The day I met Cameron, one of my first patients at Seattle Children’s Hospital, I was making rounds with my colleagues Dr. Pozzo and Dr. Bonky. Cameron was 4 years old, from out of state, and had been in the hospital for two months when the Big Apple Circus Clown Care program began in the Hematology/Oncology unit. Cameron had a painful and aggressive cancer that had ravaged her emotionally as well as physically, but the presence of the “clown doctor” sparked something vital in her, and within days of our arrival, her mother said she “saw her little girl come back.”
I was a seasoned physical comedian, new to medical clowning. I’d performed polished stage shows for 15 years, most notably as soloist for an audience of 1,000 at the Lucille Ball Comedy Festival in New York. Now, in the hospital, as part of a team of five clowns, my job was to perform bedside for audiences of one. The work was highly improvisational, driven by the needs and interests of each child. The goal was not simply to entertain but also to allow humor to emerge from voluntary connection and trust.
I remember being startled and a little intimidated by Cameron, a fearless little bald-headed girl in a tiny wheelchair, who rolled right up to us, eyed our red noses and mismatched clothes topped by starched white coats, and demanded to know who we were and what we were doing there.
“Hi, I’m Dr. Le Fou,” I said, adjusting my purple neck ruffle and poufy red dress. “We’re here because we’re looking for someone to fool with one of our tricks.”
“Oh, yeah?” she said. “Just try me!”
I pulled out a little purple scarf, said abracadabra, and made it disappear.
“Ha!” Cameron said. “Let me see your hands!” I showed her my empty palms. “It’s in your pocket! Let me see in your pocket!” I turned my two-foot-long empty pockets inside out. “He has it!” she said, pointing to Pozzo. Before he could prove her wrong, she saw the small black rubber baseball bat emerging from the pocket of Dr. Bonky’s orange crinoline skirt. “Spank him!” she ordered.
I thought it would be glorious to see our team leader bend over and get spanked, so I said, “Ah, ah, ah, I’m afraid she’s right.”
“Bend over!” Cameron said to this polite and reserved 27-year-old man, who hadn’t figured such a requirement into his job description. He looked down through the big round glasses perched on top of his red nose. I could tell he was weighing this request for slapstick. Some of the children’s injuries were the result of abuse, and any pretend hitting or kicking, even in a comic sense, was often inappropriate. But this was not a clown gag, this was at the bidding of a child who had been poked and prodded with medical instruments against her will for months. It was likely she needed a stand-in for the medical establishment, a catharsis for her frustration and pain. We all sensed that. So Pozzo adjusted his suspenders and bow tie, flipped up his white coat, which was cut like a tuxedo tail, and bent over. Tiny Dr. Bonky smiled a bit too sweetly, whipped out the bat, wound up, leaped forward, and gave him a good whack.
Pozzo jumped forward, “Ow!” He stood up and scowled at Bonky, who turned and ran. He chased her, I joined in, and we all ran around the common area in a madcap melee. Cameron laughed so loudly, other kids came out of their rooms. Parents and nurses were laughing, and I was having so much fun, I forgot I was a 48-year-old mother on a kids’ cancer ward.
The next time I saw Cameron, she was wearing a bright pink dress, a big red nose, and a gold paper crown on her little bald head. She sat in her wheelchair throne and announced herself as Yo-Yo, Mayor of Clownville. Her older sisters were her clown cohorts, dubbed Sweet Pototo and Spin. On her bedside controls, she created imaginary buttons that, when pressed, commanded the clown doctors to tell a joke, play a song, or do a trick. She ruled with perfect comic timing and a broad range of exaggerated expressions. She was every inch what is known in the clown world as a “number one persona.” We would sometimes clown for her for 10 minutes, only to be faced with a penetrating frown and the command, “Now can you do something funny?”
One of her favorite gags was the mouth coil — a streamer of folded, colored paper that uncoils to 15 feet, seeming to emerge miraculously from clowns’ mouths or patients’ ears. Yo-Yo, however, insisted that there was an obstruction in her mother’s nose, and together we successfully extricated the coil from Mommy’s left nostril. Later, she proudly showed it to a serious young pediatric resident, saying: “Dr. La Foo pulled this out of Mommy’s nose!” With noticeable skepticism and concern he replied, “Dr. Who?”
