Johanna: Facing Forward

Johanna modeled a pair of movie-star sunglasses with rhinestones arched across the crest. Striking exaggerated poses, she shook her hips to a bumping beat coming from a metallic pink iPod sent to her as a get-well gift.

It was April 2, the day before her first big surgery. She had been at MetroHealth Medical Center for nearly a month.

A friend with long blond braids jumped up to join Johanna's dance party and a sack of Skittles slipped from her pocket.

Johanna snatched the pack, wiggling her fingers inside, plucking out a piece of red candy. She rubbed it against the tip of her tongue, smearing the sugary coating. Then she shrugged, shoulders drooping. She couldn't taste it.

Dr. Michael Fritz slipped through the sliding glass door into her room still wearing a surgical cap and booties. He had a break in the middle of a cancer reconstruction surgery and wanted to check in. Johanna giggled with her shoulders and her eyes. A new trend -- it happened every time the handsome doctor entered her room.

Fritz asked Johanna if she had questions about the surgery.

"Leg?" she wrote, on her dry-erase board.

"Left leg," Fritz told her, pointing to the spot where the incision would run below her knee and above her ankle.

"When can I drink?" she scribbled.

"In four or five days," Fritz replied.

Johanna pumped her fist in the air.

"When can I talk?" she asked.

"Same thing, four or five days," he said.

Another fist pump.

"That's good because I really like to talk and it's killing me not to," she wrote.

Last question.

"When can I get teeth?"

The blast took most of the teeth on the left side of her mouth and the rest were broken or rattled loose from her gums.

"That's going to take a few months," Fritz said, his eyebrows raised. The teeth will have to be individually screwed in. Johanna nodded, not happy, but accepting.


In the morning, Johanna's family held hands in a circle around her bed. It was still dark outside. They prayed in Spanish with Johanna doing her best to mouth the words.

She was groggy, not a morning person at all, but still remembered to thank the nurses who wished her well as she was wheeled from her room.

In the area where they prepare patients for operations, the only sounds were swishing curtains and nurses' squeaky shoes. Johanna's leg poked from under a knit hospital blanket, bobbing nervously.

"Are you Alexis Kennedy?" a perky woman with a ponytail asked Johanna.

Johanna shook her head no.

Looking shocked, the woman glanced down at the textbook-thick sheath of records that followed Johanna to her appointments around the hospital.

When Johanna was admitted to Metro, they gave her a fake name to protect her from unwanted visitors and keep her safe. The plastic band around her wrist bore that name.

Whenever nurses called out to the waiting room with updates for the "Kennedy family" Johanna's walnut-colored, raven-haired relatives laughed.

A doctor marked a purple line on Johanna's leg where Fritz would remove part of her fibula to mold into her new jaw.

"Next time, use lime green, it's my favorite color," she admonished.

A nurse with coifed hair and a white coat started an IV in her arm, a process that Johanna hated. Her veins were tired of being poked.

The woman wheeled her into the bright operating room to the Latin beat of Shakira.

People in the room started touching her all at once.

"You're like a rock star," the nurse told her, as Johanna drifted off.

The nurse lulled her with thoughts of beaches, of being able to drink Sunny Delight in just a few days.

"Now all you have to do is think good thoughts," the woman cooed in Johanna's ear. "And all the bad stuff will be behind you."

If only medicine could make Juan go away, too. He invaded her dreams still. Sometimes he was the Juan who had brought her presents, who loved her. It was unfair that he was allowed to be nice in her dreams. But when she was awake she constantly feared he'd find a way to finish what he started.

Shortly after 9:30 a.m., with Johanna's body draped in blue, sterile cloths, the football-style face mask was removed.

Fritz lifted Johanna's iodine-coated leg into the air, propping it onto his shoulder. He squeezed her flank in his palm.

Johanna has thick skin, Fritz said. He sees that mostly on patients who have diets padded with fast food.

Her face was opened with an incision at the crook in her neck, running from ear to ear. Four surgeons worked there with an array of tools, mini pitchforks, big scissors with white handles and clamps to ready the area.

Suddenly, surgery stopped. Fritz raised his head for the first time.

"OK. This is an emergency," he said.

"This is not my Enya," he said pointing to his iPod, hooked into speakers in the corner of the room, under a broken clock that only made time seem slower.

"Seriously," he said. "This isn't mine."

About 1 p.m., Fritz finally cut into Johanna's leg. There was no blood, because of a tourniquet tight above her knee.

Fritz's pattern to cut was shaped like a narrow heart, similar to the kind kids cut from red and pink construction paper on Valentine's Day. He sliced down, slowly, to the bone, using a saw a little larger than a motorized toothbrush to sever the flap of skin, tissue, bone and veins.

The surgeon fitted a titanium plate, reminiscent of something from a Terminator movie, to Johanna's face. He used a tool similar to needle-nose pliers to bend it into the shape of her jaw. The metal piece, serial number 449.663, was screwed down with 12 metallic purple screws the size of pen tips.

Fritz cleaned a 6-inch piece of fibula. He used pieces of a tongue depressor to make guides for cutting the bone into pieces.

Fritz worked the bone with his hands, snapping it, then honing it with a tool similar to one used for filing fingernails in a salon. The bone was then fitted underneath the metal plate.

After nearly 13 hours, the surgeons began to stitch Johanna's incisions.

The pieces came together like a puzzle, but some were missing.

At the last minute, Fritz decided to take a small graft, the size of an almond, from Johanna's left shoulder to prop up her bottom lip.

As he stitched, Fritz wondered aloud how Johanna would react to the surgery.

Many patients, especially younger ones, take a mental dive in the weeks following surgery, when they realize healing doesn't come quickly.

"This is when she could get depressed," Fritz said. "When she sees it."

Her face will be bloated for weeks. But Fritz's surgeon's eye saw the progress.

He prepared to talk to the dozen or more of Johanna's family members still gathered in the waiting room, though it was almost 11 p.m.

Fritz looked down, studying Johanna.

"That's actually not bad," he said. "For starters."