On call with Dr. Bovine: Clowning around helps young patients cope with cancer

On call with Dr. Bovine: Clowning around helps young patients cope with cancer
On call with Dr. Bovine: Clowning around helps young patients cope with cancer

When you are a sick child lying in a hospital bed, constantly getting poked and punctured or being wheeled away for procedures that are uncomfortable or downright painful, the last person you would want to see coming toward you is one more white-coated doctor. That is, unless that doctor is Dr. Bovine.

Dr. Bovine describes himself as "a benevolent, almost plodding, always hungry, not so smart, pretty patient goofball with a porkpie hat, a short lab coat, and round glasses." He says the bovine identity was especially appealing to him because "cows give every part of themselves for something." This extremely giving person is actually the clown, Glen Heroy, and his persona as Dr. Bovine for the Big Apple Circus Clown Care program made a huge difference in the lives of many patients at Memorial Sloan-Kettering Cancer Center in New York City. A clown can provide palliative care like no one else.


The Big Apple Circus Clown Care program employs specially trained professional performers to be clown doctors. Working in teams of two, they go to children's hospitals or the pediatric units of large medical centers several times a week for about 5 hours a day. According to Heroy, who was also supervisor of the Clown Care unit at Memorial Sloan-Kettering, the performers are specially trained in all hospital hygiene protocols and familiar with all forms of medical clearances; they are even compliant with the Health Insurance Portability and Accountability Act (HIPAA).

Considered the innovator of this art form, the Big Apple Circus Clown Care program has inspired many other similar programs throughout the country since its inception in 1986. This type of activity is nothing new for clowns and other performers, Heroy says, since they have been entertaining in hospitals "for eons."


How does someone become a Big Apple Circus clown doctor? Heroy explained: "While I was Santa Claus at Macy's in New York's Herald Square, I did some outreach appearances for disabled children and found that I had a very strong connection with many of them. This inspired me to try and find a job where I could perform, get a paycheck, and do some good for children [who] were not in the best circumstances. I chose to work at Memorial Sloan-Kettering Cancer Center because the children there were facing such a tough battle. Also, the long-term inpatient aspect of the facility made me come up with new material and kept my skills sharp."

When asked what skills are needed to do what he did, he said, "You start with patience, resilience, the ability to listen, the ability to check your ego at the door, and an open heart. Then add music, magic, storytelling, juggling, tap dancing, jokes, singing, bubble blowing, puppets, origami, comic timing, trivia, impersonations, riddles, Abbott and Costello routines, etc. You name it." He said an oncology nurse or other practitioner can learn and practice those skills, too. "It's beautiful to see a nurse or doctor sing or play along when we get goofy."


Although he was usually found in the pediatric unit, Heroy worked with patients ranging in age from newborns to adults. He learned that at Memorial Sloan-Kettering if a patient is diagnosed as a child, that patient always returns to the pediatric floor for treatment. Of course he assisted the staff with patients of any age, and he was always in demand.

"I've distracted and entertained kids during all sorts of injections and finger sticks. I've had children race me, hit me, and arm wrestle me, all in the name of physical therapy. And I always tried to be with a child who was having a particularly bad day. I remember an 11-year-old boy (whom I had known since he was 7 [years old]) who got hysterical when he was brought into the pediatric ICU. He demanded, 'I WANT TO SEE DR. BOVINE!' and I was paged. A new nurse later inquired, 'Who is Dr. Bovine, a psych counselor?' The charge nurse said, 'No. He's the clown.' "

There were many requests for Dr. Bovine to see specific patients. He made birthday visits. He visited adults in other parts of the hospital. He was all over the place. "I used to love being present when a child came out of anesthesia or being there to escort a kid to radiation or to push their wheelchairs when patients were leaving to go home. (I'd also get in the car with them and demand they take me home with them and give me cookies!)"

Coulrophobia is the fear of clowns, and over the years Dr. Bovine has encountered a few cases of it in children and adults. Heroy's solution was to design and print a "No Clowns Today Please" sign, which had a picture of Dr. Bovine in a red circle with a red bar across his face. He explained that his plan backfired because the sign had a picture of a clown on it.


Dr. Bovine said he tried to "weave [himself] into the fabric of the community." He was primarily there for the children, but he also tried to include all those around him in his antics. Not everyone was receptive to his colleagues and him, though. He noted that there are always people, including medical and administrative staff, who think that having clowns walking around a medical facility is inappropriate. However, he added, "Often their opinions are turned around when they hear children laughing."


When asked if he made a difference in patient care or outcome, Heroy said, "I made children forget they were sick for 5 minutes. I didn't cure any diseases. Although Farid Boulad, MD, medical director of the Pediatric Day Hospital at Memorial Sloan-Kettering Cancer Center, told us (in regard to the clowns), that patients heal faster when they are in a better mood."

Dr. Bovine stayed at Memorial Sloan-Kettering for 8 years, entertaining as well as supervising the Clown Care unit there. He also spent six seasons as a Big Apple Circus Clown-in-Residence at Paul Newman's Hole in the Wall Gang Camp. He took his commitment to the children very seriously and often would visit them at home, meet them and their families at the carousel or the zoo, or join them on a Ronald McDonald House excursion to Disney World. He made time to go to every fund-raiser, every talent show, and every pediatric prom because he had an "all-or-nothing mind-set." He said he had a strong connection to the children, which, combined with the mortality rate over 8 years, "is an intense equation." It was time to move on.


When Heroy left the cancer center, he became a featured clown in the touring production of the Big Apple Circus. He starred in the PBS series Circus and taught a lesson in physics using the hilarious Big Apple Circus dog act as part of an educational supplement to that series. He said he is "astonished" that the children and their families stay in touch with him. He even has a number of Facebook friends who were patients when he was at the cancer center and who are now "all grown up and healthy and beautiful. That kind of makes it all worth it."

Does Dr. Bovine have advice for oncology professionals? "Try keeping a sponge ball clown nose in your pocket (see Sources for inexpensive clown noses). You never know when the unexpected provoking of a smile might come in handy." ONA

Bette Kaplan is a medical writer based in Tenafly, New Jersey.

is a medical writer based in Tenafly, New Jersey.
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