The hospital asked the clowns to appear with Cameron at the annual fund-raising telethon, filmed by a local TV station. Dr. Pozzo and I took our places on each side of Cameron, in front of the bank of volunteer callers, the room buzzing with anticipation. Cameron sat in her wheelchair, looking straight into the camera — a miniature majestic presence in red nose and crown.
A reporter held the mike in front of Pozzo. “Please tell us about your program,” he said.
“This is Dr. Le Fou and I’m Dr. Pozzo. We’re professional performers trained to empower and motivate kids who are sick by giving them outlets for laughter and play.”
“And who is this?” the interviewer asked.
Pozzo seized the moment as setup for a gag. “This is Mo-Mo.”
Cameron frowned. “No, I’m not Mo-Mo, I’m Yo-Yo! You need a spanking!” She pointed to me. “Spank him!” After a moment’s hesitation and a desperate appeal to Yo-Yo, Dr. Pozzo handed me his violin bow and I obliged, with the cameras rolling.
Cameron was so much fun, and she benefited so much from the clowns’ presence, it was hard to find a way to exit her room. She always begged the clowns to stay longer. Dr. Pozzo, Dr. Lumpstuffy and Dr. Spud came up with the idea of a grand finale: They would dance to her favorite song, “Walkin’ on the Sun” by Smash Mouth, and then she would know it was time for the clowns to go. Always one step ahead of us, in true trickster fashion, Yo-Yo would start the song again just as the clowns reached the door.
Dr. Bonky, the smallest clown, was Yo-Yo’s undeniable favorite. “Why is she your favorite?” her mother asked. “Because I like how she bonks herself on the head with her bat and says, ‘Who did that?’”
For Cameron’s fifth birthday, the clowns presented her with a clown kit of her own. She loved the squeaker and the snake in the can, the whoopee cushion and the kazoo, but there was one thing missing — a plastic bat like Dr. Bonky’s. She repeatedly asked if she could have the “bonky stick.” “Someday when I’m old, I will give it to you,” Bonky always said.
I’d begun to feel more comfortable improvising with my partner and making the right choices for the patient. It was thrilling to see children who had been crying sit up and laugh within minutes as we stole juggling balls from each other, got stuck in the doorway, or pretended to be afraid of alligators in the bathroom. For kids in isolation with bone marrow transplants, we donned gowns and gloves, wore our red noses on the outside of our masks, and used silly dances and physical comedy to reach through the protective barriers.
One day, I’d joined Pozzo in the back hallway outside of the Child Life office for our warm-up. We’d practiced “The Ash Grove” on concertina and violin, he’d tossed his juggling clubs, and I’d shown him my new hat trick. Before we made our rounds, he told me he needed to share some sad news. After six months of chemotherapy, Cameron’s cancer had returned. An additional heart surgery, scheduled for that month, had been canceled; she was too weak, and her prognosis was poor. The family was devastated. Soon she’d be going home.
“No, that can’t be right,” I said. Of all our patients, Yo-Yo, with her indomitable spirit, had seemed most likely to survive. I had trained as a medical clown to contribute to positive outcomes. In my late 20s, while working as an editor for trade magazines, I’d had an epiphany that my true purpose was to be an agent of laughter. I’d struggled through training in Paris, performing on stage, and trying to balance family and career. As a hospital clown, I’d found a deeper purpose to my art that gave me joy and contributed to my own well-being. I wasn’t prepared for the possibility of death, nor the reality that it can happen to children. Though I hadn’t prayed in a long time, and wasn’t sure who or what to pray to, I prayed that Cameron would survive.
After work that day, I thought about something that had happened to my husband, David, 20 years ago, when he was a resident in psychiatry. A patient he’d known well had committed suicide, and he’d cried tears of sorrow and guilt, feeling that it was partly his fault, that there were things he could have done. A hospital clown isn’t responsible for life or death decisions, but still, I asked him, “You haven’t lost a patient in a long time, but you see such sad things. How do you cope?”
“I compartmentalize,” David said. “I put the sadness in one part of my brain, and focus on the patient in front of me.”
It sounded too easy, and predictably masculine. But I held to it.
The families from out of state, who lived at the Ronald McDonald House, planned a going-home party for Cameron. They asked the clowns to take part. How do you plan a party for a child who is heading home to die? The same way you plan a party for a child who has years of life ahead of her, we reasoned. All five of us volunteered to perform together for Yo-Yo. The performance would feature her favorite prop, the bonky stick.
