one more time, with laughter

by Victoria Millard

DR. POZZO TWIRLED DOWN THE 6^th floor hallway of Seattle Children’s Hospital, flourishing his bow and strings like a shuttle and loom, weaving the notes of “The Peekaboo Waltz” into the disparate voices, footfalls, sounds, and rhythms of the people passing by. I, Dr. Le Fou, followed, pumping the bellows of my concertina, hoping to spin a thread of levity into the fabric of pain, grit, worry, relief, and hope that enveloped me. I caught fleeting smiles. Some glided, stepped, and turned to the beat. Some stopped for a moment to listen, and others, inconvenienced, hurried by. A few may have wondered at this strange curiosity—clowns in a hospital—like aspirin at the circus.

Pozzo and I were members of The Big Apple Circus Clown Care, a professional program that operated out of New York and served seventeen children’s hospitals around the country. From 1998 to 2009, our team of five physical comedians visited kids of all ages, equipped with musical instruments, magic tricks, juggling balls, honking blood pressure cuffs, and squirt-gun syringes. We enabled gravely ill babies to laugh for the first time, relieved kids’ anxieties before medical procedures and surgery, preserved the need for play and joy at the end of life, and gave families the memory they most cherished—the sound of their child’s laughter. But most surprising was everything I received from the children: that we are never too old to act ridiculous; that play is our birthright and a timeless source of rejuvenation; that we don’t have to be alone with our sorrow; and that joy is not the opposite of suffering but the feeling that arises when we help each other through it.

Dr. Pozzo and I waltzed around a corner near the cafeteria and were stopped by an exhausted-looking man in rumpled blue jeans and plaid shirt, in need of a shave and haircut. He smiled as if we were old friends. “Are you going to visit Intensive Care today?” he asked. When we said yes, he asked if we would look in on his son. Of course we would.

Later that day, we entered the ICU, taking care not to disrupt the solemn and silent atmosphere. I never felt prepared for this part of the hospital: the whir and buzz of bedside machines, the primacy of plastic and metal, the scent of bodily fluids overlaid with antiseptic, the red and green lights signaling a code I didn’t understand. The man we’d met that morning sat at the bedside of his eleven-year-old son, Tim, who was heavily sedated and unresponsive. I noticed his father’s hands resting on the edge of the bed. They were large and strong and rough—workman’s hands—but he motioned to us gently, fingers relaxed and curved, as if soothing the air. I saw that Tim’s right leg had been amputated at the hip, and the shock of it made me nauseous and slightly dizzy. I took my hat off, placed it over my stomach, and tried to force my face into a neutral and relaxed expression. We didn’t ask about his condition: that wasn’t our job. I looked around the room. No purse or lady’s jacket. No sign of mother. This father held his love for his son in his hands, you could see it, the way he smoothed Tim’s blanket, and cupped his palms over his shoulder and forehead. He asked if we could play some music for Tim, because he was sure his son could hear us.

We struck up “Soldier’s Joy,” an old-timey dance fiddle tune. An odd choice, someone passing by the room might have thought, for an unconscious little boy in the ICU, but the upbeat mood pleased his father. Tim didn’t respond outwardly, but his dad asked that we come back again. “And call me Mark,” he said. We were instant buddies, treated as if we had some special part to play in his son’s recovery, even if we didn’t know yet what that might be.

Tim was a boy who had, on a day like any other, climbed a tree with his friends. That day, however, he had fallen onto a sharp, broken branch that pierced his lower leg. The wound became infected with flesh-eating bacteria. Tim lost his leg and sepsis raged through his body.

He hovered between serious and critical condition, still unresponsive, but his father never faltered. Some days when we appeared in the doorway, he looked as if the tears had just dried or were about to fall, but he’d wave us in with a “Look who’s here today!” Sometimes, he played along with us, keeping the beat to our music with a little blue shaker shaped like an egg. I liked to see his large hand fold around it and feel the warmth when he gave it back to us.

One day, Mark told us the family had received a good luck symbol. A few days before, he had spotted a ladybug on the teapot in his hotel room, and later at the hospital, had noticed another ladybug on his shoulder. Tim’s aunt had also found one in her hotel room. They returned from lunch the same day to find that someone had left a stuffed ladybug on Tim’s bed. Mark welcomed their appearance as a symbol of good luck, an omen that Tim would recover. I loved ladybugs, but my first thought was the portentous rhyme from my childhood: ladybug, ladybug, fly away home. Your house is on fire, your children alone. Then I remembered something curious. “What a coincidence!” I said, “I just put some ladybug stickers in my pocket this morning!” I gave them to Mark, who wasn’t surprised at all and stuck them on top of Tim’s medicine bottles. 

Tim’s luck soon turned. He regained consciousness, but sadly, didn’t know his father, or even remember that he had once been a little boy with two legs. He had cognitive impairment and cortical blindness. He couldn’t speak. I expected to find Mark devastated, but he was bustling about the room when Pozzo and I arrived, humming while tidying up. When we knocked, he looked up, turned to his son and said, “Tim, it’s the clowns!” Tim was sitting up in bed, eyes open, but unfocused. He didn’t respond. His sandy hair had been combed to the side, his cheeks had some color and for the first time, I noticed the freckles on his nose. After our music, I thought I’d seen the corners of his mouth turn up slightly, but I wasn’t sure. Would he ever see us or know us at all?

As the days went by, Tim grew more responsive but had forgotten most of what he’d known. He struggled to relearn letters, numbers, and colors. What’s a hospital clown’s role for a child so devastated, I asked myself. It’s hard to hold hope when so much has been lost. I discovered that my job was sometimes simply to be there. My body, no matter what I felt in the moment, was to serve as a placeholder for joy.

