Six months ago, my supervisor burst in the middle of my music group at the psychiatric hospital: “We have two clowns visiting, can they come in? –Of course!” Two grinning youthful men popped into the day room; one wearing a monkey suit, the other dressed in short striped pants with suspenders, colorful socks with a butterfly pattern, red shoes, a bright Hawaiian shirt topped by a funny little straw hat. They started dancing on my accordion music, partnering with the seated patients, gently holding their hands or mirroring their movements. After a few minutes one clown pulled out juggling balls from his back pack. He alternated juggling and playing ball with some patients. The monkey clown pulled out a dog puppet. Quickly, a whole story, with sounds and words, developed about the dog and the monkey relationship. The dog was offered food and a place to sleep. Smiles were on everyone’s face.  After twenty minutes, the supervised whisked the clowns away. They left to a loud chorus of “Thank you!!” and “Come back soon!”

This first trial has been followed by regular bi-monthly visits. The pattern is similar. The clowns from the MEDICAL CLOWN PROJECT come in pairs wearing funny clothes. It could be princess dresses for women or variations on too small, too big, colorful and cute. They wear minimal make up, or none. They carry a bag of accessories: balls, puppets, “toys”, ukulele, little things that can be passed around and discussed, magic tricks, squeaky/funny sounding objects.

Sometimes the clowns perform for groups, as they did that first time for the psychiatric patients. The shows are improvised, built for the audience of that day and that moment. Other times the clowns do room visits. Guided by a staff member, they enter a patient room, when patient agrees. During five to ten minutes, they create something for and with the patient, using what they see, what they feel. I remember hearing, from the hallway, a theatrical entrance. One clown hid behind the curtain dividing a double room. He asked: “Who is there?” From his bed, the patient, who had never seen the clown, started answering in character.  The following verbal exchange was delightful, witty and clearly tapped into the patient’s creative power. These room visits demonstrate best the skills of the medical clowns. On top of their physical and drama training, from different American and European clown schools, they study counseling and psychology and intern in medical settings. I have come to completely trust their ability to deeply connect with the patients and residents, who are willing to accept an interaction.

I discovered the unusual profession of medical clown a few years ago, when Anabelle, French founder of the NEZTOILES  presented her work during a European Validation Symposium. I was impressed by her personality, her performance, the range of her emotions and her courage. While giving examples of her work at the side of very sick people, she was using the word “joy”, “joie” in French, over and over. What a contrast with the other presenters, and participants. All were in agreement to offer better environments for older adults with memory loss, to listen with empathy, to be patient, detail oriented, knowledgeable about their history and preferences. But this was not joy. Many of us were on the edge of burn-out, struggling with management, regulations and administrative weight. Anabelle was pointing to us the fun of a light hearted communication. She was leading us to a place of wonder, to the child inside us that has power to focus, to imagine and to believe. It turns out that these qualities nurture healing. I was so happy when I learn that San Francisco had its own medical clowns.

On top of their visits with patients and residents, medical clowns provide staff training. I have not attended those training but witnessing the clowns work reminded me of one of the main principle of care: PAYING ATTENTION. The minute they start, the clowns pay attention: to the juggling balls, the bodies postures, the words, the emotions, the moves, the environment. They are completely in the moment, their improvisation is being built right here, like life.