The Race Doctor

I read this interview in L’Equipe the other day and can’t get it out of my head. It’s written by Alexander Roos who interviews Professor Gilbert Versier, the doctor one sees at the Tour de France following the race in his white convertible medical car. Here following is my -imperfect- translation.

‘The orthopedist surgeon of the Tour reveals to what point racing cyclists can suppress pain and under what conditions they perform their profession.’

By Alexander Roos, July 21, 2021

Professor Versier has followed the entire Tour de France behind the peloton, in his convertible, tending to the racers who’ve crashed or suffered other issues. During the 3rd stage to Pontivy he tended to Geraint Thomas’s shoulder dislocation, permitting the Welshman to continue his race. Is it stressing to treat a Tour winner? Gilbert Versier has already seen much in his life. Besides this being his his 11th participation in the Grande Boucle, he’s followed the Paris-Dakar off road automobile race and the Coupe d’Afrique soccer tournament. But above all, he has behind him 38-years of service in the French Army Medical Corps, where he achieved the rank of Chief Doctor of the Hors Classe Medical Teams, the equivalent of a Three-Star General.

 His father drove a tank in WWII, before joining the Resistance, suffering capture and torture. Dr Versier did his military training in Lyon learning from two legendary French doctors, Gilles Walch – aka the Pope of shoulders – and Pierre Chambat who was the French National Ski doc. Versier shipped out to combat zones upon graduation, to Sarajevo in 1994, where in a bunker, he operated on sniper victims, generally those who’d tried to escape in the night to the airport.

He was in Afghanistan, in 2010, as the chief surgeon of the French hospital at the Kabul airport and in 2015-16 on the aircraft carrier Charles-de-Gaulle covering the war in Syria, and the battles in Kuwait and Libya for the fight over Mosul. The only trauma orthopedist on the Tour de France reveals his vision of the race.

“Was this Tour more difficult than the others?”

Yes, but not because of the difficulty of the races, more because of the circumstances and the accidents that occurred. The mass crashes in the beginning of the Tour impacted two-thirds of the peloton which caused many problems. I had the impression that those who crashed had a hard time recovering. Some crashed two, even three times.

“Were there racers who you closely followed day by day?”

I kept an eye on Geraint Thomas because the fact that he remounted his bicycle represented great valor for me. And of course, Christopher Froome because with him there’s a history dating back to 2014 and his double crash that forced him to abandon the race. He’d fractured his wrist which I immobilized with a tight, resin splint. I told him that with that fracture, he’d be able to continue. The next day he shouted out, “It’s going ok.” Unhappily, on the day it rained, he crashed again and broke the other side.

“That evening, the ‘communique médical’ didn’t list his wrist fracture. How do you decide between what you communicate and the right to medical secrecy?”

We have an agreement between the doctors and the team to keep the communique’s discreet. If we write “Fracture”, that’s a strong word, so if we put down “Traumatism” it’s a bit more generic. These are things to hold in consideration, regarding the tactics of the race. If the teams know that a racer is in real difficulty, they can then attack that rider the next day, which is of course their right to do. So for Froome we just wrote, “Traumatism of the wrist.”

“You spoke of Geraint Thomas. Could you explain your interactions with him at the crash?”

 When we found him, his was seated, and had all the signs of a dislocated shoulder, with bone visible in the large hold behind the joint. I laid him down to relax him. He was incapable of making the slightest movement. I performed the classic maneuvers to reduce the trauma, told him to release his tension, explained what I was going to do to him, slowly rotating his arm, and that if he really relaxed and worked with me, the pain would disappear. From that moment the pain was reduced by 90%. He then understood, began to move his shoulder, saw that the bone was back in place, then remounted his bicycle. In the normal world, someone that came in with a similar dislocation would have their arm strapped to their body, immobilized for three-weeks.

 “Is it stressing to have to repair a dislocated shoulder, on the ground, in the middle of the confusion of the racers and follow vehicles?”

What is perturbing is that the priority is the race, to get the racer back on their bicycle. What is difficult is to judge whether putting them back on their bicycles will expose themselves to considerable and additional risk. In 2012, on the stage Épernay-Metz, there was a mass crash, with thirty riders on the ground, fifteen who had to abandon. A racer had a cut artery, he could have died, so in the conditions of ‘extreme traumatisms’ one must be thorough and not ignore real damage so that ‘the show goes on’. In 2016, Jean-Christophe Peraud crashed and was ripped to pieces by gravel. He had no shorts left to speak of. I tended to him from the car, and he kept saying, “I’ve got to go, I have to get to the peloton, that’s my priority.” It was perturbing. I responded that I had to at least do the minimum, his genitals were exposed, and he couldn’t cross the finish line like that.

“One of the most stressing moments for you had to be when you had to attend to William Bonnet in 2015”

There were 35 racers on the ground and 35 grave traumatisms. It happed at 80-kph on a descending false-flat. It was a horrific image: Bonnet was wrapped around an electric pole. He wasn’t my first client, I’d already reset two dislocated shoulders. William wouldn’t stay put, I had to put him back on the ground four times so much did he want to rejoin the race. It was only after the 4th time that he finally said, “My neck hurts.” I immobilized his head, put on a neck brace as fast as possible and saw that he had a fracture at the base of his skull, potentially mortal, that by luck had not shifted. That’s what’s extremely stressing, to come upon a severely injured racer who only has the objective of getting up and jumping back into the race.

“The racers seem to be made of “different wood’”

Their pain tolerance is exceptional, because in every other sport, injury is synonymous with leaving the field. Why? Perhaps the overwhelming need to rejoin the peloton before seeking medical attention, but probably because the racing a bicycle elicits a huge discharge of adrenaline. When racing at 60-70 kph the adrenal glands must be under huge pressure which helps to eliminate part of the pain, or in any case, their analysis of pain, by their brains, is not the same as it is with others.

“Do you see similarities between racers and soldiers?”

No, not really. A soldier who is hurt generally doesn’t return to combat. Racers are certainly warriors, but the injuries are not the same. Theirs are more in keeping with those of the general public, while soldiers suffer bullets and bomb explosions and are often fatal, which is not the case with racing cyclists.

“When there’s a mass crash at the Tour, it’s sometimes referred to as a scene from war. Is that exaggerated?”

It’s got nothing to do with war because a mass crash is mostly confusion. Rather than a battle scene, it’s really like a scene from a terrorist attack. One arrives in a place where everything around is normal, but then one finds broken bikes everywhere, helmets, sunglasses, water bottles, it’s an incredible mess. There’ll be many injured persons, as in a battle scene, but it appears much more as a terrorist attack because of the suffering. One is prepared for a battle scene– the crashes are unexpected.

“You know about terrorist attacks…”

I was the head surgeon at the Begin hospital, which is a Parisian military hospital located near the attacks on the Bataclan (2015 nightclub attack in Paris) and the restaurants of the XI arrondisement. We received 53 injured that night, and me, as the oldest surgeon of the hospital, had to judge who to work on immediately and who could wait. That was my role until 12:30 am, until I entered the operating room to save the most severely injured, until 3:00 the next afternoon.