Author: Linda Rider

Jan. 26, 2023 — Melissa Strong was living her dream. 

Home was Estes Park, CO,  gateway to the glorious Rocky Mountain National Park.

Her passion was climbing, mostly bouldering, that purist sport of scaling big rocks without ropes, relying on just your fingertips, feet, and crash pads below.

Her career was hospitality, managing a busy restaurant while fantasizing about owning her own place.

Then it happened: the dream and a nightmare. 

At 43, she bought an old restaurant and gutted it. On April 2, 2017, Melissa was in her driveway adding decorative touches to the wooden legs of the tables for her restaurant, scheduled to open in a few months. She was using a high-voltage woodworking technique called fractal burning to create beautiful, river-like “Lichtenberg patterns.” 

It had gone well until she absent-mindedly grabbed the electrical leads of the wood burning tool when the 2,000-volt device was plugged in. The buzzing current pulsed through her. She couldn’t scream, couldn’t drop the electrodes, couldn’t move. Cut to black.

“They told me I’d only have four fingers — pinkies and index,” and likely no thumbs, Melissa recalls. Doctors knew her best hope was at the Burn and Frostbite Center at the University of Colorado Anschutz Medical Campus in Aurora.

As she was prepped for transfer, a nurse recognized her. She had climbed with Melissa once. “You were amazing,” she told Melissa. “So strong.” As Melissa blinked back tears, the nurse said the doctors in Aurora could work miracles.

Trauma and Response 

That nurse was right. Surgeons can work medical miracles, but a lot depends on the patient. How do they respond emotionally to devastating trauma? Are they engaged with their medical team?

Will they try to resume their prior lifestyle? Will they keep moving — literally — or succumb to common reactions like fatigue, exhaustion, and emotional numbness? 

Melissa always had goals: getting her restaurant up and running, solving the next climbing challenge. Anyone who saw her on the rock knew she was tenacious. Anyone who saw her work a restaurant shift knew she never stopped moving. But could she be the same without the thumbs and fingers she relied on, on the job and on a boulder?

Thumbs were the priority. All the tissue on the palm side was dead. “The only way to keep the thumbs would be to give new tissue, to resurface what was lost.”

For all the suddenness of the accident, electrical burns are a slow-motion emergency. They don’t “declare themselves” entirely at first; the damage gets worse as days go by. Ignatiuk took a needle and poked the tips of her thumbs. 

“When I saw some blood, that’s when I realized I could do something for her,” he says. 

Sewing injured body parts to healthy tissue—at the groin or chest, usually—is the typical move to allow healing blood flow into the smaller vessels of the extremities. But when it’s both hands? 

Ignatiuk says it was Melissa’s idea  — although she says it was his — to sew each thumb to the opposite forearm. He and the resident plastic surgeon, Seth TeBockhorst, MD, performed the procedure, partially amputating four of Melissa’s fingers while  salvaging as much flesh as possible.

Pain and Uncertainty 

Melissa awoke in excruciating pain. Her strong arms were now immobilized. Just moving was a study in pain.

Medications made her nauseous. For 3 weeks, she felt helpless, unable to brush her teeth or hair, wipe her butt, or feed herself. Sleeping was scary — what if she tugged her arms apart? (She tried once; no damage.)

Friends made her thankful. An outpouring of support from the climbing community fanned the embers of hope within. Adam and her family stood by to help the woman who had previously preferred to do everything for herself.

Reactions to trauma vary widely. Ask any doctor, or consult a textbook titled Trauma-Informed Care in Behavioral Health Services. Initial reactions can include “exhaustion, confusion, sadness, anxiety, agitation, numbness, dissociation, confusion,” among others. It can include a “loss of hope,” the thought that normal life events won’t happen, and a heightened fear that life could suddenly end.

Melissa knew about life ending suddenly — she’d seen the tunnel. Loss of hope? A little, maybe, but her gratefulness for simply being alive was dominant. Normal life events not happening? Sure, there was some of that.

“Instead of shutting down, I was trying to stay present,” Melissa says. 

For stress reduction, this focus on the here-and-now “is almost a form of meditation, and that can be very therapeutic,” says James Alan Blumenthal, PhD, professor of psychiatry and behavioral sciences at Duke University’s medical school and author of landmark research showing the effectiveness of exercise on depression.

As a hand surgeon, Ignatiuk has shepherded countless patients through very visible injuries that are a blow to the psyche. 

