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.
She entered an in-between state: “Am I dead or alive?” A forest, a tunnel, a shaft of light, and the presence of a friend and her grandmother, both deceased. She sensed they didn’t want her to go in the tunnel.
She decided she needed to get back to Adam, her husband. “It was like a reverse-tunnel effect, and my eyes opened, and I saw the gravel” of the driveway, she says. “I could scream.”
When Adam, who was inside the house, opened the door, she blurted, “Hospital, now!” and collapsed in his arms. He carried her to his pickup. Her hands “looked like melted wax.” No blood but a horrible smell. Her screams and the speeding truck prompted neighbors to report a possible abduction. The wood-burning machine remained in the driveway, its circuit-breaker tripped.
The accident had sent a massive electrical current through her body, leaving her fingers a mangled, charred, acrid mess. “I have no hands!” she screamed as Adam sped her to the local hospital.
There Melissa was stabilized and airlifted to a hospital in Greeley.
“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?
Her active lifestyle gave her a leg up, so to speak. We know physical activity is good medicine.
Studies show that exercise is nearly as effective in treating depression as medication. Moreover, researchers say it improves mental health, boosts immune function, promotes a sense of well-being and control. This in turn makes a patient more likely to take good care of herself and stick to a regimen that may lead to a better outcome.
Melissa’s doctors, who would indeed perform some miraculous procedures, agree that her story is a testament to grit, determination, and optimism in the face of grievous injury — and to the importance of movement and mindset for physical healing and mental health.
“Analyze, then overcome.” That was the climber’s approach that Melissa took in her recovery, says Ashley Ignatiuk, MD, her primary hand surgeon.
But first: you scream.
Surgery and Prognosis
Ignatiuk was the hand surgeon on call when Melissa arrived. “Immediately I could tell she was a motivated patient,” he says. “But when I saw her hands, it was hard to tell what I could do because they were so fried. Literally charred.”
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.
“We lifted flaps from both of her forearms, put her into an ‘I Dream of Jeannie’ pose, and then put the tissue from her forearms on her thumbs,” Ignatiuk says, “and left her like that for 3 weeks.”
Seth TeBockhorst, MD, is a climber, and when he first saw Adam and Melissa, both lean and outdoorsy, “I knew them for climbers by sight.” (It was mutual, Melissa recalls: “He was wearing an Arc’teryx jacket.”)
Before the big surgery — dead tissue had already been removed — TeBockhorst asked if she had any questions. “And I said yeah,” Melissa recalls. “Will I ever be able to climb V10 again?”
In bouldering, the difficulty of routes is graded from V1 (easy) to V16 (ridiculous). A V10 is professional level.
The doctor looked at her. “You’ve climbed V10?” Adam chimed in: “She’s climbed harder than that.”
“It was important to me that my surgeons knew that climbing was important to me, that I am an athlete,” Melissa says.
TeBockhorst was careful to balance compassion and honesty. “I had very little expectation that she would ever climb at any real level again.”
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.
“I thought about rock climbing because it was a part of me,” she says. “It was a sad thought because I didn’t have a lot of optimism on that front. At that point you’re not too greedy. You’re happy someone is helping.”
You’ve heard of the journey of a thousand miles. The first step, quite literally, is movement.
From her hospital room, she could see the Rockies. Part tease, part inspiration. She needed to take some kind of first step now. She was told of an exercise bike in another room and went to find it. She rested her crossed arms on the handlebars and started pedaling.
“I wasn’t accomplishing much, but I was still moving my legs,” she says. “And I would stare at my thumb that was dying, clearly dying. It was turning black where it was sewed to me. And I was just trying to will blood flow to it.” Back in her room, she did sit-ups with her sewn arms across her chest.
“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.
Exercise and Healing
Doctors know that exercise speeds healing; that’s been shown in repeated studies that were summarized in a 2021 review by Iranian researchers. Moderate exercise boosts immunity and the endocrine system, which is crucial to wound healing. And while healing requires inflammation, too much of it slows the process. People who exercise generally have lower levels of stress-related markers in the blood, a sign of inflammation. (Bonus: Less inflammation can mean less pain.)
Moderate aerobic exercise can act as an antioxidant, helping the body generate blood vessels to nourish new tissue. Low-intensity endurance exercise seems to raise levels of “endothelial progenitor cells” that help regenerate the lining of blood vessels. And exercise helps provide oxygen to wounded tissue, helping to synthesize connective tissue while also preventing infection.
But exercise can help mental health too, though there’s much less awareness around that – and less focus on mental health for recovering from physical injuries, even though research shows it can help.
At its simplest, movement is a form of distraction. “You don’t think about negative things,” Blumenthal says. “You focus on the present, not thinking about what happened or what could happen in the future.”
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.”
Melissa seemed instinctively to know this. And yet, as she pedaled the bike, she couldn’t help but look at her left thumb turning black.
After 3 weeks, the surgeons detached her thumbs from her arms, amputated that left thumb tip, used skin from elsewhere on her body to cover remaining nubs and her palms, and bandaged it all up again.
Melissa kept up her exercise routine until it was time to take off the bandages.
Tomorrow and the Next Day
“When they showed me my hands for the first time, I was like, ‘You’re kidding me. We’re done?’ But we weren’t done.”
Surgeons saw healthy pink skin and quietly rejoiced. But Melissa saw “Frankenstein-stitched baseball mitts.” They encouraged her to use her rebuilt hands, so she asked for a pen and paper.
“Hello, my name is Melissa Strong!” she wrote. “These are my first words written with my new hands. One day I will climb again!!! And probably will cry a lot along the way which is OK!”
She tears up when she tells that anecdote. As a child in Massachusetts, Melissa says, she cried all the time. And as tough an athlete as she is as an adult, she’s not Superwoman.
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.”
There were eight surgeries in all, literally fleshing out her now-shortened left thumb, and later repairing weakened bones in it that broke, and dealing with an infection.
“She’s my best patient ever, no question,” Ignatiuk says. “The attitude is the most important. If you have a defeatist attitude, you’re not going to persevere.”
Whether a patient’s outlook — her mind, really — can somehow cause lower inflammation and raise antioxidant levels is the “million-dollar question,” says Lewina Lee, PhD, a professor of psychiatry at Boston University’s medical school who studies how optimism affects health.
It’s not just biology or behavior. “They’re probably all acting together,” says Lee.
An optimistic person tends to exercise more, eat better, and stick to a recovery regimen, which is why they have better outcomes, Lee says. “In doing so, you may have kind of better bodily chemistry, your inflammation levels may be lower, and your body may react more favorably to your treatment because you have greater adherence.”
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.
By 6 months, she was climbing easy routes. A year later, she handled a simple traverse on a favorite boulder in the national park. What was once a warm-up now wrung her out, physically and emotionally. But she was back.
Patience and Acceptance
The night of the restaurant’s opening, Adam turned to his wife and said, “You must be happy. Your dreams are coming true.”
“Yeah,” she replied, “but in my dreams I always have my hands.”
Adam and Melissa used to travel the world to climb: South Africa, Switzerland, Italy. Winters were spent guiding tours at Hueco Tanks, a legendary bouldering site outside of El Paso, TX.
Nearly 6 years after the accident, with the pandemic fading and the restaurant (called Bird & Jim) thriving, Melissa is expanding her business with a new breakfast-and-lunch spot and event venue.
The climbing rangers in the national park held her spot, and she has resumed volunteering with them. She skipped only one winter in Texas. She’s now climbing V7 routes and pushing V8.
“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.”