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Clowning in Medicine An Oddity or a Calling

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					Clowning around

Appeared in Pharmacy Practice News



Clowning in Medicine: An Oddity or a Calling?
Dan Hurley




Cari Brackett, PharmD, might be the only pharmacist in America who carries toys in
her lab coat pocket while teaching classes and seeing patients.

Determined to prove that the words “clown” and “pharmacist” can be uttered
productively in the same sentence, Dr. Brackett, associate professor of clinical
pharmacy in the Ohio State University College of Pharmacy in Columbus, formed a
clowning group for pharmacy and medical students last year and presented a
program about humor in medicine at the American Association of Colleges of
Pharmacy (AACP) annual meeting in Chicago. Her goal is to encourage pharmacists
and other health care providers to dispense joy, love and warmth as well as
medications—a message that is hardly a laughing matter.

“Humor and human contact are very healing,” Dr. Brackett said. “It doesn’t take a
red nose and green hair. Clowning is just one of many techniques that can allow us
to connect with patients as human beings.”




Mission of Mirth

Her efforts were inspired by a two-week clowning trip she took in November 2007 to
Russian hospitals and orphanages with a group of 50 volunteers led by famed
physician-clown Hunter “Patch” Adams, MD, the subject of the 1988 movie starring
Robin Williams.

In a poster session (abstract 258) at the annual meeting of the American College of
Clinical Pharmacy in Louisville, Ky., Dr. Brackett noted that on their mission of mirth,
“Participants learned that laughter and care absolutely reduce pain and that the
contact sometimes affords long-lasting changes in people who have been isolated.
We learned to establish meaningful, caring contact with others even without makeup
or magic. We learned strategies that allowed these meaningful connections to occur
irrespective of language, age and social divisions.”

In a telephone interview with Pharmacy Practice News, Dr. Adams emphasized the
serious need for silliness in hospitals.

“Doing supposedly healing work in a setting that is stressed, grumpy and hierarchical
has never been shown in any paper to have a value,” he said. “There are thousands
of papers to show the healing value of wonder and humor and joy and passion and
hope.”

For Dr. Brackett, the Russia trip was a turning point in her life. “I could not come
back to Ohio and not do something important with what I learned,” she said.

At one of the first meetings for Dr. Brackett’s health care clowning group, which
draws both pharmacy and medical students, she brought in as guest speaker retired
Army Major Robert Kreidler, who now serves as headmaster of the Ohio College of
Clowning Arts.

“I was a professional army officer for 10 years, and it’s all come to this,” joked Mr.
Kreidler. But, he added, his decade in the military has given him a good perspective
on the attitude of seriousness that can infect any professional, including pharmacists.

“So many of us are infected with the fatal rationalism of the left lobe of the brain,”
he said. “I made a conscious decision, years ago, to work with both halves of my
brain. I’m trying to convince medical practitioners not to ignore the left lobe of their
brains but to explore both sides.”

Perhaps that explains how he managed to get the students in attendance that day to
stand up and begin doing a silly clown dance with him.

“We just laughed and had a good time,” recalled first-year pharmacy student Simon
Pence of that class with Mr. Kreidler. “I was about to take a medicinal chemistry test,
so I had been a little stressed. It was a great way to relax before the exam.”

Since then, Mr. Pence has become a regular member of the clowning group,
including a trip in November to a local mall to entertain children who had muscular
dystrophy.

“I had never dressed up like a clown before,” he said. “But when you put on a red
nose and dress crazy, people expect you to act silly, to start sliding over the floor
and tripping over a chair.”
It’s Not About the Red Nose

Although Dr. Brackett is not above teaching the students in her clowning group how
to do a few clown tricks, she said, “I have an agenda far and beyond wearing dorky
clothes and acting silly. What I have observed from 17 years of teaching is that even
though we say the right words about patient-centered care, we don’t do it
particularly well, and we certainly don’t teach it particularly well. Some of us can
hide behind our white coats because we don’t feel comfortable or empowered to
make more personal contact with a patient. When you’ve got green hair and a red
nose and your socks don’t match, there is simply nothing left to hide behind.”

She actually gave up wearing clown makeup after a recent experience with a child at
Ohio State University Hospital. Dressed on Halloween night in a traditional clown’s
whiteface, Dr. Brackett approached a 9-year-old girl whose mother was hospitalized
with a serious illness.

“I’m afraid of clowns,” the girl told her. “I can’t tell if you’re laughing or frowning
under that makeup.”

Dr. Brackett agreed wholeheartedly, removed her red nose, and within five minutes
the two of them were skipping down the hall together, makeup and all.

Although the clowning group has not yet taken on entertaining in hospitals, she said
she incorporates the principles of clowning into her teaching and clinical care.

“I always have my clown nose with me in my briefcase,” she said. “If I am teaching a
class and the students are getting drowsy, I might put it on briefly, without changing
anything else about my lecture. But, that keeps them totally alert for the rest of the
hour.”

Perhaps more profoundly, she said, “I will hug anybody, at any time. That comes
from clowning.”

As she stated in her AACP presentation, clowning in a health care setting “cultivates
more direct, compassionate, discerning contact with students, patients and
colleagues. It offers a unique opportunity to allow care and concern to become the
primary intention of our daily interactions with others in our world.”

Travels With Patch

Dr. Adams conducts overseas missions of mirth nine times a year, often to areas of
profound poverty or torn by conflict. He travels regularly to Peru, Russia,
Afghanistan, Italy, Japan, Kosovo and Cuba, to name a few. Individuals interested in
learning more about the humanitarian clown trips, or about the health care training
institute for which he’s raising funds, can check out his Web site at
www.patchadams.org.

Although they do not always know quite what to make of her clowning, Dr. Brackett
says that her colleagues are supportive. “I work in a wonderful place,” she said.
“There is great tolerance here.”

As for student Simon Pence, he conceded that clowning is not something he could
see doing in an intensive care unit. But, he said, “There’s definitely a place for
clowning in a hospital, for making people happier. There’s also a place for knowing
when it’s not appropriate.”

Dr. Brackett said she could not echo that last point strongly enough. “I tell my
students not to overemphasize slapstick,” she explained. “To only take that approach
diminishes what we’re trying to do. Clowns do not always act silly; we’re all used to
seeing circus clowns and they often act doofy. But clowns can also be sad; they can
be silent; they can be very quiet and bring a smile with a funny game or story. So,
it’s not only about slapstick—especially in health-care clowning.”

Dr. Brackett added that students “often do gravitate toward the slapstick stuff first,
because it is so blatant and familiar to them. But more often, I simply sit with a
patient and blow bubbles or do some simple magic tricks. The patients don’t always
want to get all worked up. Just by looking so darn funny, I distract them from their
troubles, but I do not feel at all obliged to be goofy. I wish you could see Patch at
work. He can do goofy with the best. But when the situation calls for it, he turns into
the quietest, most gentle presence you’ve ever seen. It all comes from ‘reading’ the
patient, which is what I want my students to learn. What is appropriate for one
patient (whether you’re in clown mode or pharmacist mode), will not work for
another patient.”

Seen from that perspective, “clowning is quite a lot like mission work, or entertaining
or healing. Clowns express themselves with humor or close contact, rather than
building houses, or memorizing lines or doing surgery. But it is all work of the heart,
and this is what I want the students to discover for themselves.”

As for Mr. Pence’s future track in pharmacy, he said he is not sure what role
clowning will have in his everyday approach to patients. If he does feel the urge to
use his clowning skills, he said he’ll strive to remember the balance between silly and
serene. “But I’ll keep a red nose in my pocket for whenever I need it—just in case.”

—Dan Hurley

				
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