We continued playing music, singing songs with lyrics Tim had once known. The ladybugs kept coming—ladybug cards, balloons, drawings and paintings from his classmates, stuffed animal ladybugs, even ladybug noses, which his dad made by using a black marker to put dots on the red sponge noses we gave the family. Our colleague Dr. Bonky played the ukulele and sang “Ladybug’s Picnic.” Clowns, nurses, and family members sewed ladybug buttons on their lapels.

One day, the second time through the Peekaboo Waltz, Tim turned his face toward us, opened his mouth, and made an ahh sound, followed a few seconds later by tha. He moved his lips and tongue, opened his mouth wider, and said ooh. It took nearly a minute before he could form the words he wanted us to hear, “Thank you,” in the sweetest of voices, like a little bird. That small breath was like a caress, and those two words remain one of my all-time favorite gifts.

Tim slowly regained his memory and his ability to speak and understand, but he could see only light and shadow. There was hope he could regain his sight, but he was essentially blind. This presented our biggest challenge. He did enjoy the songs we played, but he knew our entire repertoire by that time. We wanted to reach him in ways that would help his recovery and bring him more into the visual and physical world of the clown. How could we trigger his imagination and participation? 

As hospital clowns, we often reversed roles with the children. In a serious environment without many choices, our job was to empower the children by not focusing on their illness but engaging them in play, giving them control over our silly, pretend doctor characters and their ridiculous problems.

Clowning is the art of doing things wrong. Kids loved it when we ran into doors, wobbled on rubber legs, fell off chairs, put a coat on backwards or a hat on upside down. With Tim, we grappled with the existential question: If a clown tripped and fell in a hospital room and a boy couldn’t see it, would it still be funny?

Dr. Pozzo came up with an idea: Clown Sound Therapy. I would narrate a comic story, A Day in the Life of Pozzo, in which our hero would persist amid mishaps and mistakes to get dressed and out the door. We’d enhance the narration with sound effects provided by voices, rattles, slide whistles, sirens, bird calls, whoopee cushions, and bells. We laid the equipment out on Tim’s bedside table within easy reach—a smorgasbord of sound.

The story began with Pozzo in bed asleep. Tim heard Pozzo snore, snuffle, and snort. Mark rang the bell to wake Pozzo. He stirred, mumbled, mimed shutting off an alarm clock, and went back to sleep. This happened three or four times, until Pozzo got so flustered he fell out of bed with a big thump. We heard Tim laugh for the first time, just a slight chuckle, but an unmistakably sweet sound of hope. I sent Pozzo to the shower; Tim made the sound of the spray, first a trickle, then a big blast. I ran to the sink for a cup of water and sprinkled it on Mark and Tim. Pozzo screamed, “too hot,” and jumped out of the shower.

 “Oh, no, he’s slipping,” I said, and blew a slide whistle as Pozzo fell on cue. Tim laughed then, full out, like a normal and healthy eleven-year-old boy. I put my poor partner through a few more of these slips to ramp up the laughs and enforce the fact that clowns don’t give up but persist in the face of failure. Pozzo finally got up, dressed, opened and shut the door, and I sent him on his way down the street. I blew the bird whistle and commented on the lovely day. Tim made a big whoopee-cushion wind blow Pozzo off course and smash into the wall. Tim’s laughter was infectious, and we laughed until I felt like all that ailed me, too, would be well.

Then it came time for Tim to learn to walk with his new prosthetic leg, made even more difficult and scary because he still could not see. He began with a walker, steady and slow, and we cheered him on. “I think you’re doing better than Pozzo could do!” his dad said. Tim laughed and seemed animated by a spurt of energy, a little clown push from behind. 

 After months of rehabilitation in the hospital, Tim was well enough to be discharged, though he was still unable to see and had many months of outpatient rehab ahead of him. Parting was the hard part—our clown doctor program didn’t include house calls. He continued his recovery supported by family, a large community of neighbors and friends, and a colony of red and black beneficial garden insects.

About six months later, we saw Tim and his dad walk in the door, back for an outpatient follow-up. He sauntered over to us with his new leg, looked us up and down, and said, “So that’s what you guys look like!” 

I gasped and threw my hands in the air. “You can see!”

“And that’s not all—I’m playing soccer!” 

“What? Let’s see, show us a few moves.”

We started an impromptu game in the middle of the lobby. Tim dribbled an imaginary ball, Pozzo moved in on defense, Tim passed to his dad, got past Pozzo, Mark passed it back, and Tim drove the ball into the net. Game over. We laughed, high-fived, and hugged.

Mark put his arm around Tim’s shoulder and said, “There is one way my son is even more developed than before the accident.”

“Whoa, what’s that?” I asked.

“His sense of humor.”

Pozzo pumped his fist. “Yes!”

“So! Number one,” I said, “you can see. Number two, you’re playing soccer. Number three, now you’re funnier than we are! Three goals! Wait a minute. In soccer that’s called a hat trick!” 

I lifted my hat, twirled it around three times, and tried to put it back on my head, but as soon as it touched down, it popped straight up in the air, as if spring-loaded. I kept doing that—the work of my hands—and failed to get the hat back on but tried again and again, like a kid recovering from a long illness, or a boy learning to walk on a brand-new leg, or a father clinging to hope—all of us sustained by the laughter that held us. 

About the author:

Victoria Millard lives in Seattle, where she writes memoir, essays, and humor. Her work has been nominated twice for Best of Net and has appeared in Narratively, Halfway Down the Stairs, 3elements Review, Persimmon Tree, and Intima: A Journal of Narrative Medicine, among others. She received her MFA in Nonfiction from Pacific University and is seeking representation for her memoir "Heart of a Clown: How the Art of Laughter Helped Me Heal from Trauma and Despair."  You can read more of her work here.