not be true. Children may expect you to come back later that afternoon. A very sick or an extremely anxious patient may question whether or not he or she will even be around ‘later’ and think your comment insensitive to his or her situation. There are many ways to leave a room without saying “See you later!” You could mention that you need to be back at the circus at half past a freckle, or that you are in charge of watering the elephants this week. You could also say that Mama Clown wants all her clown kids home in time to brush their puppet’s teeth and hair before naptime.
Try to be sincere about how you enjoyed the time you spent with the person and that you were really glad you got to come play with them. If possible, leave them with a special memory to keep of your visit. This may be a song you sing for them, or an instant picture of the two of you, or another approved give-a-way such as a sticker or a coloring page of your clown, signed by you, of course.
