comma before second 'and' [conjunction]: of pills and their risks and


Senior Member
The patient’s immune system reactivates and, in most cases, gradually destroys the transplant, which is no longer needed. Life goes back to normal, free from a daily schedule of pills and their risks and expense. ---taken from The NYT

Dear all,

Could you tell me whether the first and should be replaced with a comma?

  • If you did, you would create a list of three things: (1) a daily schedule of pills, (2) their risks, (3) expense. The patient would be free of each of these things: they would be free of expense, in particular. I don't think this is meant.

    As it stands, the sentence contains a list of two things: (1) a daily schedule of pills, (2) their risks and expense. Item (2) internally contains another two-item list, with 'their' covering both sub-items. The patient is free of their expense [i.e. the expense of the pills]. There might or might not be other expenses.

    That said, few people know how to punctuate lists coherently. (He said, going by sad experience at work.)
    It certainly sounds a lot better to me with those two ands, LQZ ~ it's almost like three entirely separate entities: (1) a daily schedule of pills, (2) [a daily schedule of] all the risks associated with taking pills, (3) [a daily schedule of worry about] the expense of taking pills.
    It sounds remarkably 'flat' without the two ands.
    I hope someone will come along with some kind of grammatical explanation. (I can't think of one:eek:)
    ewie's interpretation of exactly what is listed is also possible, and I considered it, but I didn't think a daily schedule of risks made enough sense, nor a daily schedule of expense. In this the layering is:

    free from a daily schedule of [[pills] and [their [risks and expense]]]

    My interpretation would be:

    free from [[a daily schedule of pills] and [their [risks and expense]]]

    And this is a grammatical explanation, you!
    Thank you, ewie. :)
    I agree with entangledband, for risks and expense are not daily schedules.