This was the best psychological thriller I've read. It was a slow burn, but the way the pieces of the puzzle came together throughout kept me reading, even when I wanted to stop. I'm pretty sure Johan sitting up was just a figment of Dr Tenma imagination. I don't believe that physically happened. I do feel this was a sad ending though, Tenma really did end up all alone like Johan predicted. He has no wife, children, etc. he just travels, helping people. Very bittersweet.