The white coat symbolizes the physician’s twin covenants with compassion and science. At the UI Carver College of Medicine, as at most other U.S. medical schools, students receive their first white coat in a ceremony that conveys to them their role in carrying on what the Arnold P. Gold Foundation calls the “noble tradition of doctoring.”

 

Adam Case, a student in the UI’s Medical Scientist Training Program, got his white coat four years ago, but it’s not white anymore. First he had it embroidered not with his name, as do most students and physicians, but with the motto, “I LIKE YOU.” Then he let a group of kids in a pediatric cancer clinic tie-dye it.

 

“I told them to dye it in a way that they would love to see a doctor,” Case said.

 

That playful gesture was typical of Case’s approach to his many volunteer activities, which include volunteering at the UI Children’s Hospital, Iowa City’s Free Medical Clinic and an after-school program for disadvantaged children at an Iowa City elementary school. He said he likes to clown around and make people laugh.

 

“People would say I have a different style,” Case said, “dressing in costume, spending extra time with patients, becoming close and building attachments with patients. I try to brighten people’s lives with laughter.”

 

Friends and acquaintances began to liken Case to Patch Adams, the doctor made famous by a 1998 movie based loosely on his life. “I would thank them, but I really didn’t know who Patch Adams was,” Case recalled. When he did learn more about Adams—seeing the movie, visiting his Web site—he said he found a philosophy that “paralleled how I do things and how I go about my life.”

 

So two years ago Case wrote to Adams, “not as a piece of fan mail but as a colleague would write to another colleague.” To his surprise, he received a personal reply within a couple of weeks and has been corresponding and occasionally talking with Adams ever since.

 

In November, Case met the famed iconoclast for the first time as a member of Adams’ humanitarian clowning mission to Russia. Case flew to Dulles International Airport to join up with the group, and while waiting put on some clowning garb and began to joke with people in the terminal. Then he noticed a commotion coming from afar. “It was him doing his thing at the other end of the airport,” Case said. “At that point I felt like we were meant to be friends.”

 

The Russia trip was a three-week, 14-hours-a-day tour of children’s hospitals, tuberculosis, HIV and psychiatric units and prisons in Moscow and St. Petersburg. “From the moment we woke up to the moment we went to bed, we were in costume,” Case said. “Never did we stop clowning in Russia.”

 

Some of the group’s 30 members from around the world had distinct clowning styles, others were quieter, choosing to simply play music or hold hands with patients. “The beauty of Patch Adams’ clowning philosophy is, it’s very simple,” Case said. “A clown can do whatever he wants and never fail, as long as he tries.

 

“His idea of a clown is basically somebody who’s different, who doesn’t practice social norms.”

 

The clowning can sometimes obscure Adams’ serious—indeed subversive—purpose, which is to transform heath care from a corporate to a truly humanitarian enterprise. Adams often meets with political leaders and policy makers in the countries he visits, Case said.

 

“It’s quite a sight to see him in a roomful of politicians, diplomats and reporters, and him with his blue hair, red nose, and crazy duck hat. In reality, he is the world’s leader in what he does.”

 

Case was instrumental in bringing Adams to the UI April 10 to tell students and others about his work and views on the health care system. Entertaining and occasionally bombastic, Adams blasted what he calls “corporate medicine” and its allies in the insurance and pharmaceutical industries. The present system, Adams believes, favors greed, leaves virtually no room for love or compassion and injures the humanity of patients and doctors alike.

 

“A lot of people were very captivated,” Case said. “I know we had undergrads, students from all the professional schools, staff members. The response was very positive. When people actually heard him, they were intrigued and saw that he has a mission beyond the hair and costume.”

 

Case shares some but not all of Adams’ frustrations. Too often, he thinks, professional training is about “how many boundaries can we have, how much distance can we keep with patients.” And he chafes at some of the rules he’s brushed up against. On the other hand, he said, “I truly believe in the science of medicine,” and he sees at least the possibility of change from within.

 

“My goal is to make a small impact on health care, to see if we can start to change the system bit by bit,” Case said. He thinks perhaps little things like spending extra time with patients could be the kind of “subtle changes that could make an impact on an institution and on other doctors.”

 

With all that still in the distance—he recently passed his comps and now looks forward to completing his dissertation, finishing medical school and doing residency training—Case knows only a couple of things for sure about his future career: He will work with children, and he’d like to practice some type of free medicine.

 

And who knows—his friend Patch Adams has given him a standing offer to work at the Gesundheit! Institute, where his tie-dyed white coat would fit right in.

 

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