She enters the clinic on a walker, slow yet remarkably steady, and as Pauline Wood hails her host for the day, she gives him a bag of lemon tarts she rose early that morning to bake.
With her white hair and glasses, Wood, 89, is every inch the lovable but tough grandmother, complete with her love of puppies, her passion for raising heirloom tomatoes and her predilection for waving away offers of help with the words, "Oh my goodness, I can do that."
Then you notice the mask.
A shade or two darker than her skin, fashioned from silicone rubber, it covers the places where you'd normally see a nose and cheek. Its purpose: to conceal the hole cancer has eaten in her face, a gap so large she has been unable to live a normal life since 1997.
"I don't like to say it, but children used to stare," Wood says.
She has made a three-hour trip from Delaware to Baltimore for a new nose-and-cheek facsimile, and the man who welcomes her is one of the few people who can provide it. It's her third go-round in a nine-year process that has shaped them both.
Juan Garcia, 45, an assistant professor at the Johns Hopkins School of Medicine, is a clinical anaplastologist. He uses his talents as a painter and sculptor, along with training in anatomy and other sciences, to create and attach custom devices that disfigured people can wear, deflecting attention from their appearance while serving a variety of medical needs.
Garcia is one of 47 certified professionals in his field in the U.S., about 200 worldwide.
"I deal with a population that can't get help in any other way," he says.
Garcia, the director of the Facial Prosthetics Clinic in Hopkins' tiny Department of Art as Applied to Medicine, has been working on a sort of rough draft of the piece for about two weeks. His goal for today: check how it looks on the patient, then use his skills to perfect it, sending her home with the most imperceptible blend he can create.
Wood settles into a dentist's chair, leans back and closes her eyes. Garcia applies the device-in-progress with a special adhesive, steps away and takes a long, appraising look.
He doesn't say so, but the match strikes him as flawed — so badly flawed that he might not be able to make it work at all.
But today is delivery day. He reaches for his tray of tools. Over the next three hours, he'll close more gaps than one.
Juan Ramon Garcia Jr. is like many who end up in the field of medical illustration, the subject taught in his department within the Hopkins medical school. He was born with rare talent in two radically different fields, and the gap between them created an inner conflict.
As a child, he dazzled kids and grown-ups alike with his crayon drawings and the pots he'd make out of clay. But during grade school, when he tried to get into a gifted-and-talented arts program, he fell just short.
"Maybe art really isn't my thing," he says he thought at the time.
He soon fell in love with science. Encouraged by his working-class parents, he studied hard, began dreaming of a career as a doctor, and ended up taking pre-med courses as the first member of his family to attend college, at the University of Miami.
But the conflict never quite left him.
One semester from graduating, Garcia felt such stress from all the memorization that he decided to take an art class as a break. The act of drawing, meditative and intense, felt so liberating it led him to rethink his goals. He scuttled 31/2 years of science to start college again, this time as a fine-arts major. "It was a leap of faith," he says.