The health benefits of clowning around Matthew A. Wilson

I danced with Bella for the first time

as Bei Mir Bistu Shein filled the room.

And her blue eyes locked with mine.

We took turns singing

and forgetting the words.

She led, I followed.

A waltz step here,

a shimmy here.

(Rattle sound)

(Laughter)

Hands on our hearts,

our foreheads touching,

as we communicated
through movement and music,

making sense through nonsense.

Bella is 83 and lives with dementia.

The dance gives us a chance
to find each other.

How did I learn to dance with dementia?

Because I’m not a dancer.

And I’m not a doctor.

But I’ve played one in the hospital.

(Laughs)

I’m a clown doctor.

Or a medical clown.

My tools are whoopee cushions,

shakers

(Shaker rattles)

and a red nose.

You know the old adage
“laughter is the best medicine?”

I hear that a lot.

Now, at the same time,
there are studies to support it,

but right now,

I’d like to take you behind the nose
and go beyond the laughter

and share a few things that I’ve seen
skating through ICUs.

In my Heelys.

Size 11.

Because I take medical clowning

very, very seriously.

(Deflating sound)

(Laughter)

(Deflating sound)

(Laughter)

My mentor was conducting
clown rounds in the hospital

when he was approached by a nurse.

They needed to put a tube
up the kid’s nose.

Kid didn’t want to do it,

so rather than hold the kid down,

they asked my colleague if he could help.

So the clown asked for a second tube

and shoved it up his own nose.

Kid of like this.

Oh, please don’t do this at home.

(Laughter)

Now, the kid saw this,

grabbed his own tube

and promptly stuck it up his own nose,

kind of like this.

(Applause)

The clowns, the nurse and the patient

discovered a creative solution
for their situation together.

And guess what, there’s research
to back this up.

Randomized controlled trials
in Israel and Italy

show that medical clowns
can be as effective as tranquilizers

with no side effects.

In 2004, I started conducting
my own clown rounds

at the Memorial Sloan Kettering
Cancer Center in New York City.

My colleague and I were invited
to accompany a young six-year-old

with the most adorable southern accent,

to accompany him while he got
his chemotherapy port flushed,

a very uncomfortable
and regular procedure.

We joined him, his mom and the nurse

in this tiny, closed curtain cubicle.

Every medical clown encounter begins
by obtaining consent from the patient.

So we ask him if we can be there.

He says, “Sure.”

We’re often the one element
that a child could control

while they’re in the hospital.

So we start with a card trick,

fan the deck so he can pick.

But as soon as the nurse
approaches with the needle

to flush the port,

he starts screaming and cussing

like no six-year-old
I’d ever heard in my life.

So we say, “Hey, should we
come back later?”

He stops, mouth open,

eyes wet with tears,
face flushed pink with anger,

and he smiles,

“Oh no, you’re fine,
I want you to be here.”

OK.

So we start playing a song,

my colleague on recorder,
me on whoopee cushion.

The nurse approaches with the needle,

and it happens again,
this torrent of four-letter words.

He went from playing and laughing

to screaming and crying,

back and forth until
the procedure was complete.

For the first time,

I experienced this odd duality
of joy and suffering.

But not for the last time.

See, when we’re there,
we’re not there merely to distract

or make anyone feel better per se.

The medical clowns work moment by moment

to create connections between the clowns,

the nurse, the parent and the child.

This provides a source of power
or control for the child

while supporting the staff
with their work.

I’ve spent over a decade
bringing joy and delight

to the bedsides of terminally ill children

in the top hospitals in New York City.

And you know what I’ve learned?

Everyone’s hurting.

Staff, family, patients.

The patient’s in the hospital
because they’re hurting.

The family’s hurting
as they navigate uncertainty, grief

and the financial burdens of care.

The staff is hurting,
only it’s more than burnout.

More and more health care workers

are reporting feeling overworked
and overextended.

Now, I’m not so naive as to suggest

that the solution is
to send in the clowns.

(Laughter)

But what if?

What if the tools of medical clown
arts practitioners from around the world

permeated our entire health care system?

In 2018, at the Healthcare Clowning
International Meeting,

they represented over 150 programs
in 50 different countries.

University of Haifa

offers a formal undergraduate
degree program in medical clowning.

Argentina has passed laws
requiring the presence of medical clowns

in public hospitals
at their largest province.

And this work affects
more than the patients.

It makes things better
for the whole health care team.

One of my favorite games
to play in the hospital

is elevator music.

I love elevators, because they’re a place

where paths cross, different worlds meet.

It’s intimate,

uncomfortably quiet

and just begging
for a little playful disruption.

The doors close

and “The Girl from Ipanema”
starts playing on Hammond organ,

because I keep a portable speaker
hidden in my pocket.

So for those used to using
the silent, sterile elevator,

it’s a moment of surprise.

Folks have permission
to acknowledge or not this disruption.

The game grows with every stop,

because as soon as the elevator stops,

the music stops.

New passengers get on,

and the current passengers
get to witness the new passengers –

their surprise – as they hear
the elevator music for the first time.

You experience the shift of adults

standing silently,
strangers in an elevator,

to attempting to suppress their mirth,

to, “Is this a party or an elevator,”

filled with full-on laughter.

Research conducted in Brazil,

Australia, Canada and Germany

confirm that the artistic
interventions of medical clowns

improve the work environment
for the staff, beyond the elevator,

and support their work administering care.

Promising research in the US indicates

that arts programing in the hospital

can improve the work environment,

leading to increased job satisfaction

and better quality of care.

My work has taught me

how to actually be present.

How to breathe in a room
with a person in pain.

How to connect

and build trust, no matter
the age, ability or illness.

And how medical clowning
is an excellent way of using the arts

to put the care back in health care.

Thanks.

(Applause)