Team doctors adapt and serve during pandemic

Rally Cycling doctors Kelby Bethards, Kristie Nicholls and Mark Greve report in from the front lines

2 months ago by Tom Owen

During a normal season, Rally Cycling’s team doctors wear a lot of different hats. One moment they’re treating road rash, the next they’re advising via telephone on finding the right allergy medicines in Australia, or flying across the world to be with the team at races in Europe, South America or the Middle East. Now, with racing suspended for the foreseeable future, they are back at their ‘day jobs’, contending with something they’ve never seen before.

Rally Cycling team doctors Kelby Bethards, Kristie Nicholls, and Mark Greve have seen their lives changed immeasurably by the pandemic. Their experiences provide a deep insight into the varying effects of coronavirus in the USA. 

Personal letters sent to Greve’s hospital in Rhode Island.

Dr. Mark Greve is an ER physician and associate professor of emergency medicine at Brown University in Rhode Island. The virus has changed he and his colleagues’ entire mindset.

“It’s almost like combat medicine. We’re working in a system that you’d normally never have to contemplate and you don’t know where the resources are. You can’t assume you’ll have access to all the things you normally would. And that includes personnel. So as a medical practitioner, you have to be able to operate autonomously.

“We’re not so much having to become a jack of all trades, master of none, we’re having to become a master of everything.”

Dr. Kristie Nicholls has also seen her job change in scope. As a family doctor who was already providing telemedicine services before the pandemic, she has seen the number of states in which she is allowed to work surge, as states with a shortage of expertise relax their telemedicine rules. Officially licensed in four states, she is currently seeing patients from 14, from Alaska to Florida.

“It’s confusing because every location is so different; whether they’re doing tests or not doing tests, or requiring a lab slip, not requiring a lab slip. In New York, for a while, I don’t even know if they are now, but they weren’t doing any outpatient testing for coronavirus. But in other places, they were trying to test as many people as they could. It’s almost impossible to keep up with.”

For the team’s medical director, Dr. Kelby Bethards, who works in urgent care, treating patients often not-yet-diagnosed with coronavirus adds an extra precariousness to the situation.

“A colleague of mine who works with those who already have a diagnosis said to me ‘At least I have a ventilator with a filter between myself and the patient.’ For us we don’t have that, you have people walking in who maybe don’t even know they have it.”

And that is to say nothing of the profoundly strange nature of the virus itself. 

“I used to work at a medical facility at 9,000 ft and we saw a lot of altitude sickness. Coronavirus is mimicking altitude sickness a lot. But it’s infectious, meaning that people aren’t necessarily coughing and hacking, and they don’t even know or feel like they’re short of breath, but their O2 saturations are very low. You’ll see these people and you’re like, ‘This guy’s got it for sure, he’s got a temperature of 103. He’s huffing and puffing 30 times a minute instead of 12 times a minute.’ But he doesn’t even know he’s doing it. It’s bizarre.”

Bethards puts in the work, even when he’s “off the clock”.

Greve says that while cases have yet to spike in Rhode Island, their proximity to badly-affected New York means he and his colleagues are trying to find out everything they can from physicians in other states. 

We’re talking to doctors in other parts of the country and finding out what happened with them. As doctors we are used to having a body of literature to refer to, we’re used to evidence-based medicine which allows us to know what the next step is. We have none of that really. We’re learning on the fly, communicating with places that have already been badly hit. It’s like ‘OK what did you need? What did you find you were lacking? What are the other things we can do?’

“Right now in Rhode Island, we’re on the front lines and everything’s quiet, but we need to make sure that we’re ready [if there is a surge in cases]. The endgame ultimately is having a vaccine and having antibody testing, but we don’t know when that’ll be.”

A halt to racing

For Bethards, the decision to suspend racing could not have come sooner. He was one of fourteen doctors from 11 professional cycling teams who in early March signed a letter to RCS [organizers of the Giro d’Italia], ASO [organizers of the Tour de France] and the Union Cycliste Internationale, calling for the cancellation of races like Paris–Nice and Strade Bianche.

“It said, basically, ‘Look, this is dangerous. We don’t want cycling to be a vector for this thing. You need to either shut down these races or have a plan.’ Obviously we were just trying to keep our riders safe, as well as preventing the spread to people who are at more risk than the young, fit athletes who are – comparatively – more resilient to the virus.

“A bike race is a traveling circus where you have 130 riders from 30 different countries all roll in and stay in the same hotel,” Bethards continues. “We all eat in the same dining hall. We all hang out together and then we go on to our next race.”

Like all of us, the doctors are finding their personal lives and living situations changed by the social distancing measures put in place. Greve has been prevented from seeing his family because he is in daily contact with patients.

“What I’m doing all day is taking care of COVID patients, so I’m pretty much in solo isolation whenever I’m not at work. I’m either at work or in my loft. I’ve been learning to play bass guitar, so I have a teacher I go on Zoom with once a week.”

For Nicholls, though, the reverse is true. 

“We live in a really tiny house and now both my husband and I are working from home. I had a baby in July, and we also have a three-year-old – she used to be in school, but then the school’s closed. So the four of us are here in the house and I’m trying to take video calls. I have a little room that’s sectioned off and we’ve now put a lock on the door after my daughter came in running in one evening when I was speaking to a patient shouting, ‘Mommy, we have pizza!’” 

Based in Fort Collins, Colorado, Bethards has been receiving requests for advice from some unexpected quarters. 

“The bike shops here in town have even got a hold of me because they know I’m a team physician. ‘Hey, what do you think of my sterile process for working on bikes? We wash it down with bleach and we do this, and we do that.’ I just tell them, ‘don’t drink the bleach and you’ll be fine’.”

Coming through this

While it can be disconcerting to see on the news some of the more radical responses to the anti-pandemic measures put in place, Greve points out that these sorts of reactions are not all that unusual.

“If you step back, this is not an unusual human phenomenon. People start wilting under pressure. As much as we want to think we advance as a society, we still have these primal instincts. What we’re seeing is a primal instinct, a response to being restricted and restrained. I think everybody is feeling the stress. I’m personally feeling the stress. I’m sick of it!”

There are, of course, healthier ways of managing the stress heaped upon us by social distancing, changed working patterns, and home lockdown. Both Greve and Nicholls have been out in their gardens, developing their green thumbs, while all three have been making use of Zwift. 

At least I can ride my bike,” says Greve. “It’s the one thing we can still do [in Rhode Island]. I just ride on my own, of course, or on the trainer in my basement. I really would love to see what a spike Zwift has had – there have to be three to four times more people on there at the moment!”

Nicholls advises social media use in moderation. 

Try to unplug. That would be my recommendation. I guess maybe try to stay off social media – which I need to do a better job of myself. Try to get outside and get fresh air and maybe try to pick up a new hobby, if there’s anything you’ve been meaning to try.”

Greve adds, “Looking at the positives – most people are making all their own meals, which is an opportunity for healthy eating as well as social interactions. Finding other ways to interact with groups is great. Regular social interactions, even if you can’t be physically present. Try to get outside, within what’s a safe parameter – because outdoor exercise has some of the most beneficial attributes of anything out there.

The more you can get outdoor exercise, within safe measures, the better your wellbeing is probably going to be.”