Fran Etzkorn survived three life-threatening conditions so she could get back to clowning around.
Her health care story, which unfolded at UCHealth University of Colorado Hospital on the Anschutz Medical Campus (UCH), not only reflects Etzkorn’s grit and desire to continue to serve, but also encapsulates in a single patient’s story several stunning advances in medical science – advances that have enabled her remarkable recoveries from health emergencies spanning pulmonology, cardiology, and oncology.
Etzkorn, 80, is much more than a clown, but she is indeed a clown – Kolo the clown. She got into clowning through Easter-Bunnying, which may or not be the usual career path.
She and husband John lived in Rollinsville near Central City. One year several decades ago, the Lady Elks were looking for an Easter Bunny. Etzkorn gave it a try, and found that suiting up in a goofy costume very much suited her.
Not long after that, the Christmas party was coming up at the Blue Cross/Blue Shield office where she worked. One of Etzkorn’s bosses, a Shriner who usually donned whiteface and a red nose and so on for the event, said he wouldn’t be available that year.
“He lent me his clown outfit,” Etzkorn says.
Etzkorn may hit five feet tall on her tippy toes, but the outfit somehow fit, and so did clowning. She was busy with other things, though, and stayed busy after her retirement in 1982 – mainly as a volunteer firefighter with the High Country Fire Protection District. She did that for the next two decades, even serving as chief for two years. In 2002, Etzkorn retired from firefighting and from the District’s board. A friend of hers suggested she try clowning again. Etzkorn poked around on the web and noted a weeklong clown camp coming up in Lacrosse, Wisconsin.
“I drove out there by myself and have been an addict ever since,” Etzkorn says.
Over the next few years, she clowned at hospitals, in parades, for kids, and at clowning competitions. She did sight gags; she told jokes. Some typical clowning, she avoided.
“I don’t do balloons, and I don’t do face paint. People say, ‘What do you do?’ I say, ‘I just clown.’ I don’t like kids standing in line,” Etzkorn says.
Idiopathic pulmonary arterial hypertension
Toward the end of the 2010s, she noticed she was increasingly short of breath. A community clinic in Boulder diagnosed asthma. The drugs didn’t help. In 2012, she arrived at UCH on the recommendation of a doctor at National Jewish. By that point, Etzkorn’s health had declined to the point that, when golfing with friends one day, she found herself too tired to get out of the cart to walk over to her ball on the fairway.
At UCH she came under the care of Dr. Todd Bull, a University of Colorado School of Medicine pulmonology and critical-care medicine specialist and director of UCHealth’s Comprehensive Lung and Breathing Program. This definitely wasn’t asthma, he recognized, but rather idiopathic pulmonary arterial hypertension.
Pulmonary arterial hypertension happens when the lungs constrict the blood flow coming from the heart. It’s often caused by the narrowing of blood vessels due to inflammation or other causes. That strains the right side of the heart, which has to work harder to pump blood into the lungs. Pulmonary arterial hypertension symptoms include shortness of breath, fatigue, dizziness, fainting spells, and edema-caused swelling. The added stress on the heart’s right ventricle can lead to heart failure.
“Idiopathic” meant it wasn’t clear what was causing Etzkorn’s PAH. What was clear that it had to be treated quickly.
“Historically, people usually died within two years of diagnosis,” Bull says.
The past two decades have seen the approval of more than a dozen drugs to treat PAH, and survival rates have gone up, Bull says. The most potent of these medications are called prostanoids; Bull started Etzkorn on one of these – treprostinil (trade name Remodulin). It’s a powerful vasodilator, meaning it opens up blood vessels. Often, patients work their way up to Remodulin. Etzkorn jumped straight onto it due to her disease’s severity.
Administering the drug involved more than popping pills. Remodulin must continuously flow into the body. Patients wear a portable pump that they refill every 48 hours, ad infinitum. That took some getting used to, but Etzkorn’s lungs opened up, and the right side of her heart responded to the lesser workload by reverting to a near-normal state, Bull says.
The Etzkorns recognized that Fran would be better off living with more ambient oxygen than available at 9,000 feet. They considered moves to places as diverse as Arizona and Minnesota. They settled on Longmont, Etzkorn said, because “I didn’t want to move away from the team – from Dr. Bull and everybody here.”
She got back to clowning. She volunteered at a hospital in Longmont and at nursing homes; she helped out at “PH in the Park” walks sponsored by the Pulmonary Hypertension Association. In addition to her standard outfit, Etzkorn brought along Corny the Corndog (a faux ear of corn harnessed to an invisible dog leash) and a “Port O Potty” she wheeled along with her. This was a plastic fire hydrant whose principal role was to conceal her oxygen tank. She brought along some pals, too.
