Cancer patient John Lukow perked up when the giant caterpillar and the flower lady entered his hospital room.
"Hello! I'm Katy the Caterpillar," Mary Beth Creighton said, adjusting her bright-green costume.
"Yeah, and I'm Frankenstein," Lukow responded, chuckling.
Creighton laughed and gestured toward her partner, Meg Schnitzlein.
"And she's Daffy," Creighton said of Schnitzlein, decked out in a white dress with big yellow polka dots, striped pantaloons, a straw hat with yellow flowers and pink shoes.
"Ain't we all," quipped Lukow, 71, who was being treated for two brain tumors.
Creighton pulled out a cloth bag and told Lukow to place a piece of paper inside of the bag, say "Abracadabra," and reach in and retrieve the paper.
But when Lukow pulled out the paper, it was a dollar bill.
"I don't believe it," the Fallston resident said, feigning disbelief. "Do it again."
"OK, but I can't turn it into a $100," Creighton said.
The banter was part of an act the two women created for Healing Clowns, a program at Upper Chesapeake Medical Center in Bel Air through which volunteers and staff members train to be therapeutic clowns who visit patients.
"Being a therapeutic clown is different than being an entertainment clown," said Creighton, the hospital's director of rehabilitative services. "We use a low-key approach. And a lot of kids are too young to get our jokes, but the adults play right along. We're just silly."
The clowns are part of Healing Arts, a program that started at Upper Chesapeake in 2000 with an art supply cart and a program in which community members make cards for patients. Later, music therapy and Pets on Wheels, a program that arranges visits by dogs to patients, were added.
Hospital clown programs have been around since the mid-1980s, when what is believed to be the first program in the United States began in a New York City hospital. Since then programs have been popping up all over the world, said Arne Swensen, who established a program for the hospital system in Scottsdale, Ariz., about a decade ago.
"There has been a growth in hospital clowns ... because of the acceptance of hospitals of clowning as a recognized therapy," said Swensen who traveled with Patch Adams, a doctor credited with starting hospital clowning in Virginia in the early 1970s. His story was portrayed in a 1998 movie starring Robin Williams.
Although program requirements differ, volunteers should have a sense of humor, and be compassionate, creative and flexible, Creighton said. They should also attend a clown college where they learn to apply makeup, dress and act like a clown, as well as learn how to deal with patients appropriately.
On a recent evening, Schnitzlein was putting on her clown face to make rounds in the hospital.
"The trend for applying white makeup is to use the smallest amount possible," said Schnitzlein, a registered nurse at the hospital. "It used to be that clowns caked the white on, but the clown face is less intimidating if the white makeup is applied lightly."
However, even when the makeup is just right, some people are still afraid, Creighton said.
"I don't know if it's Stephen King or what that makes people afraid of clowns, but some people are very scared," said Creighton, the Healing Arts coordinator for the hospital. "So we have to be intuitive and read the patient's expressions."
One way of dealing with clown phobia is to develop a persona that is more friendly than slapstick, Creighton said. Learning to create a face evolves over time through trial and error, she said.
When she started as a clown, Creighton used a foam nose. But when the nose repeatedly fell off, she painted her nose, she said.
Her costume also has changed, she said. Creighton wears a shoulder-length green wig, a black T-shirt, stretch pants, pink-and-black socks and pink tennis shoes.
She tops it off by slipping into a child's fabric-and-coil play tunnel decorated with big purple and green spots that is supported by shoulder straps.
Schnitzlein's character is Daffy Dill, named for her love of daffodils and the color yellow. In addition to her garb, she stamps hearts on her face with red lipstick.
Hospital clowns use typical clown devices; costume and makeup, juggling, magic, singing, joke telling and bizarre behavior. But they have to customize their visits to fit the individual situation, Swensen said.
While most of their time is spent with patients, the clowns also entertain staff and visitors, Creighton said, while Daffy blew bubbles in the hospital hallway for Anna Kisel, 2, of Bel Air, who was visiting a patient with her mother.
"When there aren't a lot of patients, we grab doctors, nurses and team members for a snippet of time and entertain them," Creighton said. "And most of the time, we don't reveal ourselves out of our personas."
Clowns are smile specialists, said Martha Knutson, also known as Peaches the clown. This month, she visited patients while wearing a black T-shirt and an orange turban with a large yellow silk flower attached. But she changes her costume frequently, she said.
"Once you become a clown, you never shop the same again," said Knutson, who is legal counsel for the hospital. "Every time I go to the store I find something that I can use for my costume. So it constantly changes."
Knutson carries a bag of tricks that contain such items as "gallstones" (marbles), a rubber hose and a "stool sample" (a small bar stool in a plastic container). She tests the sense of humor of the patient before she decides what to use. She has learned to be flexible.
Although some patients make them work hard for a smile, Lukow was thrilled with his visit from Katy and Daffy Dill, he said.
"My wife is never going to believe this," he said as the clowns left his room. "They were just great. Anytime someone does something that brings a smile to your face in the hospital, it helps you think more positive. Maybe laughter really is the best medicine."