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Tour de France

Inside Fabio Jakobsen’s remarkable recovery: ‘His body was in ruins’

Dr. Heiko Locher takes us inside the process that took Jakobsen from career-threatening injuries to the top of the Tour de France.

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Twenty-two months after operating on Fabio Jakobsen’s trachea to allow him to speak again, Dr. Heiko Locher was shouting with happiness watching at home as his former patient sprinted to Tour de France victory in Nyborg.

Jakobsen was a picture of poise and power, encapsulating a remarkable recovery from a life-threatening crash for the Quick-Step Alpha Vinyl ace.

When Locher first laid eyes on Jakobsen a week after his fall at the Tour of Poland in mid-August 2020, he couldn’t speak and “his body was in ruins”.

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The list of his injuries is long and frightful: skull fractures, brain and lung contusions, ten teeth lost, broken palate, damage to parts of his jawbone, a broken thumb, and a bruised shoulder.

One invisible injury that threatened to derail his return to top-level sport was his initial level of vocal cord paralysis. A laryngeal expert at the Leiden University Medical Center (LUMC), Locher put his chances of recovery at 50-50.

“It would have been completely normal if he hadn’t recovered. That’s how big his injuries were,” he said. “If somebody who is this broken heals, it’s especially special. Even though I have my professional and medical distance, it warms my heart if he wins.”

Fighting for life

Fabio Jakobsen crashes during the Tour of Poland
The crash at the 2020 Tour of Poland left Jakobsen ’50-50′ of recovery. (: Luc Claessen/Getty Images)

After crashing heavily against the barriers in Katowice on August 5 2020, Jakobsen was brought to the Sosnowiec hospital’s ICU and put in an induced coma.

After waking, he had difficulty breathing due to his tracheal tube and injured lung.

“I kept losing consciousness, slipping in and out. Every time I thought ‘this is it, now I’m dying’. This happened 50 maybe, 100 times. I didn’t die but it felt like that … These were the longest days of my life,” he told AD in a 2020 interview.

Locher, a 39-year-old specialist in neuroscience and ENT medicine at the LUMC in Leiden, got in touch once it appeared Jakobsen had suffered laryngeal and tracheal problems. The LUMC is among the foremost experts for such injuries in Jakobsen’s home country.

“I knew from experience that if this is not treated right, it’s basically finished,” Locher says.

As a cycling fan, he had a personal affinity with Jakobsen too. He reached out to Quick-Step using their website contact form, also asking the maker of his custom-painted steel frame to put him in touch with the team.

Giving Fabio a voice

Locher’s own passion for cycling led him to Jakobsen. (Photo: Heiko Locher)

After Jakobsen’s arrival at the LUMC from Poland on August 12 2020, a week after his crash, Locher and his colleagues made an assessment and operated to take out his trachea cannula, the curved tube inserted to help his breathing.

“That’s very important for recovery. If you have this cannula and opening, you have excellent breathing opportunities but you can’t speak. And also because it’s physically in the way, your larynx cannot function the way it should,” Locher explains.

“So if you have a laryngeal patient who has a tracheostomy, it’s very advantageous for healing to remove it as soon as possible. But this is something doctors are afraid of because if you take it out and lose the airway, patients die. So you really have to have a lot of knowledge and know when you can and can’t do this.”

On an emotional level, the tracheostomy was important: Jakobsen could finally communicate with his family, girlfriend Delore, and those closest to him. And alongside relevant medical information, he and Locher could discuss his recovery and his cycling career.

Locher is full of praise for the job the Polish doctors did, necessitating no further operations at the LUMU. After more medical and physical tests in Leiden, Jakobsen was discharged within a week.

“He was still weak, sleeping a lot. He could walk a little but then he was tired very soon,” Locher says of his time at the hospital. “Your body needs energy to heal after a huge crash and he had been immobilized for a long time. He was not able to do any large physical exercises, that’s what he did the months after, at home.”

50-50 chance of recovery

Jakobsen suffered brain, skull, jaw and vocal cord damage in August 2020. (Photo: Pool/Getty)

For the first couple of months, Jakobsen lay in a darkened room. His girlfriend helped him to wash. Getting out of bed for breakfast exhausted him.

It was an anxious waiting game for his vocal cord nerve damage too.

“In his case, it had to heal by itself or it wouldn’t,” Locher says. “At the time, it was very unsure he would recover. I think there was a 50-50 chance that his vocal cord would heal. If it hadn’t, he’d have been unable to be a professional cyclist.” Jakobsen himself accepted that he might not come back to his previous level; even if both vocal cords recover, sub-optimal airflow could prevent a return to the top.

Locher followed his tracheostomy healing closely in a bid to reduce the build-up of scar tissue and not diminish the lumen of his trachea. He says it took around “half a year” for it to be clear Jakobsen’s larynx was going to work.

Yet that was just one necessary component of his convalescence. His body and mind had to recover too. He also had to undergo several surgeries, including one to reconstruct his jaw, before he could receive teeth implants, working with doctors in Nijmegen.

“Fabio is mentally especially very strong, otherwise this wouldn’t have happened,” Locher says. “He’s analytically very strong and has patience. His body was in ruins but right from the start of his recovery process, he was planning, speaking to us and the other doctors in Nijmegen saying ‘what do I need to do to get a full recovery, how long would it take?’”

“He was very actively thinking about all these things and not putting too much pressure on himself. I think in his mind, he made a plan: step by step by step, I have to do these things, and then I will get this, this, and this. You have to have this mindset, otherwise you will never recover.

“And you see where it got him: I think he recovered way sooner than we all expected, both us and the public.”

Back to full fitness

Jakobsen won the first bunch sprint of his first Tour.

The 25-year-old attended his team’s January training camp in January 2021 and was back racing by mid-April that year. He took his first win three months later at the Tour de Wallonie; sixteen more have followed in the last twelve months.

As a mark of thanks, Jakobsen gave Locher a signed Dutch champion’s jersey for his office wall.

“He’s a special person and a grateful guy, grateful to everybody who helped him. And I gave him the LUMC cycling jersey,” he says, laughing. “I don’t know which one is nicer.”

Jakobsen is due a final check-up with Locher to ensure his full recovery. As for his maiden Tour de France stage win, the Dutch doctor isn’t sure whether he’ll send a congratulatory message. “Because one part of me also wants to accept that it’s already normal that he wins a stage. But I will speak to him later this year or next, so I can always congratulate him then.”

An American in France

What’s it like to be an American cyclist living in France? Watch to get professional road cyclist Joe Dombrowski’s view.