Professor James Calder held the health of the world’s most expensive soccer player in his hands. Neymar, the Brazilian forward who Paris Saint-Germain paid Barcelona $263 million for in August 2017, lay on the operating table. Professor Calder was the surgeon tasked with helping to fix the club’s crown jewel.
“When you’re first entrusted to look after a big name, you are nervous. And it’s a challenge because there’s a lot of other baggage that comes with that injury,” Professor Calder told Forbes Robert Kidd in an interview.
“The injury is attached to a very important, highly-demanding athlete. And that athlete is worth an awful lot of money to other people. I think in the early days I was very much aware of it. Now I’ve become immune to the cost of the patient and I can hone it back to the importance of the relationship between the injury and the patient.”
Professor Calder is a founding member of UK-based Fortius Clinic, where he works as a consultant orthopaedic foot and ankle surgeon. The clinic, the largest group of private sports physicians in Europe, cares for professional athletes across all sports. Several dozen professional athletes a week are referred to Professor Calder. He works with players from Premier League clubs and European giants including Paris Saint-Germain, FC Barcelona and AC Milan. He also helps Olympians, professional ballet dancers and, increasingly, NBA and NFL players.
With high-profile stars, the pressure is high. At a top soccer club, everyone from the in-house medical team to the injured player’s agent has an interest. “There is pressure from the club and pressure from the media. A lot of clubs, if it’s a top player, will bring the physio and probably the doctor to the operating theatre,” Professor Calder said. “Some clubs want to video the operation, so there may be a film crew. I prefer when they’re there. They can understand exactly what’s gone on with the operation and we can discuss why we’re doing a particular type of operation and the rehabilitation.”
Since Fortius opened its first clinic in 2009, the money in soccer has continued to grow. Professor Calder said his medical indemnity insurance used to cover him for £10 million ($13.2m), but is now “very, very high”. Professor Calder is not attached to any one club in particular and is usually contacted by a team’s physio or doctor to discuss an injury. Occasionally though, a player or their agent requests their chosen surgeon. That is what happened in 2016, when Real Madrid’s Gareth Bale went under the knife for surgery on his right ankle. Bale, once the world’s most expensive player, had previously worked with Professor Calder and asked that he be the one to perform the operation.
“The (Real Madrid) medical team knew me as well. I have looked after players from Real Madrid before and subsequently,” the British surgeon said.
Seeing his patients back on the pitch is a big reward. “My part in the story of their recovery, my two-hour operation or whatever, is only very small. They’ve got the hard work to put in and the rehab involved is so important,” Professor Calder said. “But it’s a fantastic feeling to watch them get out and play in the Champions League or play for their country.”
Of course, not every surgery is a success and not every injured player recovers. Just like in sport, there is an element of luck involved in putting players back on the pitch. “You could do the same operation on two different players and they may have completely different rehabilitation paths because of their genetics and their rehabilitation. That can be frustrating,” Professor Calder said. When a player has a serious injury, it is important to understand what they expect from the rest of their career.
“We have a very honest discussion and I say ‘what’s your objective?’ If you’re hell-bent on playing we’ll try and patch you up and get you to play for as long as we possibly we can, but there may be a price,” Professor Calder said.
“You may play at Championship level but not Premiership level. But whilst you’re doing that, you’re probably doing yourself more harm which will then lead to longer term problems like arthritis. And then later you may have trouble playing recreationally and kicking a ball around the garden with your kids.”
An even tougher conversation is telling a player that the damage is too severe – that they will never play again. Professor Calder recently told a professional player in his late teens that he would have to retire. “That’s a really tough conversation. It takes a long time discussing that with a player,” Professor Calder said. “That’s been his life, his passion, and it’s cut short. It was heart wrenching for him and his family and there were a lot of things that could have been done to prevent him from injuring himself. But he was pushed on and he wasn’t protected.”
While bad news must sometimes be delivered, Professor Calder acknowledges it is a “luxury” working with professional athletes. “You’ve got a very motivated, well-informed group of patients who also have the most amazing back up to get them back on the field at an early stage,” he said. “I pinch myself. I’m in a very, very lucky position. Yes, it’s hard work, frequently anti-social hours and you have to put the hours in and respond quickly. But if you love it, you’ll carry on doing it.”