Fowler — Alex Caravantes' grin gave him away.
Finding the Fowler High School senior among fidgeting, jostling band members had been a challenge until the Louis Armstrong-wide smile emerged.
"He's always smiling," band teacher John Zamora said when asked to help locate the teen amidst a pack of boys in the back of class on the last day of school before winter break.
Alex, 17, blends in at this school a few miles south of Fresno where almost one-in-four students is in the 175-member marching band.
But his medical history sets him apart from the rest of the student body. His parents say it's a miracle that he's even alive, let alone that he can march and play the trumpet.
Less than three years ago, Alex was struck by a sports utility vehicle as he stepped into a crosswalk in Clovis. The impact separated his skull from the spine. Ligaments -- strong fibrous tissues -- were ripped loose, and only the skin of his neck held his head to his body.
Alex had been "internally decapitated."
Most people with the injury die. In the past 47 years, as few as 105 people worldwide have survived the trauma to reach a hospital alive, said Dr. Meg Verrees, a Fresno neurosurgeon who reattached Alex's skull to his spine. Those who survive often cannot walk or use their arms or even breathe unassisted.
"It's amazing that Alex did live," Verrees said. The damage to his spine came within "one-millionth of a millimeter" of his brain stem, which is responsible for basic life functions such as breathing. Verrees is writing a book about medical decision-making, and she said it includes the Fowler teen's case.
Alex's chances for survival depended largely on what happened at the scene of the accident on March 12, 2011.
He and his older brother, Eric Gomez, had gone to get sodas and were walking to join the family for a movie at Sierra Vista Mall when Alex was struck. Eric, who had safely made it across the street, rushed back to his brother, dialed 911 and then phoned their parents.
A woman who happened to be in the area came to Alex's aid, Eric said. She identified herself as a nurse, and as Alex wavered in and out of consciousness, she told him not to move. When the ambulance arrived, paramedics strapped Alex to a backboard and put heavy blocks on each side of his head to keep it straight.
"The people did the right things in the field" to keep Alex immobile, Verrees said.
No charges were filed in the crash, Clovis police said.
At Community Regional Medical Center, doctors put Alex in a "halo vest," a device anchored to his head with screws to keep his head straight on his shoulders. Alex's parents, Alejandro and Ruby Caravantes, prayed his injuries would heal if he remained immobile.
But Alex needed surgery. The dura mater, a strong sheaf of tough, connective tissue surrounding the brain and spinal stem, was damaged along with the torn ligaments holding the skull to the spine. "A sneeze could kill him," Verrees said.
He had other injuries, including nerve damage to his right arm, a fractured left shoulder blade, a broken rib, internal bleeding and badly bruised lungs.
Alejandro, an airline mechanic, and Ruby, a county worker, took turns at their son's side. When Alex awoke in the hospital, both assured him that he would be OK, but he wasn't fooled: "I knew how bad it was as soon as I saw the reaction on my parents' faces."
The first two weeks in the hospital were crucial. Verrees repaired the dura mater in one operation. In a second, she realigned the skull and the spinal column, connecting them together with a rod and screws.
The operations were successful at stabilizing his skull and spine, and as soon as he was out of surgery he was on his feet to assist his recovery. But Alex, who turned 15 in the hospital, faced a long road ahead. And he was afraid: "It all sank in that very moment when I stood up for the first time."
After two months in the hospital, Alex was sent home in the halo vest to recuperate. The vest was tolerable but "itchy and disgusting." As his spinal column healed, concern shifted to the nerve damage to his right shoulder.
He had little movement in the arm and hand. "I just hated the way I was," Alex said. "I thought, 'I'm not going to be like everyone else.' "
Fortunately the nerve damage was to his shoulder, not the spinal cord, and the nerves could heal, Verrees said.
But to revive the nerves and strengthen muscles that had weakened from disuse, Alex had to move his arm and hand. But how to get him to exercise them? Before the accident, he had played electric guitar at home, sometimes to the annoyance of his parents. The summer after the accident, his father encouraged him to play.
But there was a problem -- the electric guitar was too heavy to hold.
Alejandro made a deal with his son: strum the electric guitar one time and he would buy a lighter, acoustic guitar. "I stayed up all that whole night just trying to work on it," Alex said.
The next day, he moved his fingers across the strings. Alejandro bought a new guitar and the more Alex played it, the more feeling and movement returned to his arm and hand.
In January 2012, Alex became healthy enough to return to Fowler High.
At first his friends were protective of Alex, said Principal Hank Gutierrez. "He couldn't fall down. Falling down was like the biggest thing we had to be careful with, and his friends would walk side-by-side with him almost like pillars to stabilize him."
But that guardedness didn't last. Now, his friends are more apt to give him a friendly shove upon meeting and Alex responds likewise.
These days, Alex is seldom without the acoustic guitar slung over his shoulder and a pick in his right hand to pluck the strings. The slight teen with a soft voice spends hours writing lyrics and putting words to music for himself and to share on YouTube.
One of his songs is "Get Away," which he wants to record.
"It's a good song," longtime friend Nicolas Meza said last month to encourage Alex to sing and play guitar between classes at the high school.
Music links Alex with many of his friends. Before the accident, Alex and Nicolas had been in a garage band. Most of his friends are members of the school's marching band, and many came to see him in the hospital and at home during his months of recovery.
When he returned to school, his trumpet was waiting for him. Zamora had kept it behind a whiteboard in the band room. Alex had to relearn the instrument, but that didn't take long, Zamora said: "He plays the guitar and sings as well. He's a very talented musician."
Although he was able to return to his music activities, Alex had to give up being a member of the school's wrestling team.
But he's determined not to let the accident define him. He's so animated that it's difficult to spot the slight stiffness to his movements. With his reconnected spine, he can bend, but only from the waist down. He can turn his head slightly side-to-side but not in a swiveling motion.
When student Shelby Scribner met him last year, she was unaware of his accident and that he had just returned to school.
"Honestly, until he told me, I would have never known," she said.
It's OK if people know about the accident, Alex said. "It gives them a better idea of who I am and how I am." And, after a minute's pause, he added: "I'm not upset with who I am."
The reporter can be reached at (559) 441-6310, email@example.com or @beehealthwriter on Twitter.