“People catastrophize over a tiny little fingertip amputation,” he says. When rehabilitating, some are afraid to use an injured finger, delaying recovery.

Melissa, on the other hand, “started her road to recovery immediately,” says Ignatiuk. “If you get into a state where you’re in depression, you have a catabolic state, you’re not going to heal your wounds properly.”

A paper by Stanford researchers that was coincidentally published within weeks of her accident concluded that mindset is crucial to healing, as are a doctor’s support and the patient’s expectations. Melissa was three-for-three.

In a deeper sense, exercise conveys to patients “a sense of mastery and control,” he says. “They feel, ‘I’m doing something to improve my health. I’m doing something for me that I have control over.” Psychiatrists call this “self-efficacy,” which can lead to greater confidence and a sense of well-being.

The physiological explanation for exercise’s benefits isn’t entirely clear, he says, beyond the endorphin release by exercise, which improves brain chemistry and lifts mood. But anecdotal evidence abounds, Blumenthal says. “People who have had a significant injury or loss, whether it be physical or emotional, immensely benefit from physical activity.”

Even Melissa’s easygoing cycling pace helped, he surmised: “The incremental benefit of physical activity really begins when a person just starts a program. Even a low level of physical activity is better than nothing,”

TeBockhorst says the benefits of exercise are “innumerable and immeasurable” for both mind and body. After an injury and surgery, “those benefits are only amplified. It’s the single best thing patients can do for themselves.”

The accident “was absolutely devastating for her. But I never saw her cry,” Ignatiuk says. “She just kept asking more and more questions. You could just tell: She wanted to figure it out.”

Oh, she cried, Melissa says, just not around her doctors. “I’m good at compartmentalizing. I would take that thought of climbing that was making me sad, let it come out of the box. I would talk about it with my husband if I needed to, and that’s when I would cry.”

A Vanderbilt University study of 100 years of research found that a positive attitude is crucial to handling stress and healing. Among the keys are knowledge (check), inner resources (check), and social support (check). Melissa’s friends were always there. When the climbing rangers she volunteered with at Rocky Mountain National Park called, she asked that they hold her spot. 

Meanwhile, she was distracted with sourcing materials for the restaurant: lighting, paint colors, tiles, menus, everything. “I had to open this restaurant. I had a loan, I had employees,” she says. “That was my biggest focus, besides putting all my energy into being positive and hopeful for my best outcome.”

It’s a notable cycle: Biological and behavioral pathways are “all probably acting in concert, or that one is leading to another,” she says. Optimists tend to have lower levels of inflammation, better endothelial function, higher levels of good cholesterol and lower levels of triglycerides, she says. But it’s just an association: “You see the two things tracking side by side, but we can’t really say that that causes lower inflammation.”

Moreover, when an optimist suffers trauma, she will “focus less on how dire the consequences are, or the pain, and orient herself to the bigger goals.” 

“We know that optimistic people tend to be more persistent in reaching their goals,” Lee says, and they may view an injury “more as a challenge rather than a threat.”

Back home, Adam bought Melissa a Peloton bike. As her hands healed, she shopped for new holds for their home climbing wall, ones that her now-smaller hands could grip. About 3 months after the accident, she was doing “pull-ins” on their home wall — extending her arms and pulling her body to the wall. 

“What this accident taught me is patience, acceptance,” she says. “It forced me to ask for help — first in personal care and then with the restaurant.”

The Peloton is crucial, she says. 

“Every part of me has to be 10 times stronger than what I was in the past to overcome the loss of fingers and thumbs. Your core, your legs, everything has to be super-strong because my grip isn’t as good. I fall off the boulder a lot because I don’t have the tops of my fingers to really get on those holds.”

She had to rewire her brain, which would warn her, “Don’t grab that hold, you don’t have fingers!” But each year, she’s able to cling to progressively smaller holds.

Ignatiuk says her always-strong attitude evolved “once we had the certainty of what the final result of her hands would be, once she came to that closure and she accepted it. And when she got back to climbing, that’s when she really accelerated.”

Her athlete’s approach to improvement  — “I couldn’t do this yesterday, but I can today” — also set her up for success, Ignatiuk says. 

“Now she’s kind of on a new course, and she has to see her improvements in a completely different way,” he says. 

A climber is a special kind of person, he says. It’s mostly down to perseverance. 

“The mindset. Focusing on the good, not perseverating on the bad. Her inquisitive nature, the problem-solving skills, overcoming adversity, and having a support group,” says Ignatiuk. “It was the perfect mix.”