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Volunteer Visitors with Red Noses: An Interview with DR CurlyBubbe

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“DR CurlyBubbe” and I met a year ago in the parking garage at the Hospital of the University of Pennsylvania (HUP) as I arrived for one of my weekly chemotherapy visits. She was hard to miss, what with her bright yellow knee socks, hat with a red rose, and doctor’s coat covered with smiley faces and various badges. As I took in her whole outfit, including a badge saying, “Eat a prune – start a movement,” I realized I was watching a volunteer “clown doctor” report for duty at the hospital! Naturally we started talking.

DR CurlyBubbe, a/k/a Esther Gushner, is a founding member and currently president of the board of Bumper “T” Caring Clowns. The day we met she was on her way to Radiation Oncology but had some fun with me first.  She put a red-nose smiley face sticker on me (see selfie to the left), which I wore all day. She also gave me tea bags to use as earrings because, according to Eleanor Roosevelt, “You never know the strength of a woman until she gets into hot water.” And she told me that she was a doctor specializing in Smileology. In fact, she said, she was “Director of the Department of Medical Humor because at HUP,  well, let’s just say, they only talk to specialists.” (I told several of my nurses that comment during the day and everyone laughed.)

We exchanged business cards and I told her that I wanted to write an article for e-Volunteerism about her work. It took a year, but I finally sat down to interview her and three hours zipped by with all sorts of fascinating insights. Gushner is a bubbly, petite woman in her late 70s who is, in her own words, “passionate about hospital caring clown volunteering” that she has now done for almost 18 years.

While we’ve all heard of volunteers dressed as clowns visiting hospitalized children, Bumper “T” Caring Clowns has evolved to serve those affected by illness throughout the lifespan, including not only patients, but also their families, friends, and even the hospital staff. Gushner also draws an important distinction between the traditional image of a circus clown and a birthday party clown and what her corps of Hospital Caring Clowns do:

Dressed in scrubs and lab coats with gentle make-up, we wear our hearts and our smiles openly and gently focus our attention on the human spirit. While patients may not be willing to share their stories and concerns with a total stranger, they are often willing to open up to a “visitor”with a red nose and gentle humor. Humor and compassionate care like this are important elements in the recovery and healing process.

Gushner actually doesn’t like the word “clown” very much because of their stereotyped image. She prefers “hospital visitors with red noses.”

The History of Bumper “T” Caring Clowns

As so often happens with volunteer initiatives, the organization started with a personal connection to a need.  In the 1990s at Cooper University Hospital in Camden, NJ, George Edwards gained first-hand understanding of the patient experience when his father was hospitalized with a heart attack. As a clown who performed at children’s parties and the like, he decided to visit his dad dressed in his clown outfit. The nurses were so impressed with the positive effect his humor and magic had on the patients that they escorted him throughout the hospital to spread the joy. On that special day, DR Bumper “T” Clown had significantly changed the environment of the hospital.

Before too long, DR Bumper "T" tapped two other clowns, DR Bucket and Silly Reba, to join him at Cooper. Aviva Gorstein, a/k/a DR HuggaBubbe, a former Director of Volunteers at Vanderbilt University Hospital, was next to join, and last but not least, Esther Gushner, DR CurlyBubbe joined their ranks.  These five founders shortly realized that Hospital Caring Clowns was serious business and they were not simply a diversion. They had become a valuable force at Cooper, promoting healing in mind, body, and spirit. 

[In case readers are wondering, I asked why all the names were written as “DR” and learned that this was purposeful. By capitalizing both letters and not using a period, the faux clowns do not misrepresent themselves to the public as true medical professionals.]

In a 2016 article in the Chestnut Hill Local, reporter Rita Charleston described what happened next:

As a volunteer for Caring Clowns in hospitals throughout the area, George  Edwards, who became known as DR Bumper “T” Clown, “Funnyboneologist,” visited many lonely and often frightened patients, helping them understand they were more than their disease. But his fondest dream was to establish an organization that would train other caring clowns to serve hospitalized patients, their families and caregivers.

Gushner knew she wanted to commit to this work and, in 2001, with the help of several others like her, Edwards achieved his dream with the creation of the Bumper “T” Caring Clowns. Gushner comments that, despite its success over the last 16 years, the group “is always a work in progress.”

In the early days, new Caring Clowns were brought in one by one with personal but informal attention. Gushner herself trained by shadowing DR Bumper “T” for three months – in her street clothes – while he made the rounds at Cooper. While she adored her role model (“he began as a volunteer clown, then became a fixture, and ended up a legend”), it soon became clear that more formal training would be needed for future volunteers if the program was going to grow in quality as well as in size. 

