Definitive answer as to whether Johan woke up to question Tenma or it was a hallucination?

Question

When Dr Tenma visits a comatose Johan in hospital, we see a scene where Johan wakes up from coma to ask an existential question, which contrasts with this philosophy that life is inherently meaningless. Tenma does not answer; we cut to a scene where Tenma is panting in a cold sweat over a comatose Johan.

Which of these interpretations is true:

1. Tenma has hallucinated it entirely and Johan has never gained a conscious state, much less walked away.
2. Johan has indeed woken up and questioned Tenma and later escaped.
3. The screenwriter (or manga artist) has made this a perfect ambiguity.

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Background

The scene seems open to interpretation as I later discovered. The contrasting interpretations:

1. I infer that Tenma hallucinated this entirely as in the next scene Johan appears to not have ever stirred. Tenma feels safe leaving him alone. Tenma hallucinated this, overcome by understanding the reason for Johan's bitter life philosophy.
2. Popular Wikia author (quoted below) says that there is a possibility that it's for real (Johan woke up, questioned Tenma, went back to sleep while Tenma was in a cold sweat, then later left the building). This is supported by the fact that Johan leaves his bed by escape (or death; as the same article presents this ambiguity), proving that he was physically capable of doing so.

From Wikia:

...end of the series, Tenma paid Johan a visit in the state police hospital, where he had been unconscious ever since the massacre. After being informed that he had [a] name, Johan sat up and began talking to Tenma, retelling the story of his mother's choice and asking which child wasn't needed. It is unclear whether this was a hallucination that Tenma experienced or if it was actually real.

and

His mother's true sentiments while making the switch might have been frightening for Johan, leaving him to question the scene for years to come. However, if that segment is to be interpreted as a hallucination by Tenma, this might not be the case.

Answer 1

Compare these two images:

_{(Click image to enlarge)}

• The first image is from the scene at 18:31 (before the flashback of Johan's memories)
• The last image is from the scene at 21:12 (after the flashback of Johan's memories)

Once you're done comparing them, in the second image, you would notice that not even a single hair is out of place. Johan's face shows virtually no expressions different from the first image. The wrinkles shown over the pillow are identical.

It is simply impossible for a person to take care of all of these things in a time of split-second, specially when somebody is sitting beside.

Johan certainly had masonic charisma, but that doesn't imply that every action of him was perfect. In the words of Hans Georg Schuwald and Julius Reichwein (Episode 36: The Monster of Chaos):

Schuwald:

How any person could ever be that, perfect? I imagine having one sight just confuses the matter. But I can always sense it. Yes, the presence of something so unerringly precise, like Johan. I feel as though he is not of this world at all. I do.

Reichwein:

Oh he's very much of this world, I assure you. And he has left a paper trail, just like the rest of us. And here it is.

If you also compare the scene at 20:51 and 20:59 of that episode, then you would notice that at 20:59 Tenma's chin and eyes were in the position similar to where they were before the scene of Johan being awake was showed. But in the scene at 20:51 (during the conversation) the situation was rather different where Tenma had his chin and eyes oriented very differently.

The images are sufficient evidence for me to consider that the ending was an imitation of the state of Johan in Episode 2, where Tenma was talking to him or rather himself but once Tenma left the room, Johan was shown to came back to his senses and was listening the entire conversation of Tenma.

In short, Johan listened to what Tenma said, but didn't respond and left the room later, which means the conversation between Tenma and Johan was hallucination of Tenma.

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I noticed a bit of conflicting evidence which challenges my proposition. I'm not certain whether it's a design fault or deliberate information introduced in the story. In any case, take a look at the following images.

• The first image is from the scene at 21:02 (Tenma was done talking to Johan or rather himself)
• The last image is from the scene at 18:24 (Tenma came and started telling about his meeting with Johan's mother)

Anyhow, I'm done!