Send in the clown—me!

This physician went to clown college to make children laugh and to get in touch with her silly side.

By Rebecca S. Kightlinger, DO
Ob/Gyn, Erie, PA

I graduated from Jolly Jesters Clown College seven years ago. Before students are even allowed to try on our oversized shoes, we learn clown ethics—never smoke, drink alcohol, or use inappropriate language while in wardrobe, for example—and skills like improvisation, balloon twisting, juggling, face painting, and magic.

My strong suit is improvisation, with a minor in balloon animals. I make what I intend to look like 35 different animals, but kids invariably say, "Oh, look at the cute dog!"

Makeup isn't easy, especially when you're over 40. When your face has its own lines, you have to design your clown-face around the existing terrain. Otherwise the makeup can crack when you laugh, and you do that a lot.

Graduation day was a riot. Commencement exercises involved tightrope-walking, skits, and the big rubber hammer. The graduates, or Joeys as we're called, wore wigs, big shoes, and red noses and were awarded "First of May" degrees, so called for the traditional opening day of the circus year.

People take up clowning for all sorts of reasons. For me, it brings out the light-hearted side that's buried under a mountain of serious medical information and business concerns. Some occasionally need to be goofy, but have few outlets in their real lives. Others just love kids and want to interact with them in a way that is pure fun. Many clowns entertain patients at nursing homes. There's even specialized training for hospice clowning.

Clowning is more than just being silly. Don't get me wrong: there's lots of silliness, thank goodness. But there's a plan to it. The pros have extensive training and rehearse skits to perfect their timing. And clown meetings are governed by Robert's Rules of Order. To me this was a surprise. I expected lots of goofing around. But organizations and charities of all kinds request clowns, and it's during meetings that the clowns have to make serious decisions about which events they'll attend. Then they have to plan activities to perform.

My favorite clown events are parades—because you can get large. Give me a parade route and lots of space, and you will see one happy clown.

There are also events featuring face painting, balloons, and walkarounds where you can interact with kids and their parents. Walkarounds are trickier than other types of performance because you have to be careful not to offend, frighten, or say or do anything that could be misinterpreted by children or parents—that's where those clown ethics come in.

Birthday parties are favorites with many clowns because you can entertain a lot of kids at once and even make a living at it. Not for me. Kids can be tough audiences, and can turn on you suddenly and pull off your nose.

I haven't told many people that I'm a clown, but that's more out of a sense of clown professionalism than to protect my identity as a physician. My patients know me pretty well and are never surprised when they find out that my alter-ego has bright yellow hair and wears size 45 shoes.

Clowning around with Patch Adams

Being a clown myself, I jumped at the chance to meet the ultimate medical clown, Hunter D. "Patch" Adams, when he recently had a speaking engagement nearby. I knew from the 1998 movie that Adams had created the Gesundheit! Institute in rural West Virginia in 1971 to address problems about the way care is delivered, but I didn't realize that his mission was now global.

The facility never charged money, never carried malpractice insurance, and never accepted third-party reimbursement. Initial patient interviews were three to four hours long. The institute integrated complementary medicine and connected the practice of medicine with social issues. A pilot project based on the Gesundheit! model involved 15,000 patients from 1971 to 1983. Since then, Patch has been raising funds to complete his fantasy hospital.

When, in March 2002, officials from Rome asked him to visit Afghanistan, he agreed as long as 22 clowns from six continents be allowed to accompany him. Oh, and that the Italian government provide 10 tons of aid—he couldn't show up empty-handed.

They provided 30 tons.

In the Afghan hospital for four weeks, his clowns used music, bubbles, and nonsense syllables to distract and comfort a little girl while her doctor debrided her third degree burns without analgesics.

Adams' quest is beginning to look quixotic, but he's relentless. He's on the road 300 days a year, speaking, teaching, raising funds, and clowning.

"The role of a doctor is to relieve suffering and promote the possible," says Adams. "Compassion affects every moment, every interaction in your life.

"Get off your butt and serve. There's no higher function than to serve."

—Rebecca S. Kightlinger, DO

Go to www.patchadams.org for more information on the Gesundheit! Institute.

Rebecca Kightlinger. Send in the clown--me!

Medical Economics

Aug. 22, 2003;80:56.