For those who know Mike Wells, an image of the soft-spoken, red-headed teddy bear of a guy comes immediately to mind.  Mike completed residency in Internal Medicine in 2008.  Since that time, he has been Chief Resident of Internal Medicine, a Pulmonary Fellow, and is now an Assistant Professor in Pulmonary Medicine.  Shortly after starting his faculty position, the life of Mike and research mentor Mark Dransfield changed drastically with the acceptance a manuscript by The New England Journal of Medicine.  In the September 3, 2012 issue of NEJM, Drs. Wells and Dransfield report a groundbreaking observation. In patients with COPD the strongest predictor of exacerbation and hospitalization in two multicenter cohorts was a pulmonary artery larger than the ascending aorta on CT scan (having a PA:A ratio >1).  Since the publication of this article, they have been invited to speak at numerous institutions locally and internationally.

What gave you the idea to do this research?

Dransfield: 
There had been an article published a few years ago— if you had a COPD exacerbation before, you were at risk for future events. I was trying to come up with a better model for who these people are. I think that’s where the idea came from.

Wells:
In fact, we initially looked at all other comorbidities and determined what role they played in exacerbations.  At the time that the NIH-sponsored COPDGene study was getting started, there were several reports describing different CT findings in the thorax in various patient populations, and one of these was this P-A measurement.  Pulmonary vascular disease and pulmonary hypertension continued to recur as factors independently associated with decreased time to exacerbation, hospitalization and increased risk of mortality in the setting of acute exacerbations.  With the COPDGene study enrolling over 10,000 subjects with baseline CT scans, we knew that this cohort would be the ideal setting in which to investigate the hypothesis that a non-invasive marker for pulmonary vascular disease would be associated with exacerbation related outcomes.

Were you surprised about the findings?

Dransfield:
Yes, we were pleasantly surprised at how much better the PA:A ratio performed than other variables.

Wells: 
The fact that it came out to be the strongest predictor for hospitalization was surprising.  It was also reassuring to see how well the two clinical cohorts (the COPDGene and ECLIPSE study groups) matched.

Who were the people that influenced you the most as a resident?

Dransfield:
Dr. Dismukes probably influenced me more than anyone during residency but I had many great attendings.  One of the best months I remember was with Nass Cannon at Cooper Green.  He provided just the right mix of autonomy and supervision and his approach really helped me develop as a physician.  I also learned a lot from my fellow residents – they were a great group.   

Wells: 
In residency, I was heavily influenced by Dr. Heudebert, Lisa (Willett), Dr. Stamm, James Davis—they all really pushed me to excel as a clinician.  During my time as a chief resident, my fellow CMRs further influenced me to pursue a career in academic medicine. In fellowship, Drs. Mark Dransfield and Ed Blalock have both been outstanding mentors. 

What was one story about residency that you remember and don’t mind sharing with the rest of us?

Dransfield:
I remember a lot of stories but most of them are inappropriate. 

Let’s see, my class was the first class that could not spend the night at Camp Dismukes. We were not responsible for this, but were the victims.  Also, I remember that Vera Bittner awarded me something like “Most-Disgusting Post-Call Resident.” It wasn’t “Smelly” but that was the implication.

Wells:
A group of residents went to Las Vegas for a weekend—including myself, George Smallfield, Nipun Reddy, Abeezar Shipchandler, Tom Lewis, Chad Burski, Brent McQuaid, Shaun Donnegan, Ryan Bozof, and several others. Thirty minutes into the flight, the flight attendant rang the emergency call button asking for physician help with an in-flight emergency.  Several people responded.  After a few minutes of watching the first responder getting more frantic, George Smallfield and I went to investigate.  One of the passengers had a stroke, and the first physician to respond told us “Thank God you are here, I’m a psychiatrist!”  The pilot ultimately had to land the plane, delaying our trip to Vegas by a few hours.  Fortunately, we were rewarded with free drinks for the remainder of the flight!

I developed a strong bond of friendship with many in my intern class.  In fact, we still make attempts to meet on a regular basis.  Each year, we try to organize a beach trip for everyone interested.  This year, Jody Hughes, Bryan Wells, and I were able to reunite – last year, Ryan Bozof, Shaun Donnegan, and their families were able to attend.  This summer, I met up with Brent McQuaid in Florida for Tom Lewis’ wedding. 

Tell us a bit about your family

Wells:
My wife Whitney and I have been married for seven years.  We got married in November of my intern year.  We have a 2-year old son named J.P. and a 9-month old daughter named Charlotte. 

Dransfield:
I have two sons. One is 13 almost 14 and the other one is 10.