Stan Cope had plans for his 70th birthday. They did not involve an emergency, life-saving surgery that would include, as Cope would later joke, the installation of a “stomaphagus.”
But sometimes things don’t turn out quite according to plan. Rather than dining and enjoying the mountain charms of Eagle County with his wife Mary Ellen and a few friends at the Frost Creek Club on May 23, 2021, the Denver resident lay unconscious in an operating room at UCHealth University of Colorado Hospital on the Anschutz Medical Campus.
Cope had been, until about two days before, a picture of health over pretty much all of his 69.995 years. He had lived in the mountains – Steamboat, Breckenridge, and Vail – from 1973 until a couple of years earlier, when Mary Ellen’s trouble with altitude and a solid offer led him to sell his Vail-based property-management business and split time between the Front Range and Scottsdale, Ariz.
His lifestyle had passed well to the mountainous surroundings – Cope skied in the winter and biked in the summer. As the decades passed, similarly active friends, with their various tendon repairs and joint replacements, joked that Cope was still bouncing around like he was 25. And in fact, the last time he had been a hospital patient was for his tonsillectomy. He was 5 at the time.
Cope would soon more than catch up. Prior to a round of golf on Friday, May 21, 2021, he was warming up on the Frost Creek driving range when he swung a club and collapsed to his knees.
“It felt like an alligator bit my right shoulder and just dug into my chest,” he said.
The knifing pain subsided and a deep unease set in. He told his friends he’d catch up with them later. Back at the rental house, Cope took pain relievers and planned on waiting it out. Mary Ellen had been away; when she returned, she took one look at her husband and delivered him to urgent care.
A doctor there did a workup. It was inconclusive, so the Copes returned to Frost Creek. Cope skipped dinner with friends that night, feeling no better. The next morning, the urgent care physician called and said he should get to Vail for a CT scan. By that evening, Cope was in an ambulance headed for UCH.
Roughly a half gallon of fluid had collected in his chest cavity. It would take the resources of an academic medical center to understand its origins and fix it.
Epiphrenic diverticulum and esophagus cancer: A 50-50 chance
Dr. Robert Meguid, a University of Colorado School of Medicine and UCHealth cardiothoracic surgeon, was on call on Sunday, May 23, 2021. It happened to be his wedding anniversary, but perhaps the phone wouldn’t ring. At about 3 a.m., it did, and he drove through the predawn darkness to UCH.
By the time Meguid started operating on Cope, the UCH team understood more about the case. An esophageal perforation – a hole in the esophagus – had been the source of all that fluid. Sepsis, the body’s extreme response to systemic infection, had also set in. Dr. Anna Duloy, a CU School of Medicine and UCHealth gastroenterologist, had investigated with an endoscope. Had Cope’s problem been a hole in the esophagus, Duloy could have done a minimally invasive procedure to place a stent and seal it. But instead, she identified an epiphrenic diverticulum, an outpouching of the esophagus just above the stomach, a rare condition. The repair would require open surgery, the possibility of which was why Meguid had been called in.
Meguid went to work and quickly saw how serious Cope’s problems were. Food had gotten stuck in the epiphrenic diverticulum and led to a squamous cell carcinoma, the most common form of esophageal cancer. When Cope had swung that golf club, the tumor had torn loose, leaving a hole about size of a quarter. It was, as Meguid described it later, “a one-in-a-million type of situation, one of those your read about in textbooks but no one has ever seen before.”
“The hole is going to kill him immediately if we don’t fix it, and the tumor will kill him eventually if we don’t fix it,” Meguid recalled thinking.
Meguid figured Cope had a 50-50 chance of survival. The tumor had spread into the lower lobe of the right lung and into one of the blood vessels returning blood from that lung to the heart. Lymph nodes had blackened with infection. But the tumor didn’t seem to have spread beyond those areas – had Cope not torn the tumor loose, it surely would have. He had been lucky to avoid injury his entire life, and he had been lucky to injure himself now.
Enter the ‘stomaphagus’ (aka neoesophagus)
For the next six hours, Meguid and CU School of Medicine cardiothoracic surgery fellow Dr. Michael Cain removed part of Cope’s lung, repaired the blood vessel, did 23 biopsies for pathology to investigate for possible cancer, and cleaned Cope out. Rather than patching the hole in the esophagus, Meguid removed it entirely. In its stead, he stretched out and sutured into place Cope’s stomach. Meguid performs this procedure, called an esophagectomy, about 40 times a year. The stomach would function just like an esophagus, but Cope would have no stomach. For the rest of his life, he would eat multiple small meals a day and chew his food thoroughly. For the next couple of months, he would collect his calories through a feeding tube Meguid also installed.
For three days Cope wasn’t allowed even to put liquid in his mouth, and for five days, he wasn’t allowed to swallow it. When the sutures were judged to have held properly, “The first swig of water was like the finest champagne you’ve ever had,” Cope said.
For days, Cope judged the progress of his recovery by the number of tubes nurses removed. By the time he left UCH 12 days after surgery, he was down to the feeding tube and two PICC lines, one for an antibiotic, the other for an antifungal prescribed by Dr. Esther Benamu, a CU School of Medicine and UCHealth infectious disease specialist.
Given the cancer diagnosis, Cope underwent chemotherapy under the guidance of CU School of Medicine and UCHealth oncologist Dr. Scott Kono at UCHealth Cancer Care and Hematology Clinic – Cherry Creek. When the standard fluorouracil (5FU) treatment led to painful – and, true to form, rare – blood-vessel spasms, Kono shared his case with the weekly GI Tumor Board at the Anschutz Medical Campus, where about two-dozen specialists – radiologists, oncologists, surgeons, pathologists, and others – came up with an alternative that worked.
Two months after his surgery, Cope had recovered enough to ride his bike from Cherry Creek to a bagel shop in the Lowry neighborhood and back.
“I don’t think it was 10 miles. It felt like 100,” Cope said. “But it felt great to be back on my bike. To be a human being again.”
Cope’s rides got longer and steeper as weeks and months passed. He has been golfing two or three times a week in Arizona. In late February, he and Mary Ellen skied Mission Ridge near Wenatchee, Washington, during a visit with his son, daughter-in-law, and first grandchild, a baby boy.
And the term “stomaphagus”? That portmanteau emerged in a conversation with Meguid, not long after the surgeon explained to his patient that he no longer had a stomach because it was functioning as his esophagus. It’s technically called a neoesophagus, Meguid told him. Cope said he prefers “stomaphagus.”
Perhaps it will stick.
“I’ve given him permission to trademark it as his own,” Cope quipped.