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February 4, 1998

When Healing Is More Than Simply Clowning Around

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JAMA. 1998;279(5):401. doi:10.1001/jama.279.5.401-JMS0204-4-1

I remember the first time I used the pouch, on a trip to Russia in November 1996. We were working in an orthopedic hospital for children who have tuberculosis of the bone. I have been a family doctor since I graduated from the Medical College of Virginia in 1971, but I visit these patients as a clown. For 9 years I have taken 30 would-be clowns to Russia for 2 weeks during which we practice the art of clowning all day long in hospitals and orphanages.

Dr Patch Adams with a young Russian patient. (Photograph by Benjamin Stechschulte.)

Dr Patch Adams with a young Russian patient. (Photograph by Benjamin Stechschulte.)

The pouch is a potent medical tool to relieve pain. Before its creation, we often would be in hospitals that could not afford treatments readily available in the United States. I found myself wanting to add something to my work that would be good medicine yet not detract from my clowning. I thought of myself as a clown-shaman. Since a symbol for a clown is the nose, I thought I could also use aromatherapy, an ancient healing technique. I had my costume designer create a rectangular flat pouch that resembles a fanny pack but holds aromas and other surprises.

Wearing the pouch I soon met an 11-year-old girl who had been hospitalized for 3 years, all of them spent on her stomach. She was beautiful, having lost none of her sparkle. She was quickly enchanted by my clown character, a simple, sweet, and slow fool whose presence creates a magical atmosphere.

The pouch has many distractions. Soft bells and beads dangle on the outside. The surface is richly colored and textured so that a blind person can experience it. On either side of the pouch are 2 pockets. From one pocket I plucked a mirror, showing the girl I can put her in the mirror so that I can keep her memory. And I propped up the mirror so that I could see her twice in any moment.

The other pocket has a red satin pouch containing various minerals. Gems have been used for healing since Egyptian times. Different gems are supposed to have different healing qualities. I took one up and, with hands spread, I passed the gem over the girl's entire body. There is no hurry.

From one pocket I pulled a magnifying glass. I examined her all over slowly, then turned to her stuffed animal. I constantly monitored her absorption by observing her face and body language. I could see she was delighted, intensely focused, and pain-free. By looking at her tenderly in the eye and focusing my attention on her, I implied that she was the center of the universe.

Each of the 10 vials of aroma at the center of the pouch are individually wrapped with different fabric and tied with a colored ribbon. We selected an aroma, untied its bow, slowly unwrapped the vial, and presented it to everyone attending, including the girl's mother. To observe this procedure is to learn the art of distraction. In nonpharmaceutical pain relief, distraction is a potent tool. Every gesture and prop becomes part of the melange of magic that drew her attention away from suffering.

In hope of prolonging the relief, I left objects that will evoke special memories. From behind the pouch I pulled out a cartridge belt lined with quilted pillows, each one unique and the size of a postage stamp. The girl selected a pillow which I christened with a few drops of the scent explored earlier. She kept the pillow and a photograph of the moment. I hope the magic of the visit will linger indefinitely.

I am just beginning to understand the value of the aromatherapy pouch and have used it on nearly 50 occasions with people of all ages. Suffering seems to diminish during those moments. It is a tool of what I call the medicine of inefficiency.

Modern medical practice often sacrifices contact with the patient in the name of efficiency. This loss of intimacy hurts both doctor and patient. So much of the great magic and therapeutic power of the doctor-patient relationship occurs because we spend time getting to know each other.

Even in the sophisticated hospitals of this nation, patients suffer from afflictions that cannot be relieved by technology or pharmacology. For those patients, compassion and creativity in any form should be called into play.