References to the Clowndoctor charity that Sarah and Rueben form together are prevalent throughout Ghosted. Clowndoctors are a symbol of hope in dark circumstances. The connotation of clowns as trite entertainers is dispelled by this symbolism, primarily through Rueben’s descriptions of his training. Walsh presents imagery contrary to the stereotype of a clown when Sarah meets Rueben while he is drinking and smoking outside a children’s party at a Mexican restaurant. Amongst this discordant imagery, Rueben takes his practice seriously, telling Sarah, “I trained with Philippe Gaulier in France. I’m meant to be a theater practitioner, not a kids’ entertainer” (146). As they research hospital clowning and form their charity, Rueben studies with “psychotherapists, child psychologists, and theater practitioners” (148). Clowndoctors therefore take on symbolic significance as something that initially seems trite or simple but can be more complex and powerful than initial impressions suggest.

Clowndoctors represent the introduction of hope to dark circumstances. Ruth describes her most recent interaction with a clowndoctor: “Your people have never talked to me like I’m a kid. Last time I saw Doctor Zee, he said he was going to help me write a poem for my wake.