In 2000, Gushner attended a clown training program offered by a local organization. She didn’t like it. It was “too clown-y” and focused only on antics to entertain children, “but that’s not what we do.” Together, DR CurlyBubbe and DR Huggabubbe proposed that Caring Clowns develop their own curriculum specifically for the hospital environment. Edwards agreed. They made plans for the first class, and recruited new volunteers by putting posters around Cooper elevators. Four or five people registered, but as fate would have it, the class was scheduled for September 11, 2001! Edwards felt obligated to run the class anyway and trained several new volunteers then and at a make-up session. This was the prelude for things to come.

DR Bumper “T” was convinced that the clown program would be born and would die at Cooper. But the “Bubbe Brigade” had other plans. DR CurlyBubbe and DR HuggaBubbe lived across the Delaware River in suburban Philadelphia.  Their passion for the project led them to speak with Laurie Watson, Director of Volunteers at Lankenau Hospital in Wynnewood, PA.  They proposed bringing the clown program to this suburban facility. Watson, herself an RN, recognized the value of humor in a hospital setting and invited the clown docs to participate in a trial run – which quickly transitioned into a permanent volunteer endeavor. The rest is history.

The first clown classes at Lankenau took place in March 2002. All told, 24 graduates from that class were dispersed to hospitals throughout the Main Line Health System and reached across yet another river to Abington Hospital (Abington), St. Mary’s Hospital (Langhorne) and Jeannes Hospital (Northeast Philadelphia). The healing power of humor became contagious as the organization spread its wings. Gushner and Gorstein attribute the success of this launch to the support of Laurie Watson, their biggest advocate and mentor still today. The DR Bubbes refer to her as “our Fairy Godmother.”

The group incorporated as a 501(c)(3) nonprofit organization in early 2003. They have never had a physical office nor paid staff, although they do pay a consultant to coordinate scheduling and classes, maintain their supplies, and answer phone and e-mail messages. They seek small grants and individual donations  to meet their budgeted expenses.

To demonstrate the seriousness of the service commitment, they also charge volunteers $110 for their clown training,  which covers the cost of the course and the bag of “supplies” each receives (a red nose, badges, stickers, make up, and more). The “faux clowns” also have to buy a white lab coat, scrubs, and a funny hat – the required foundation for their costume.  

Today, approximately 120 trained Caring Clowns (men and women, usually 55+ in age) work in 27 hospitals in six states. Watch the great YouTube video about their service experiences.

Connecting with the Volunteer Services Department in Each Hospital

Before Gushner even put on her red nose, she had served for many years as the chair of the docents at the Pennsylvania Museum (clearly a leader of volunteers already). And Aviva Gorstien, one of the other founders of Caring Clowns, was herself a Director of Volunteer Services (DVS) at Vanderbuilt University Hospital in Tennessee.

Given the readership of our journal, I asked Gushner about how Caring Clowns mesh with the regular volunteer services in each hospital. She gave a smart response: everything is run through that department. This strengthens all parties by assuring that volunteers are properly screened and vetted, and in compliance with whatever requirements each hospital places on all volunteers. In turn, it provides liability coverage to protect the volunteers.

For each of the current 27 hospitals – and any new ones to come – a Caring Clown board member opens a collaboration through meetings to discuss the clowning concept, learn of the hospital’s interests, and establish a formal arrangement. The hospitals have final say over where the clowns may visit and other policy matters.

Bumper “T” Caring Clowns now recruits new volunteers and puts each applicant through a stringent interview process with one of the trainers. They determine if the applicant seems qualified in temperament and enthusiasm and find out in what hospital the person wishes to serve. The person is then referred to that hospital and goes through whatever the normal volunteer application process is for that facility. They must be “accepted” by the hospital, which does the necessary legal background screening and health checks, offers orientation and training to that setting, and considers the volunteer a part of their corps. However, it is agreed that the volunteer will officially serve in the role of a Caring Clown.

It should be noted that not every hospital welcomes the organization with open arms. Some have their own visiting clowns or do not think the service would work with adult patients. Sometimes the politics of a community intervenes. That’s all right – there are plenty of facilities to choose from. But Bumper “T” Caring Clowns specializes in hospitals only, not nursing homes or other care facilities.

What Makes Caring Clown Visits Special

Gushner likes to relate the story of Gorstein's “interview” before going to Cooper over a decade ago. Gorstein had been referred by a friend, and the volunteer whom she contacted at Cooper told her what the work would be. The interviewer asked: “Can you tell jokes?” Gushner answered, “No, not really.”

