August 2007

by Andrew Luke Patrick Pirotte
(or more accurately, my clown name, E. Normus Farticus)

Often enough, the reality of an experience is nothing like our preemptory perception of it. My clowning trip with Gesundheit Institute vividly illustrated this concept to me and left me grateful for a reality that far exceeded my expectations.

My interest in the Gesundheit Institute was originally peaked by the Hollywood film depicting Patch's work. After some prompting from a dear friend (who was as excited about humor and love in medicine as I was), I read Patch's book Gesundheit. The book expressed the beliefs and ideas behind the movement much more clearly than the movie, and it left me with a strong desire to further explore the Gesundheit philosophy. I gathered my courage and mental goofiness and wrote Patch a letter expressing my interest in his movement. I expected a response along the lines of, "Andrew, I'm glad you think I'm awesome. I think I'm awesome too." But the response was far from arrogant or blasé. Patch called me and we discussed the letter – my interest in Gesundheit's work, our hope for human love and the unity of different peoples, as well as my plans for entering medical school the coming fall. We talked about the academic and financial concerns of medical school and about the trend of physician jadedness toward patients from overwork, stress, and the enormous lack of daily humor. After our brief conversation, he invited me to go to Ecuador to live the Gesundheit idea, rather than just understand it theoretically. I accepted.

To follow my caveat, my adventures in Ecuador were far from the experience I forecasted. My anticipatory mental image was a traditional medical setting with a nontraditional look and attitude: We would provide conventional medical care with red noses and funny shoes. I pictured, for example, John or Bowen (two of the Gesundheit clown docs) suturing a laceration while sporting goofy pants and a red nose instead of trousers and a tie. The care would be essentially the same but would have a different presentation. My prediction, however, was unlike the reality.

The actual focus of a Gesundheit trip is the transmission of love in an unabridged and unapologetic form. This love is not expressed in medical procedures (though these are legitimate acts of charity and service), but rather in joyful performances and courageous activism. Our clowning was principally concerned with bringing love to people and promoting social justice. We clowned in order to give joy, foster mental health, and fight injustice.

Our group of clowns spent time in the Ecuadorian cities of Quito, Guayaquil, and Cuenca. Much of the trip consisted of visiting hospitals and schools (and, in Quito, a women's prison). We really enjoyed goofing around for the patients and their families, students, and nearly everyone else we encountered. We met so many wonderful people! I remember specifically (How could I forget?) one beautiful child:

The clowns were parading around the corridors of a children's hospital in downtown Quito. Most of the children were absorbed in our craziness and were wearing huge smiles. We clowned around with them by chasing them, performing magic tricks for them, or painting their faces. The environment was electric. Everyone in the hospital seemed to be alive with joy and goofiness. But there was one very young girl who was hiding from our clowning in a room at the end of a corridor. Wanting to bring the fun and love of the group to this little girl, I went into her room. While talking with her mother through an interpreter, I discovered that the child had been in a traumatic car accident and that the world had since been a very frightening place for her. It was clear that to reach out to her, I needed to shift from my usual raucous style of clowning to a calmer, gentler type.

The room's silence after my conversation with her mother was broken only by the girl's quiet crying. She was bent over a picture she was coloring. I put away my balloons and juggling balls and sat down with her. For the next half hour we colored together with no words. We began to clown around by coloring on each other's drawings and pushing each other's crayons around to mess up the pictures. Ever so slightly, she brightened; her eyes dried up and her smile came out. We had connected. My Ecuadorian hosts had to plead with me to leave her, and it took some serious convincing before I would go.

I had another unforgettable experience during our group's visit to a school for children with Down's Syndrome. We had a totally crazy time at the school! We spent most of the day dancing jigs, tying our shoelaces together, and giving out goofy gifts. At the end of the day, the children took their turn as the entertainers. With help from their teachers, the children put on a fantastic dance. I thought my sides would split from laughing! After the children's performance, everyone began to dance around together. I was boogying all over the place when my clown friend Matt came over to me carrying a beautiful young girl with Down's Syndrome. Both of them were smiling ear to ear. We were all dancing together when the little girl stretched out her arms to me. Matt helped her into my arms. For the next few minutes, the little girl and I danced and clowned together. She had the kindest way about her – smiling and hugging other children and teachers, waving to everyone, and showering my cheeks with kisses. I have not yet had the blessing of fatherhood, but for a moment I understood the overwhelming power of a father's love for his child. In that moment, she became a part of me that will not fade or be replaced.

I offer these examples to illustrate the beauty and love in the work of the Gesundheit Institute. Every clown has similar stories; experiences like mine are common on clown trips. But, of course, there's nothing commonplace about experiencing vibrant, living love. Much of this remarkable love was exchanged directly between the clowns and others. I came to learn, however, that the Gesundheit love extends beyond clowning and individual connection.

The Institute complements its loving clowning with ardent social activism. Gesundheit cannot literally give every person a red clown nose. It can, however, strive for the improvement of social justice. Gesundheit works toward this goal by cooperating with other altruistic organizations, performing charitable works, and courageously expressing itself in the political arena. These efforts are carried out with an amazing energy and resilience. Without a doubt, Gesundheit's untiring devotion to improving social justice is fueled by the pursuit of what is right.

My predictions of clowning and Gesundheit were far from the reality, but it was a pleasant surprise to discover the truth. With all the sincerity I can convey here, I highly recommend that the curious explore the Gesundheit mission and that its supporters renew their love of it.

A special message for my colleagues in medical school or those thinking about going into medicine: A trip with Gesundheit will throw you a curveball. It will change many of your assumptions about medical care and conventional practice. The only thing to fear is that you will loosen your ties to some of the traditional, but not necessarily beneficial, customs of the medical profession. Jump in with your clown boots tied.