Centers of Excellence

Mia’s Story: Her Best Foot Forward

Mia, trauma center patient

What happened to Mia last summer became the stuff of urban legend among her classmates. When she finally returned to her elementary school last September after a two-month absence, one of the students asked if a shark had really tried to bite her foot off.

It wasn’t a shark that attacked Mia that fateful day in July. But what did happen to Mia was no less harrowing.

It was supposed to be a fun family day boating on Lake Saguaro in Arizona’s Tonto National Forest. It was the first time Mia had ever been on a boat, and Mia’s dad Will, was excited to finally get the boat on the water. He and his friends had been fixing it up for months.

They were the first people on the lake that morning; Mia, Will, her mom Angela, her younger sister Anisa, and Ronnie, a family friend. Not more than 500 yards from the shore, they passed the buoys and began zipping across the lake. In a split second, the float tube inside the boat caught wind and began to soar out of the boat. As it did, the slack of the rope got tangled around Mia’s right foot. The force of the tube picked up the petite 11-year-old sitting in the middle off the boat, pulled her straight up in the air, over her dad’s head and into the water.

Mia, trauma center patient

Will dove off the back of the boat after his daughter, but Ronnie, who was driving, got to Mia first. As Mia bobbed in the water, she told her mom that her foot felt weird. “She wasn’t crying, but I could tell she was anxious,” says Angela. “I bent down to help pull her leg out of the water to see what was wrong, and never fathomed what I would see.” Mia’s foot was virtually severed from her leg, attached only by a few tendons.

When Will reached Mia he cradled her in his arms. “I lifted her up and her leg came out of the water with no foot. The foot came out a little later…like a Barbie doll when the foot has snapped off.” Angela was already calling 911 from her cell phone as Will and Ronnie lifted Mia into the boat and began wrapping her leg and foot with towels as they headed back to the shore.

Reliving what happened that day is still clearly painful for all of them, just as agonizing for her parents as it is for Mia. In fact, most of what happened over the next few hours is a blur to Mia even though she remained conscious the entire time. “I just remember being scared…afraid that I wasn’t going to have a foot anymore,” she says.

Mia hadn’t been too keen about going boating that day in the first place. “She’s not a thrill seeker. She doesn’t like roller coasters or anything like that,” says Angela. But as all parents would, they had reassured an already tense Mia that nothing bad was going to happen. “It haunts us to this day that we had just told her minutes before the accident that everything was going to be fine.”

Mia, trauma center patient, with family

Both Will and Ronnie had basic EMT training. But it was little consolation to them considering the severity of the injury and the fact that they were in – what seemed like – the middle of nowhere and miles from the nearest hospital. It was only 8:30 in the morning and they were still the only people on the lake. It was eerily quiet, surreal, and terrifying. Sheriff’s deputies, police officers, an ambulance, and a helicopter had all been dispatched. But every precious minute that ticked by felt like an hour.

As her dad and Ronnie tended to Mia’s foot, Angela tried to comfort her daughter, who remained surprisingly calm. “She wasn’t reacting like I would have expected. She wasn’t hysterical at all and seemed more concerned for us, telling us that everything was going to be OK,” says Angela.

Mia’s parents were overwrought with emotion but tried not to show it, not wanting to frighten Mia or her sister. Will and Angela took turns pacing out of eyesight of Mia, trying to pull themselves together as they waited for help to arrive. Angela starts to cry as she remembers the most heartbreaking moment of all; when Mia called her family over to her one at a time. “I don’t know if she was saying goodbye to each one of us…I don’t know.”

From Tragedy to Twist of Fate
Three Maricopa County sherriff’s deputies were the first to arrive. One of them was an EMT and began to stabilize Mia and treat her for shock. Once the helicopter arrived, Mia was airlifted to Maricopa County Medical Center.

The first surgeon to see Mia thought her foot would need to be amputated, but he was more concerned about saving Mia’s life rather than an appendage. But he called in one of his colleagues to take a look, an orthopaedic surgeon who made the call to Phoenix Children’s looking for Dr. Jozef Zoldos, a Phoenix Children’s plastic and microvascular surgeon, and the only person he thought could save Mia’s foot.

Mia, trauma center patient

Within 10 minutes, Mia was in an ambulance on her way to the Phoenix Children’s Level 1 Trauma Center. When they arrived, Angela says 20 to 30 people were waiting for them. “It was amazing, amazing, amazing,” says Angela. “There were doctors, nurses, even the child life staff waiting for us. From the moment we got there, it was like Mia was the only patient.”

The trauma center had only been open for four days, and Mia was the first level 1 patient – the most severely injured – and the first to be taken straight to the operating room. “I think it really speaks to the planning of everyone involved with the trauma center,” says Zoldos. “The system was up and running and able to take on an extremely intricate and complicated case right out of the gate.”

Zoldos admits that reattaching Mia’s foot was risky, and something many surgeons wouldn’t have attempted. She would need a series of several operations in just a few days, each of them having a limited success rate. “A doctor questions whether or not to put a child through something like that or just amputate,” explains Zoldos. “And when you present the facts to parents, they always seem to make one definite choice. Mia’s parents never wavered on their desire to reattach the foot.”