“Her whole clown community comes out to support her, helps with the kids, drives the golf carts around, and helps direct traffic,” Bull says.
Word got out, and soon she and her Colorado Clown Alley pals were doing a 5K walk or other fundraiser every couple of weeks during the warm months, for conditions as diverse as cancer and apraxia. The World Clown Association took note, presenting her with its Humanitarian Award.
Pulmonary arterial hypertension and TAVR
Five years passed. Then another major health problem emerged. Severe aortic stenosis was sharply lowering the blood flow through her heart’s aortic valve – the gateway to the body’s blood flow. The Pulmonary arterial hypertension that had threatened heart failure was under control; now the failing aortic valve posed a different, serious threat.
Again, not many years ago, Etzkorn would have had few options. Given her age and her pulmonary hypertension, open-heart surgery to repair the valve would have been too risky. But now there was another option: trans-arterial valve replacement, or TAVR.
CU School of Medicine and UCHealth Interventional cardiologists Dr. John Messenger and Dr. John Carroll had been doing TAVR procedures since 2012, when the procedure to insert replacement heart valves via a catheter inserted through the femoral artery was still in clinical trials. TAVR’s initial U.S. Food and Drug Administration approval was for patients too ill to undergo an open procedure. The FDA has since broadened its approvals to the point that TAVR is the first-choice option for nearly all patients, Messenger says.
The combination of Bull’s management of her pulmonary arterial hypertension and TAVR’s minimally invasive nature (patients don’t even need general anesthesia, Messenger says) made Etzkorn a good candidate. On Sept. 27, 2017, Messenger, with help from CU School of Medicine and UCHealth cardiac surgeons Dr. David Fullerton and Dr. Joseph Cleveland, replaced Etzkorn’s aortic valve via a small incision near the groin.
Afterwards, Messenger says, “She dropped off clown noses for the entire team.”
And now, cancer
Another two years of living and clowning passed before Etzkorn’s third mortal health care battle in the span of seven years – this time with esophageal cancer.
A visit to UCHealth Longs Peak Hospital confirmed the diagnosis. She continued her care at UCH with oncologist Dr. S. Lindsey Davis. As cancer of the esophagus often does, the cancer was growing at the juncture of the stomach and the esophagus. Etzkorn went through chemotherapy and radiation treatment, but the tumor remained. Davis recommended surgery to remove it. On June 6, 2019, cardiothoracic surgeon Dr. Robert Meguid and cancer-surgery specialist Dr. Martin McCarter suited up to perform the surgery with one small addition from the normal garb: stickers from Etzkorn in the shape of a yellow heart with a smiley face with a red clown nose.
This was a major surgery – an eight-hour affair involving detaching and moving the stomach, which McCarter did – and then the removal of the lower two-thirds of her esophagus and the upper quarter of her stomach, which Meguid performed. Adding to the technical challenge was the surgeons’ use of a da Vinci surgical robot to minimize trauma and speed recovery.
Given how difficult Etzkorn’s recovery was, going with the robot may well have saved her. Rather than the typical one or two days spent in postsurgical intensive care, she was there for 20 days.
“There were two nights when I thought I wasn’t going to get better,” Etzkorn says. “When I thought it was over.”
Bull checked on her daily, as did Meguid. During one of those dark days, Meguid took her hand and told her that the cancer was gone, and that the hardest part was behind her. Etzkorn made her mind up to push ahead.
“I think you will yourself to feel better,” she says. “I think you get to the point where – what’s the saying? – get busy dying or get busy living.”
As she got busy living, Bull saw a familiar sense of humor reemerge.
“That’s when I knew Fran was feeling better – when she started busting out the various clown jokes and clown paraphernalia,” he says.
Meguid put one of those yellow heart stickers on his eyeglasses case back home. Every day, when he takes out his contacts and puts his glasses on and vice-versa, he thinks of one of his favorite patients ever, he says.
The affection goes both ways.
“I wouldn’t be here if it weren’t for them,” Etzkorn says.
She went home in early July 2019 and has been getting stronger ever since. The pandemic has put a damper on clowning, but in late May, she suited up and performed below the second-floor window of an 85-year-old woman confined to an extended-care facility. Given the distance, she did sight gags involving a big camera, some oversize flowers, and Corny the Corndog.
“Clowning is my life. It has helped me understand other people who have illnesses, and I’m more aware of other peoples’ feelings, I think,” Etzkorn says, and chokes up for a moment. “It’s just what I do.”