Late afternoon, on a gorgeous day in July, the clouds hung like dollops of whipped cream about to drop. On the lawn outside the Ronald McDonald House, families were spread out on quilts, afghans and blankets. Kids sat hugging stuffed animals. Some wore sweaters and caps. Some sat in wheelchairs, legs covered with blankets. The mood was festive. Yo-Yo sat at the front, in a frilly pink dress, wearing her crown and red nose, a dozen helium balloons attached to her wheelchair, as if she were about to lift off.
All of the clowns but Dr. Bonky came running out of the Ronald McDonald house, stood in a row, and took bows. The bit we’d developed called for the four of us to set up a conflict by playing “The Blue Danube Waltz,” with Dr. Pozzo on violin, me on concertina, Dr. Lumpstuffy conducting with a toilet plunger, and Dr. Spud filling in with goose call and fart whistle. Dr. Bonky would be left out, thus creating a motive for revenge later, but before we could begin, Cameron protested that Dr. Bonky was missing, and incited the audience to chant “Dr. Bonky! Dr. Bonky!” Finally, Dr. Bonky ran out of the house, over to Cameron, and assured her with a wink that she had a plan.
Dr. Bonky assumed a position at the end of the line but was told that a quartet could have only four players. She could sit down and listen. We continued the song, forming a tight line, but she tried to edge her way into the middle. Finally, when it came time for the chorus, Bonky drew out her bat and retaliated in perfect waltz rhythm. As we played da da da da da from “The Blue Danube Waltz,” she bopped each of us on the head in turn with the four beats that came after, bonk bonk, bonk bonk! The audience cheered for Dr. Bonky, but we pretended they were cheering for us and took our bows.
Later, we changed out of our costumes and ate potluck in the lounge of the Ronald McDonald House with Cameron’s family and the others. We laughed as we shared stories about Yo-Yo, interrupted by silences in which we gulped more lemonade or made comments about the food. “Can I have your recipe for these cookies?” or “This casserole is delicious!” — words that disguised our grief. We lingered through coffee and dessert, not wanting to let go, not knowing how to let go. Cameron was lying on the couch, exhausted. Her mother had turned down the lights and put a movie in the VHS, but Cameron was listless, clearly not distracted and in considerable pain. She was holding tightly onto the bonky stick. There on the couch, we all snuggled in together. The mood turned relaxed and happy — a family of clowns. The evening felt almost complete.
I looked at Cameron, her head in her mother’s lap, and I was suddenly unable to contain my sadness. I didn’t know how to behave around the family. Were we supposed to act as if nothing had changed? Were we supposed to say we were sorry?
I leaned over to kiss her cheek. “Goodbye, Yo-Yo,” I sighed. But this was not the way she wanted it to end. Yo-Yo suddenly sat up and ordered Dr. Pozzo, her favorite victim, to bend down in front of her. “Pozzo! You … here … now!” she ordered. “On the head-head?” he asked meekly. “No! The butt-butt!” she ordered. “Bring me your butt-butt!” His yelps were accompanied by Yo-Yo’s mother’s running commentary: “That’s for the IV!” Bonk! “And that’s for the chemo!” Bonk! “And that’s for losing my hair!” Bonk! Bonk! Bonk!
Dr. Lumpstuffy was next. After taking his lumps, he grabbed the bonky stick, drew it back and “accidentally” bonked the mother sitting in the chair behind him, who grabbed the bat and retaliated. Someone else reached for the bat, which built to a spontaneous bonking session involving each adult and child present, until a cumulative, raucous laughter filled the room. I looked around, into the faces where love and joy, anger and grief had blended, creating a presence I could only describe as sacred.
And then Yo-Yo pleaded, “Could I please keep the bonky stick? I want it so much! Please! Please! Please!” with all of the appropriate “poor little me” looks she had mastered so well during her illness. “I don’t know, Yo-Yo,” said Dr. Bonky, “do you think you could be a little more convincing?” Without missing a beat, knowing the joke was on her, Cameron made a full out, contorted grimace, and let go a comically pathetic, over the top “Wahhhhhhh!” that brought the house down. The bonky stick was hers.
A few weeks later, the bonky stick came back, adorned with pink ribbons. Dr. Bonky held it in her hands for a long time before she finally turned it over. There, on the side, scrawled in bright pink letters, was: “Yo-Yo” — the incomparable, unforgettable Mayor of Clownville.