For hospital clowns Joyce Friedman and David Levitin, no two tours of duty are quite the same. Which is just how they like it.
During rounds at Boston Medical Center, Friedman (a.k.a. Frizzle) and Levitin (Toodles) showed off their improv skills room by room, careful to assign an active role to each young patient they visited.
At the bedside of 10-year old Cheyanne, the pair held a mock marriage ceremony, prompting Cheyanne to exclaim, through her oxygen mask, “You forgot to exchange vows!” Next they coaxed Leandro, 8, to perform magic tricks as his mother looked on, beaming. The two then staged an episode of “America’s Next Top Model” for Paoloa, a 21-year old college student, who snapped a photo of the bumbling fashionistas while Toodles cooed, “You’re beautiful, too, Paoloa!” She blushed.
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Stepping out of character briefly, Friedman and Levitin ducked into a vacant room at BMC to discuss their work with the Hearts & Noses Hospital Clown Troupe, a group of professionally trained volunteers serving several local hospitals.
“Hospital clowns are inherently stupid,” explained Friedman, a musician and actress in her 15th year with the organization. “We mess up everything. Pointing out our ineptness empowers the child in an environment that usually doesn’t give them much control over anything.”
Founded in 1997, Hearts & Noses boasts 21 current members, among them a psychiatric nurse, professional storyteller, preschool teacher, and, in Levitin, a retired physician with a fondness for flowery neckties. Their mission? To promote healing while providing a few chuckles to some kids badly in need of a belly laugh.
Hearts & Noses trains its clowns to deal with a variety of medical situations, from rooms crammed with high-tech machinery to sedated or nonverbal patients to adolescents coping with mental-health issues. They work closely with hospital staffers, follow strict hygiene protocols, and regularly interact with the sickest and most vulnerable pediatric patients. Emotionally, these encounters can be draining. Yet their commitment to comfort kids is unwavering.
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For Friedman, clowning provides a “creative, healing outlet” for her performing side, she said during the break. She also runs training sessions and has traveled to Israel for a clowning conference attended by representatives from 40 countries. In many countries, including Israel, Canada, and parts of Europe, hospital clowning is highly professionalized, unlike in most parts of the US. Clowns are paid to work in tandem with doctors, nurses, physical therapists, and other team specialists. Israel’s Haifa University, for one, offers a degree program in medical clowning.
The philosophy behind Hearts & Noses is relatively simple, if no less therapeutic, according to Friedman and others: Allow the child to control the encounter — even to the point of saying: No, go away — then crank up the silliness.
Troupers typically work in pairs, playing off each other’s goofiness. Although names, costumes, and props are individualized, and clowns are encouraged to “grow” their characters in ways that feel natural, the goal is the same: to calm stressed-out families while inviting each child into “Clown World,” where imagination and interactivity rule.
Levitin, for one, finds clowning to be personally liberating after years of approaching patients from the other side of the stethoscope.
“When you put on the [clown] nose, you have permission to be silly,” he said. “And that’s actually very freeing emotionally.”
More importantly, he added, what he and his fellow clowns do “fosters wellness,” a view echoed by the group’s chief medical adviser, Children’s Hospital endocrinologist Dr. Michael Agus.
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It’s this “gift of choice” granted to patients and their families, says Agus, that elevates these encounters beyond mere entertainment. Handed a joystick, a child might be encouraged to “control” the clown as he or she chooses. Another patient, nervous or scared, might not want a visit at all. Either way, something positive comes from the encounter.
“Being empowered is really a key component of the healing process,” says Agus. “The more passive you are with an illness, the more challenging it is to heal.” He describes Hearts & Noses clowns as “emotional consultants” to the medical personnel entrusted with a child’s care.
Children’s Hospital relies on a different troupe — the Big Apple Circus Clown Care Unit, a group of professionals who dress in doctor’s garb — to entertain its patients. Although skilled at what they do, says Agus, those clowns work differently from Hearts & Noses, for whom joining the circus is not in anyone’s plans.
“There’s a certain gentleness that comes with an all-volunteer crew,” he says. “Their main obligation is to provide the best experience they can to as many patients as they can see.”
The troupe’s executive director, Cheryl Lekousi (Tic Toc), draws another subtle distinction between the two approaches. “There’s no ‘show must go on’ with us,” she says. “If a kid loses interest, we drop what we’re doing. It’s completely child-centered.”
Hearts & Noses was founded 17 years ago by Jeannie Lindheim, an actress and theater teacher, after taking a trip to Russia with Dr. Hunter “Patch” Adams, a physician, author, and pioneering clown portrayed by Robin Williams in the eponymous 1998 movie.
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A 501(c) nonprofit, it operates on a yearly budget of approximately $340,000, money primarily used to cover training and travel expenses. According to its board chairman, David E. Williams, a health care consultant, funding also supports recruitment and strategic development, with the aim of strengthening ties with other medical institutions.
After Lindheim retired from active clowning, Lekousi took over as troupe director in 2005. The daughter of a professional magician, she has a background in early childhood education and runs a home day-care center. Weekly, she makes rounds at Franciscan Hospital for Children and Spaulding Rehabilitation Center, two of the hospitals currently served by Hearts & Noses. The troupe also makes appearances at charity events and held a gala fund-raiser in May at the deCordova Sculpture Park and Museum in Lincoln.
On a recent morning at Franciscan, Lekousi and partner Arlene Fruchter (Fleurette) met in the lobby to prepare themselves, expecting to see two dozen or so patients over the next three hours. These patients would range in age from infants born prematurely to adolescents coping with mental illness. Beginning last year, the troupe began a training program to serve the latter population, under the supervision of Dr. Albert Hyman, a Brookline child psychiatrist.
Dealing with conditions like clinical depression requires great sensitivity, notes Hyman, which Hearts & Noses members have already shown. “They’re very good at reading personalities,” he says, “at understanding [a patient’s] disability and what their limitations are.”
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Whatever a patient’s age or condition, said Lekousi, she and her colleagues focus on the positive, even in the bleakest situations.
“Our message to the kids is, we’re a witness of you, of your childhood,” said Lekousi. However, they make no promises to “fix” what ails a child, physical or otherwise. “We’re not clown doctors,” she said. “But we don’t ignore what a child is saying, either.”
A baby born with serious congenital or medical issues is particularly challenging, she added, because parents are desperate for relief from their stress. “I look at that baby, and I find what is beautiful. ‘Look at those eyelashes,’ I might say. I gush for the parents, putting in the [emotional] stuff that’s been missing for them. But it’s also truly from the heart.”
The pair’s first stop was the cribside of 14-month old James, born at 24 weeks with serious breathing issues. His dad welcomed Lekousi and Fruchter into the room. While the two sang to James, he said that he and his wife had been through “a roller coaster ride” since their son was hospitalized last August.
Next in line was 5-year old Christopher, nursing a broken leg, and his mother, who’d been sleeping in a cot beside the boy’s bed. Christopher wanted to show Tic Toc his favorite stuffed animal, Mr. Giraffe. Tic Toc returned the favor by urging him to tug on her wristwatch. “Zip line!” she cried as a long band unspooled from inside the toy timepiece.
Christopher’s eyes lit up in surprise, his day already looking just a bit brighter.
Hearts & Noses Hospital Clown Troupe’s video:
Joseph P. Kahn can be reached at joseph.kahn@globe.com.