**Ron Lands is a clinical professor of medicine at the University of Tennessee where he teaches and practices hematology**

Meghan Adler’s poem, “Pre-Elegy for John”(Fall 2014, Intima) opens with the narrator asking her stepfather whether there is anything good about Parkinson’s. That question reminded me of an elderly woman I met early in my career who assured me that she was thankful for her cancer. She described a kind of comfort in knowing, based on clinical evidence, her likelihood of surviving six months, nine months, or even a year. Her life now had boundaries, a beginning and an end, predictable if not exact. She had a measure of time to set her affairs in order and prepare for her death. As a newly-minted oncologist, I had never weighed the advantages or disadvantages of sudden death versus death by chronic disease. I’d heard my mother talk of her brother who was killed in WWII and witnessed the effect of the retelling on her and her siblings. My dad described going AWOL from his naval unit when his dad died unexpectedly. He hitchhiked from San Francisco to East Tennessee in mid-winter and barely arrived in time for the funeral. That memory still caused him pain more than a half century after the fact. I had not yet met death personally. To me, it was the same in every case, a sad story told in hushed voices, always traumatic and painful. My dad died for ten years before he went to hospice, and I was still surprised at how fast it happened. It seemed like one day we sat in his attorney’s office while he documented advanced directives and designated powers of attorney, then God hit the fast forward button letting us blur through the next few years to the predawn hours of a summer night in June where I sat in his bedroom and watched him labor to breathe. For several years after that afternoon in the lawyer’s office, little changed. He continued to mow the yard he’d tended year around since 1950. His only concession was a flimsy face mask that he wore to pacify my mom. He did forty push-ups every day, at first all at once, and later in divided doses. He walked laps around his car parked in the garage to“exercise his lungs.” While his decline at first was barely obvious, over time this man who had fought in two wars on the far side of the globe, whose idea of a summer vacation was to load our family into a station wagon with no air conditioning and tour Civil War battle fields, had deteriorated to where his world was defined by the length of his oxygen tubing. Despite his advanced directives and knowledge of the natural history of pulmonary fibrosis, he nurtured a childlike faith that his scarred lungs could be healed. He insisted on seeing his pulmonologist regularly up to the week he died. He planted the seed for my poem, “The Appointment,” (Fall 2015, Intima) the morning of his last doctor visit when I steadied him and looked over his shoulder at our reflection in the mirror while he shaved. Our images side by side looked like a time lapse photograph of me changing into him. I remember feeling a sense of appreciation for the generosity of time and the opportunities it had afforded...the only good thing I can think of that accompanied his chronic, lethal illness.

Adler’s poem illustrates with elegance what I experienced personally and what my wise patient tried to teach me. If there is anything good about Parkinson’s, pulmonary fibrosis or any other chronic, incurable disease, it is the time it gives to remember, to appreciate, to love in spite of a different theology or political leaning and time to prepare for the inevitable appointment that modern medicine might postpone, but never cancel.

Ron Lands is a clinical professor of medicine at the University of Tennessee where he teaches and practices hematology. Prior to his partial retirement, he practiced medical oncology and hematology near the community where he grew up, and has experienced both the privilege and burden of treating friends, acquaintances and a few relatives. His writing is drawn from that experience, and often deals with poor, uneducated people and how they grapple with matters of life and death. At the age of 50, he pursued an MFA at Queen’s University of Charlotte to better tell their story. He continues to practice because of his love for the biology in medicine and the stories that make it human.