These doctors are real clowns

The energy level in the surgery admitting area of Children's Hospital Boston is low. Tense parents are whispering to their children; young siblings wander about aimlessly.

A man in a white lab coat strides into the room and makes an announcement.

''Excuse me, did somebody lose their underwear?"

The man -- who wears goofy oversized shoes, a red nose, and a device around his neck that appears to be a hybrid between a stethoscope and a toilet plunger -- holds up a pair of black boxer shorts large enough to allow three or four children to fit their entire bodies inside. Before long, laughing children and smiling parents are playing peek-a-boo with doctors Gonzo and Gracie.

The Clown Care Unit has arrived. Later, when his nose is off, Dr. Gonzo -- who is Robb Preskins, a veteran clown and supervisor of the hospital's ''CCU," as it's called -- gets serious.

''We're there to help give the kids and their families a chance to feel completely normal for a moment," says Preskins. ''Goofing off is a kid's natural state of being."

Just as often, says Preskins, a child will retreat from the clowning and remain a distant spectator.

''Parents routinely say to us: 'My kid was silent when you came around, but the next day couldn't stop talking about the clowns.' Our job in an area like admitting is to play to the kids who want to be played to and to remain very aware of the kids who want to watch from afar."

Founded in 1986 in New York City, the Clown Care Unit, a division of the nonprofit Big Apple Circus, came to Children's Hospital nearly 10 years ago as the program's first pilot project outside of New York. (The Boston CCU's anniversary is in November). It was an almost immediate success and soon became a five-day-a-week program.

The $200,000 annual cost is split by the Big Apple Circus and the Children's Hospital League, a 500-member auxillary that raises hospital donations. The program has since expanded to other cities, including Washington, D.C., Atlanta, Miami, Chicago, and Seattle.

The clowns' professionalism and sensitivity has commanded the respect of the hospital staff and, according to many at Children's, made the CCU an indispensable part of the hospital's mission. Dr. George Taylor, chairman of radiology, is an admirer of the clowns' work.

''They are brilliant performers," says Taylor, ''but to be successful in a setting like Children's, you need to have situational awareness. The clowns have a remarkable ability to walk into a room and 'get' the situation immediately -- who is scared, who is engaged, who needs space. They are an integral part of the staff here."

Working as part of the Child Life division at Children's, eight clowns -- all professional performers who receive hospital training when joining the CCU -- partner up for daylong shifts.

Partnering, says Preskins, is essential to the tough job of hospital clowning. ''Your partner helps you keep on eye on the situation in a variety of different ways. She also knows you well and knows that after a tough situation, even when you say, 'I'm fine,' that you're often really not fine and that you need to take a break to collect yourself."

The clowns also have regular meetings that sometimes include the presence of an ''emotional hygienist," a psychologist hired specifically for the clowns.

During their rounds, the clowns must be prepared for any situation. Some patients are teens or preteens, a notoriously tough crowd. Preskins, whose skills were honed during street performances in front of Faneuil Hall, is as comfortable performing for a skeptical 14-year-old as a shy 4-year-old.

He recalls an encounter with a young woman who had to miss her prom while in the hospital. ''She was in no mood for clowning," remembers Preskins. ''So we went in there and just dropped character completely and spent some real time with her." Eventually Preskins was able to engage the patient by making sarcastic remarks about people walking by outside the room.

The clowns of the CCU view their mission broadly, to include not only the patients but anyone in the hospital who might be feeling stressed, including parents, siblings, and the hospital staff.

At other times, a parent might be enlisted as the butt of the silliness -- which often includes satirical medical procedures such as ''chocolate-milk transfusions.''

''Seeing us give his parents the business is good for a child in the hospital," says Preskins. ''It gives him a break from being the center of attention."

Dr. Gracie, whose real name is Nancy C. Quintin, has already seen much in her 11 months working on the CCU. She remembers a father who came to the clowns asking for help with his daughter. Nurses, who were having difficulty encouraging the reluctant child to walk, turned to the clowns.

''We pulled out every bell and whistle that we could find," recalls Quintin. ''Finally we pulled out the guitar and said, 'Hey! we're having a parade today . . . Yay! We're having a parade!' "

With her father's help, the child was motivated to walk down the hall and back.

Afterward, the father came up to the clowns with tears in his eyes to say thank you. This is what the clowns call a ''ricochet" -- when a joke that provokes laughter in a child, in turn, brings tears to the parent.

''Me and my partner just looked at each other and sighed," says Quintin. ''There really wasn't anything to say."