Among the crowds of scrub-clad interns and doctors wearing lab coats racing throughout Johns Hopkins Hospital is a small group whose appearance can't help but draw attention from passersby. With their gigantic shoes, comical hats and bright face paint, the members of the Big Apple Circus Clown Care at Johns Hopkins Children's Center bring a dash of color to hospital hallways. They joke with nurses in the elevator, they stop and say hello to a nervous-looking patient, and they smile at whoever crosses their paths. And all of this happens during a little bit of downtime amongst their true workdays -- visiting the children's and adolescent's units in the hospital and bringing laughter and optimism to the lives of young hospital patients.
With its roots tracing back to 1986, when Big Apple Circus co-founder Michael Christensen began Big Apple Circus Clown Care, the nonprofit program has grown to become a team of over 90 professionally trained performers at 17 pediatric health care facilities nationwide. It began at the Johns Hopkins Children's Center in 2001. Bill "Dr. Boots" Boots, supervisor of the program at Hopkins and one of the clown performers, had worked at the Washington, D.C. branch for several years before becoming a part of its upstart in Baltimore. Now the Clown Care Unit (CCU) at Hopkins includes a team of six clowns -- Dr. Boots, Dr. Short, Dr. Spats, Dr. Beano, Dr. Bugnet and Doc Molly. Three days a week, pairs of clowns make their "rounds" through almost every unit with child and adolescent patients.
The Big Apple Circus Clown Care program, at its core, brings the old adage "laughter is the best medicine" to life. "First and foremost, we're clowns," said Boots. "We address the heart of the kid."
Karen McCarty, the Big Apple Circus' community programs associate creative director, agrees with Boots' sentiment.
"I think that Clown Care works because we treat the healthy part of the child," she said. "People tend to treat a sick child as if they are all sick; only a part of them is sick. We reignite the healthy, glowing part of the child which is always, always there, even in the smallest of ways."
They also work to demystify the hospital environment, which can be an overwhelming place for the children. Often this involves cracking jokes about the situation -- the clowns wear the classic white lab coats as a fun yet respectful parody of the coats worn by the physicians the child encounters. In some cases, they use jokes and exaggerations to help ease the discomfort of medical procedures, such as the time when Boots visited a child who needed to practice deep breathing but was having difficulty. So he and his partner challenged the child to a breathing contest -- one that, as the joke snowballed, had the power of the child's breath creating a breeze that pushed the clowns throughout the room. By the time the joke was over, the child had accomplished the breathing, and the once-difficult task had become a game.
The "clowns" in the program are professionally trained and well-practiced performing artists, most with considerable clowning or miming experience. Andrea Kopel, Vice President of Community Programs at the Big Apple Circus, emphasizes that through the intense, multiple-step audition process, clowns with great talent in their art are chosen to be a part of the program. But, aside from that, she said the clowns need to be "people with big hearts."
After an initial audition narrows down the pool of applicants, the potential clowns go through a second round -- this time it's a test of their capabilities in the hospital. If the performer is hired after this audition, he goes through an intense, two-week training, which includes shadowing a veteran clown. From there, Kopel points out, training is technically a continuous process, as each day brings on new challenges which act as learning opportunities for the clowns.
After the selection and training is complete, the clowns work in a partnership with the overall team of hospital staff--the nurses, doctors, child life staff and medical staff. They dress in what can only be described as a "clown-ified" version of the usual hospital gear, sure, they don those long white coats, but they also wear the gigantic shoes, tiny bow ties, bright, mismatched clothing, clown face paint and, of course, the requisite red nose. Though the costume is important, the true essence of the "clowns" is that they provide a light-hearted change of pace to hospitalized children and their families.
"Our goal is to change the energy level of the room," said Boots. Even if this change comes in the form of a wink or shy smile, it's still a victory for the clowns -- Boots compares such responses to a standing ovation.
One of the challenges that the clowns encounter is that there's no fixed formula for eliciting positive reactions from the patients. That's where a combination of the clowns' intuitions and innate talents comes into play. "The clowns are skilled at honing in on what gets the child excited," said Kopel. "They'll play around with the repertoire to see what the kid likes."
Boots also emphasized the creativity that he and his colleagues exhibit. "I don't think that we think out of the box," he said. "I just think we have a different shaped box."
In the hospital environment, young patients are often given little control over their routines, and this can be frustrating, even for the smallest kids. When added to the discomfort and stress caused by the situation that brought the child to the hospital, daily doses of the playfulness and humor that are characteristic of childhood are sometimes overlooked. And that's where the CCU comes into play. "We empower the kid to be a child," said Boots.
They accomplish this is by first giving the child the option of allowing the clowns to enter the room and visit. Boots admits that in situations where the child seems on the fence about having the clowns as visitors, they'll linger outside the room and act out a quick routine, but ultimately, the child's decision is respected.
Once the child gives the clowns the OK, their visits become a group activity for everyone in the room. "The thing that strikes me the most [about the Clown Care program] is the effect that we have on the whole family," said Kopel. Parents of the patients often become wearied by their children's situations, and the clowns' positive effect on the children brings joy to the adults. Perhas most notably, "the effect lingers," said Kopel. Once the clowns are finished with their visit, "the parent and child can sing the song or laugh about a routine together," said Kopel.
For patients who spend a lot of time in the hospital, the clowns can sometimes take on the role of a surrogate family member. Sadly, this can become apparent when tragedy strikes. "We do, from time to time, lose a friend -- they get wings," said Boots. He explained that the members of the CCU are sometimes invited to funeral services -- sometimes photos of the clowns are amongst the displays of pictures of the children and their families. On two occasions, Boots even spoke at the funeral services. He explained there's a that it's that fine line between tragedy and comedy, that is the reality of working within the CCU.
Not only do the patients and their families benefit from the visits with the clowns 5f the performers themselves truly love their jobs, and that shines through in their work. At the end of the day, "I'm almost always disappointed to leave," said David "Dr. Beano" Gaines, the newest member of the CCU at Hopkins.
Gaines joined the team about two months ago, after a friend encouraged him to apply for the job. He felt that the program matched the part of clowning that he preferred the most -- the sympathetic aspect of humanity, "instead of just making people guffaw," he said. It's that focus upon factors beyond the humor alone that make Gaines and the other members of the CCU fulfill their unique roles so well.
Boots also entered the world of Clown Care thanks to a friend's advice. Eight years ago, a friend involved with the program called him and said, "You're going to get a phone call in ten minutes. Say yes," he recalled. Boots received the call with the job offer and followed his friend's advice. Since making that decision, Boots said, "it's given me new life."
Boots places a great emphasis upon the rewarding nature of his job. "When I see the smiles, strength and courage of the families and kids here, I am fulfilled," he said.