The first step was for Phoenix Children’s orthopaedic surgeon, Dr. Greg White, to reattach the bone and rebuild her ankle. Zoldos would then reattach the arteries and veins one by one to reestablish circulation.

Before they could take Mia back for surgery, she insisted that doctors first take a look at her father’s hands, which had been badly burned when he grabbed the rope as the tube and Mia flew over his head. “After everything that had happened to her that day, she was worried about me,” says Will as he fights back tears. “That’s just how Mia is. She has a big heart.”

Surgeons Zoldos and White worked on Mia for eight hours. By midnight, she was recovering in the Pediatric Intensive Care Unit (PICU). It would take a series of four more surgeries over the next 12 days to reconstruct the nerves and transfer ligaments and veins from her left leg to her right. Lastly, Zoldos would need to bridge the gap from Mia’s foot to her leg where skin and muscle had been torn away. This would involve a free tissue transplant where the surgeon removed skin and muscle from Mia’s torso and transferred it to the area between her leg and foot.

But Zoldos is quick to give credit to the rest of those who worked on Mia: the trauma surgeons he refers to as the “captains of the ship," the intensivists, anesthesiologists, nurses, social workers and child life staff. “We take a multi-disciplinary approach to the treatments of these patients, which is what makes a trauma center work. Every patient has different needs, and in Mia’s case, they were extensive.”

Besides the work of the surgeons, Angela says the staff was with Mia every step of the way. “The nurses and child life staff would go out of their way to do stuff for Mia. Our time there was a good as it could possibly be, from the therapy dogs, music therapy, the food in the cafeteria, even the coffee cart that came around each morning. There was never a time when we thought, ‘when can we leave this place."

Mia had a constant stream of visitors in the PICU: friends, classmates, teachers, and her parents’ co-workers. The staff even pulled some strings so Mia’s beloved dog, Frodo, could come for a visit. “Mia has always had a special personality and everyone there took a personal interest in her,” adds Will. “Even these doctors who are so highly regarded developed a personal relationship with her.”

Through it all, the staff marveled at how calm and cooperative Mia was. “She was an absolute trooper and never lost her sense of humor despite what she was going through – an experience that was physically and psychologically taxing,” adds Zoldos. “It was outstanding to see what a strong person she is at such a young age. She’s an adorable child who obviously has a very strong emotional makeup, something I’m sure she owes in part to her parents, who are wonderful people.”

But there was one thing Mia refused to do. She couldn’t bear to look at the foot – a defense mechanism of sorts after catching glimpses of it when she was initially injured. Zoldos says it’s a common reaction for people who experience an injury as horrific as Mia’s. She made sure it was always covered with a blanket. When the doctors or nurses would come in to look at it, Mia would cover her face with a pillow. “The scariest part of it all was not knowing what I would see,” explains Mia.

Mia and her family had prepared themselves for a two to three month stay in the PICU. To everyone’s astonishment, Mia was ready to leave in just two weeks. She would still spend months recovering at home and would need physical therapy. But she was returning home just the way she had left – something that no one who saw her foot that day would have predicted.

Back on Her Feet
Her parents still marvel at how well Mia handled everything and how fortunate they were. “The stars were aligned that day to have as many things fall in line the way they did. And everyone at the Hospital who had any interaction with Mia was amazing," adds Will, who also gives credit to those first on the scene. They're also grateful for the support they received during such a difficult time. "Our employers were so understanding, Mia's teachers, the school district, even our insurance company did so much to help us out."

Mia learned a lot too during the ordeal. This athlete who likes the Jonas Brothers, scrapbooking, and doesn’t go anywhere without a book, says the experience made her appreciate her family even more, including her 7-year-old sister Anisa, who looks up to her big sister. “My family has always been there for me and I know how hard this was on them too. I’m so glad they helped me,” adds Mia.

There were few perks too. Mia giggles when she says she got to shave her legs a little earlier than if the accident hadn’t happened. She got every adolescent’s most coveted possession; a cell phone. And she got a tattoo…of sorts. One of the scars on her right ankle is in the perfect shape of a heart. When she finally returned to school, rather than capitalizing on her newfound notoriety, she got tired of retelling the story and resorted to telling people that she simply broke her foot.

Mia has full function of her foot, but has to be careful about not putting too much pressure on it until she regains all of the feeling back – a process that could take a few years while the nerves regain function. She says it “felt weird” to put a shoe on for the first time, and admits that she’s still a little self-conscious about her ankle that doesn’t look completely normal.

But the girl has some serious grit. She recently participated in the 5th Annual Pat's Run in honor of Pat Tillman, and even mustered up the courage to get back on a boat when she went on a field trip to San Diego with her classmates.

But those things were a cakewalk compared to what Mia calls her biggest challenge; finally looking at her foot. More than two months after the injury, her parents convinced her that it was time. As Angela undressed the wounds to give Mia her first peek, Mia says the moment was both the scariest – and the happiest of all. When she saw her foot she began to cry. This time it was tears of joy. “It’s my foot. It’s really my foot!”

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