BLUE KNOB - Every once in a while, Monica Walters says, a stranger still somehow recognizes her: "Oh, you're Monica."
It's been 19 years since she struggled in a specialized hospital unit, weighing 1 pound, 2 ounces - and, in her mother's words, the length of a pen and the width of three dimes.
"A lot of churches were praying for her," Dianna Walters said on a hot Tuesday afternoon outside their Greenfield Township home, explaining how her daughter stirs up memories even among strangers. "And it wasn't just a once or twice prayer."
Next Sunday, Monica, the daughter of Dianna and Lance Walters, will graduate from Claysburg-Kimmel High School, her name listed on the honor roll for four consecutive marking periods. She'll have fought through a dangerously early start to life - she was born at 24 weeks - and a late start to education, graduating with her peers to seek work and responsibility like any other teen.
"It's a miracle that I'm here," Monica said in her distinctively quiet voice, the result of a paralyzed left vocal cord. "I'm just taking it one step at a time."
The first steps, which she remembers thanks to looking at baby photos and videos, were the hardest.
Monica was born Dec. 15, 1993, in an emergency operation at Geisinger Medical Center in Danville, Montour County. Dianna had struggled with pregnancy complications that left her hemorrhaging dangerously; the newborn Monica, suffering from a bevy of health problems, required immediate, specialized care away from her family.
She remained in the hospital for more than nine months. Her family was able to visit only on weekends. They stayed from Fridays to Monday mornings, living in Danville's Ronald McDonald House, Dianna said.
Photographs from the time show a tiny Monica, seemingly tangled in tubes and wires, sleeping under a heat lamp and plastic wrap. Her 2-year-old brother, Ethan, couldn't visit her in person: Premature babies' weakened immune systems leave them highly susceptible to young children's germs.
In a Mirror article at the time, Dr. Keith Marks, chief of newborn medicine at Hershey Medical Center, hailed the medical advances that had gradually reduced infant death rates. But even today, complications related to premature birth are the leading cause of death in infants, according to the Centers for Disease Control and Prevention.
Monica survived, and she headed home for the first time in October 1994 - more than nine months after she entered the world.
"Our living room was a hospital room. ... She was on a ventilator. She was on oxygen. She had a pulse oximeter and a feeding pump," Dianna said. "It was kind of like we lived in a box. Very few people were allowed to come into the house."
Nurses cared for her in shifts, working 16 hours each day. Hospital readmissions were a monthly occurrence: Monica would frequently "code," or stop breathing, Dianna said.
"We should've bought stock in Life Flight," Dianna said of the medical helicopter service. "We'd be rich."
Monica required surgeries on a regular basis: on her eyes, her vocal cords, her stomach, even one that grafted rib cartilage to her trachea. She endured operations literally from head to toe, her mother said.
Her hearing is badly damaged; she has required hearing aids for years. Even learning to crawl posed unique problems, as she would stretch her tracheotomy tube until it disconnected.
"Other than that, we're perfectly normal," Dianna said with a laugh.
As Monica grew older, her health problems became more manageable. But dealing with a frequently sick child can put a heavy strain on any family. The stress often ends in divorce, Dianna said, but it didn't happen with their family.
And for children just starting school, as Monica did a year late, trouble communicating with other kids can make life difficult, said Roberta Pears, a teacher for the deaf and hard of hearing who worked with Monica from the time she was in preschool until last year, when Pears retired.
"She had to work hard for everything," Pears said. "But she's very strong-willed. She's a very hard worker. And her parents are fantastic."
In gym class, Monica can't run as long or as far as other students. During lectures, she sits near the front so her hearing aids pick up the teacher's voice over the magnified hum of the air conditioner. And there's always an inhaler nearby.
"If I didn't have all these problems, I probably would have been on some kind of team," Monica said.
But she's possessed of a self-described love for learning and a willingness to work as hard as she can. On Tuesday, she was excitedly awaiting her cap and gown and preparing for an honors award ceremony at Claysburg-Kimmel.
Pears recalled a state audit of the district's special-education program, in which experts interviewed students to tally their teachers' success.
"I can just remember, the two auditors came out of there and just said: 'Wow. She is so wonderful,'" Pears recalled.
With school coming to a close and graduation just days away, Monica said her next step is to secure a job and to get a driver's license. She's already filed job applications, and soon she'll have to learn to manage money and pay bills, her mother said.
Monica admitted to at least a little nervousness.
"But I feel better than before. I do feel more safe than I was when I was younger," she said.
She isn't leaving home just yet, though. Like her family, she's moving one step at a time.
"In Monica's world, people are basically good," Pears said. "That's the way she thinks, but you know she's going to run into people that aren't."
Asked whether her life has made her feel tougher than most, Monica hesitated. The long-term results of her risky birth - occasional surgeries, extra needs at school, multiple doctor visits each year - are familiar, she said. She's known them her whole life.
The family's struggles have changed them, as well, Dianna said. When her daughter was about 5, Dianna took classes to become an emergency medical technician, a job in which Lance had long served.
"When Monica coded, we'd always have an ambulance there," she said, noting that many emergency responders in the Blue Knob area were distant relatives. "That was my way to give back."
Now, with spring turning to summer and Claysburg-Kimmel's Class of 2013 preparing to say their goodbyes, Monica said she's noticed her fellow seniors getting along better than usual. It's just now hitting many that they won't see their classmates again, she said.
Still, she's excited to get her diploma. Pears, her longtime hearing-specialist teacher, said she'll make the three-hour trip next Sunday to watch her former student join the adult world.
"I always would say to her: She's had to fight since the time she was born," Pears said. "That strong will of hers is what's going to get her through."
Mirror Staff Writer Ryan Brown is at 946-7457.