A curious patient spurs one physician on to a life of research.
For most people the name Willy Wonka conjures up images of chocolate, Oompa-Loompas and a little orphan boy named Charlie. But for Dr. Alex Spyropoulos, an anticoagulation and clinical thrombosis researcher, the name summons up an entirely different narrative. For him, Willy Wonka is not a man in a funny purple hat, but a real-life patient that spurred his lifelong interest in studying anticoagulation.
In 1992, Alex Spyropoulos MD, graduated from the University of Pennsylvania and started working as a hospitalist. He had a diverse set of clinical interests and didn’t know quite what field he wanted to focus on. Not long after settling into practice in New Mexico, Spyropoulos attended an event in Albuquerque where his eventual mentor – Graham Turpie, MD – gave a lecture on deep vein thrombosis. The young doctor was enthralled by the speech. “I dove deep into VTE and PE and got to know the field well. So then my department chair said ‘Alex why don’t you head up an outpatient DVT program?’” The young doctor began to create a program from scratch in his hospital in the desert.
“I was just starting my research career. I started doing outcome studies in the 90s and clinical research in the late 90s. As a hospitalist then we had patients as well as hospital duties so it was a little less abrupt than it is today. So we could actually spend some time with them.”
During a one-week period in late September 2001, about six years out of residency and med school, Spyropoulos’ life changed and his passion for studying venous thromboembolism became a personal matter.
Spyropoulos was heading for a bite to eat one day when one of his colleagues came to him and said, “Do you wanna see Willie Wonka?”
“What the hell you talking about?” said Spyropoulos.
“There’s this guy who I think is the real Willie Wonka, and I’m gonna give him to you.”
Incredulous but curious, Spyropoulos took the case.
The physician walked into the room to find a feeble man with gray hair unable to sit up in the hospital bed. His breathing was shallow and uneven. As the doctor took Wonka’s pulse, he found the man’s hands were icy and nearly lifeless.
Spyropoulos treated him as he would any patient in his condition, with round-the-clock check-ups. For the next seven days, he treated Willard J. Wonka for several issues related to venous thromboembolism (VTE.) As Wonka’s health returned, he was able to speak to the doctor. Silent, twenty-minute checkups turned into conversations. The man seemingly had no visitors to his bed besides the nurses and Spyropoulos, so the physician pulled up a chair and turned a listening ear. Every time he sat down, the tall, thin Wonka would sit straight up in his bed. With a wry smile and a twinkle in his eye, he finally told a curious Spyropoulos his connection to the famous tale of the chocolate factory. It went like this:
At the start of World War II, a teen-aged Wonka joined the US Air Force. He was sent to serve with Britain’s Royal Air Force at the Battle of Britain, where he served as a tailgunner. He met and became friends with an RAF pilot who showed him the plight of the many orphans filling Britain’s streets. The two became very focused on the idea of helping the orphans at the end of the war. According to Mr. Wonka, the RAF pilot later wrote him letters spelling out that he wished to open a chocolate factory, and that there could be a special ticket prize allowing an orphan to visit once a month and get free candy. Spyropoulos theorizes that the letters or conversations somehow made their way to Roald Dahl, the author of Charlie and the Chocolate Factory, who was also active with the RAF in World War II. If so, Dahl decided to adopt Willie Wonka’s memorable name for the story, to be the chocolate factory’s famous proprietor.
Spyroupolos marveled at the story, but didn’t know if he could believe it. So he continued to unravel the mystery in their daily conversations. “He said he would always mess with his RAF compadres,” says Spyroupolos. “He would go into this weird twang so they wouldn’t understand what the hell he was saying.” Wonka recounted how he would put his leg behind him and pretend to be an amputee. In the middle of the night, Wonka would run to the loudspeaker in the RAF base and call out bombing raids to get all the men to run outside in nothing but their underwear. “He said the Brits were stiff-lipped and that his mission was to get them to cut loose,” laughs Spyropoulos. “He also said they were tough and he learned a lot from their work ethic too.”
“He was always more playful than dark. There were times when he was talking about the Battle of Britain when he was more distant, more dark, but he emphasized joy.”
Doctor and patient became close, and at the end of the week Spyropoulos felt Wonka was prepared to go home and return to daily life. With a spring in his step – and a little help from the nurses – Wonka walked out with a wry grin and a strong, warm handshake to his new friend. Spyropoulos felt confident in himself and Wonka, assuming the man would live to be quite old.
Spyropoulos discharged the patient, asking him to call and check up within a day. He went about the next three days doing hospitalist rounds and organizing the department. Every day, Spyropoulos checked his pager and went to his office to wait for a call or voicemail. Willie Wonka never followed up. He finally decided to pick up the phone. “I called about three days after he left and someone told me he…he had expired from a massive pulmonary embolism. This means he died on my watch.” Guilt swelled inside the doctor. He spent the day in a fog, going slowly about his rounds. A few days later, the physician decided he had to do something to understand Wonka’s death and make it right, as right as possible. Spyropoulos sighs, “Maybe it was a little bit of hubris since I was the supposed VTE expert in New Mexico at the time, but I was a young investigator and really wanted to know what happened.” Wonka’s death sparked Spyropoulos’ interest in the clinical study of administering prophylaxis in-hospital and out-of-hospital.
“He is the sentinel patient I always put in front of my eyes when I think of my work. This guy, he had playful, dancing eyes. The fact that he was Willie Wonka made it different and unique for me. This spirited guy I talked to every day went…just like that. I’m a physician. I know that most fatal PEs are sudden death, but it still was jarring.
“I was doing all the right things a hospitalist should do. I was giving him the standard 5000 units of heparin twice a day, and was doing in-hospital prophylaxis at a time when doing so was unconventional – and I was even criticized (by colleagues) for it.” It was then that Spyropoulos put all his energy into studying in- and out-of-hospital care and best practices for the prevention of PE. “I realize now that the only mistake I may have made was not giving him enough prophylaxis out of the hospital.”
Spyropoulos has dedicated his studies to Wonka and has even kept Wonka’s death certificate as an oath to work for the betterment of patients.
Today Spyropoulos is a head of the Mariner Trial for rivaroxaban, which is a drug that is used for pulmonary embolism, and has done four trials over a decade with 27,000 patients to discover the causes and effects of various types of VTE. His work also encompasses the hospital ACTIVE measuring system for PE and VTE for patients. The system, which risk stratifies patients on a scale of 1 to 5, would have put Wonka at a 3 or 4, which would be cause to keep a patient like him on anticoagulation medication today.
While there is still much to learn about VTE and anticoagulation, Spyropoulos traces his work to a certain patient with a twinkle in his eye and a wild story from World War II. Willie Wonka, whether or not he was ever the inspiration for the famous story, will live on in the legacy of those working to understand and save the lives of VTE patients. Spyropoulos points to that event with Wonka as the cornerstone moment for his practice in DVT studies and daily work.
Today, Spyropoulos helps lead clinical research at Northwell Health hospitals in New York, and is a professor of Medicine at Hofstra University School of Medicine. He thinks of Wonka every time he does a presentation for Mariner or deals with a difficult patient. “I remember him and how important it is to realize that we’re all just human. We need each other to make it through life. Doctors can forget that. We forget we’re not just machines and that they’re not just patients.”
Emergency medicine is full of everyday heroes. Lives are saved, families restored, and the emergency department staff just goes back to the rack for more. No standing ovations – rarely even a thank you.
If there’s a member of your team who deserves credit for saving a life, or simply for being an everyday hero in the emergency department, we’d love to hear their story, and consider telling it in these pages.
Write to Logan Plaster: lplaster@epmonthly.online.