“Can you do magic tricks?” Answer: “No.”

“Can you generally clown around?” Answer: “No.”

“Well, you sound perfect!”

That exchange taught Gorstein that Bumper “T” Caring Clowns had a different mission than their clown “cousins.”  In many ways, that’s the basis of the training new volunteers receive: not how to clown but how to brighten the day of someone with whom they visit. The training stresses:

  • “Your red nose is the passport to people’s hearts.”
  • “You are ‘make-believe doctors’ determined to change the atmosphere of the hospital.”
  • “We can’t change someone’s diagnosis, but we can lighten their day.”
  • “The most precious gift one person can give another is attention” (Rachel Naomi Remen).

While “on duty,” most of the clowns are free to roam the areas of the hospital where they are permitted, stopping to talk with anyone. Of course they visit with patients, but may also spend time with patient families and visitors, especially in waiting rooms where tension can be high and sitting time long. And they can visit with staff, too. Gushner has discovered that employees in the medical records department or food preparation center rarely see anyone from the outside. They love the recognition of a visitor. She notes, “Remember that our purpose is to brighten the atmosphere of the hospital, so when we make a staff member smile, it ultimately affects patients, too.”

Volunteers are advised that “less is more” when creating their costumes, especially in terms of patient infection control. For example, they do not wear wigs because those can carry germs. Trainers oversee the make-up and costume accessories of the new clowns-in-training. Every volunteer must sign an agreement to be in compliance with the policies and procedures of the organization.

Regular clowns can sometimes be intrusive, popping up “in your face” without normal conversational boundaries. Again, that’s not the point here. Each person is approached gently and asked if they would like to have a visit. It takes empathy and good communication skills to understand how to initiate such interaction – and when to leave. Gushner always aims for a smile, though. If she gets an outright “no” from a patient, she may respond, “That’s fine: I just empowered you! I’m probably the only person around here to whom you CAN say NO!” That repartee inevitably brightens the mood.  

Visits are of any length, as needed by the patient, visitor, or staff member. It may be a quick hello or a much longer sit-down conversation at a bedside. Because of this most of the volunteers spend several hours at the hospital on the days that they visit, moving from area to area wherever they sense the need. Gushner notes, “We’re for quality, not quantity.”  As she told the Chestnut Hill Local:

 “We have a dress code for each clown, so they don’t look ridiculous. And because we’re supposed to look like part of the wellness team, we wear our lab coats. We don’t want to be seen simply as clowns. We’d rather be seen as visitors with red noses because, in reality, we are here to help people get well. We do believe that laughter is the best medicine.”

And, in many cases, it has proven to be just that. “Nobody expects to see a clown come into their room — and we do so only with their permission. But once in, in many cases you can hear the bouts of laughter throughout the halls. I carry a big bag of smiling face stickers that I pass out, and if they want a red nose, they get that too.”

The organization’s Web site further explains:

From the moment we enter a hospital, the Caring Clowns are a positive, healing force. We are masters in the art of “reading” a room, listening, and using gentle humor to make true connections with the people who need them. 

We are always professional and respectful, and are trained to be “in the moment” when it comes to the needs of the patient. We may be spontaneous and playful, or may offer a willing ear and a shoulder to cry on. The result is that we help to nurture patients’ spirits, ease some of the stress they feel, and play a role unlike any other in the hospital. This is why we are recognized as valuable members of the hospital wellness team.

Looking Ahead

Gushner and I talked about what the future may hold for Caring Clowns. First, Gushner has been president of the group since 2011 and will soon be turning 80. “So we have to do succession planning and I’ve told the board I want to stop being president by the end of this year, if possible. Of, course, I will keep visiting patients on a regular basis and go out and spread my passion for this magical mission, whenever and wherever needed.”

There is no question that Bumper “T” Caring Clowns are a great success and have the potential to grow in numbers and in facilities visited. But this has to be well coordinated and will require volunteers willing to handle administrative duties as well as clowning. They also want more diversity in their ranks and are planning initiatives to invite younger people and people of color to join. They want to update their Web site and incorporate more technology tools.

The training curriculum that Gushner and Gorstein developed continues to evolve and is an important “product” that others could use. They are exploring ways to publish the material and sell it to any interested group or institution. Gushner would love to help more hospitals learn the Caring Clowns technique and implement it themselves. “We don’t need to have every visiting clown under our umbrella – and we want to make sure that those who are officially representing us are of the highest quality.”


What an adorable story. Emailed it to my older sister. She has the perfect bubbly personality and can see her and a couple of friends doing something similar.

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