From the moment she first leapt off a flying trapeze platform as an 8-year-old, Jacqueline Nager loved circus arts. Pretty soon, she was spending her summers at Circus Arts Camp, eventually becoming a counselor. “I had the best time there,” says Nager.
While researching for a journalism class assignment as an undergrad at Swarthmore College, Nager stumbled across the Circus Arts Institute in Atlanta, where founder Carrie Heller had merged clinical social work with her professional trapeze career. Intrigued, Nager secured a Swarthmore Foundation Grant from her school to attend Heller’s Circus Arts Therapy training. There, Nager learned about the psychological, developmental, and physical benefits of circus arts, as they encourage crossing the body’s midline improving overall physical dexterity, help develop mental focus and trust, and improve self-esteem.
Nager’s experience inspired her to create a Circus Arts and Dance special major and start a campus circus club, Swat Circus, when she returned to Swarthmore. She began to identify as a “circademic” and met occupational therapists, psychologists, and doctors who were finding new clinical applications for circus arts, further validating that circus arts have real potential to help people be happy and healthy.
Still, when she enrolled at University of Southern California’s Keck School of Medicine, the odds that she’d fall in with a troupe of circademics and integrate circus arts into her studies were about as long as a floppy clown shoe.
That is, until she joined MedMeals, a program in which Keck med students are randomly assigned to attend a group dinner at a professor’s house as a way to connect with their classmates. As Nager shared her “fun fact” about herself at the dinner table, her host Dr. Lawrence Opas, the chief of pediatrics at LAC+USC Medical Center, interjected, “Circus arts? I just signed off on a Medical Clowning Program!”
After Nager told Opas more about her circus arts studies, he invited her to join the medical clowning program committee.
Now, as a Los Angeles Schweitzer Fellow, Nager is addressing the intrinsic social issues of being hospitalized—fear, anxiety, and isolation, for example—through medical clowning, which deploys play, humor, music, and circus arts. She is also training fellow Keck med students in medical clowning as a means to improve their physician-patient interaction skills and to build trust between healthcare professionals and medical clowns, establishing the program as a permanent offering at LAC+USC.
“I’m thrilled to have this opportunity to be so involved in establishing Medical Clowning at LAC+USC, finding a way to give back to the patients who are providing me with my education, and sharing my love of circus arts with my fellow classmates,” said Nager. “It is all being made possible by the support, format, and networking of an Albert Schweitzer Fellowship.”
Her goal is for patients to enjoy visits from medical clowns and benefit from strategic play, and for students to hone skills they can apply in their own medical practice: reading a room, quick improvisation, active listening, and empathy.
Nager says the success and sustainability of the medical clowning programs depends on how well it is integrated with the care team. Doctors must trust the clowns and vice versa.
“One of the best ways to ensure a well-grounded and sustainable program is to have medical professionals experience the practice for themselves,” she said.
With interest from the USC drama school and LAC+USC Pediatrics in the program, Nager said it’s time for the medical clowns to start seeing patients and building trust with hospital staff.
“We’ll be present and active so we become more familiar and learn how we can best fit into the rhythm of LAC+USC,” she said.
Nager will rely on surveys and other feedback to fine-tune and further root the program at the hospital. Her ultimate goal is to establish medical clowning as a permanent offering and asset to LAC+USC, which would attract more professional medical clowns to the facility and foster a productive relationship between the medical clowns and established healthcare teams.
In the meantime, Nager is happily using medical clowning techniques, although without costumes or other clownish accoutrements, in her clinical rotations, which has made her even more confident that her classmates will also see benefits in using them. “There is definite overlap in clowning and care,” Nager said.
For example, while seeing patients during her family medicine rotation at an urgent care center in Glendale, Nager encountered a 4-year-old who tearfully clung to her mother as soon as Nager entered the room. She had cut her foot and was fearful of Nager touching it.
“Oh, you seem upset and we haven’t even started talking yet!” Nager said. “What’s wrong?”
Nager said she wanted to take a look and the child cried even louder, wiggling away from her.
Grabbing a box of latex gloves Nager asked her patient, “What are these for?” The girl looked but didn’t reply. Nager handed her a glove and took two for herself.
“I think these are so I don’t have to touch your stinky feet!” she said, finally eliciting a smile and a laugh from the girl—and her mother. The tension in the room lightened, enabling Nager to treat the foot wound. Nager punctuated the exam with plenty of “pee-ooo’s” and smelly-feet face scrunching, while the patient alternately giggled and cried.
“I could tell she was conflicted between being in honest discomfort and enjoying playing along with me,” said Nager. But although I couldn’t alleviate all of her nervousness and pain, I was able to help her overcome most of the anxiety that came from not knowing what was going to happen and interacting with a stranger in a white coat.”
When Nager’s preceptor joined the exam later, the 4-year-old became anxious all over again and looked at Nager for help.
“You need to talk to her like she did,” the child’s mother told the preceptor, pointing to Nager. “She’s her friend now.”