In January of 1983 John Florio, a seventy-eight year old landscape gardener, was contemplating retirement. He developed abdominal pain and underwent a GI series, which showed an ulcer. He was treated for one month and re-x-rayed to see  if the ulcer had healed. This time, however, it was larger and looked malignant. A biopsy revealed cancer of the stomach.
   I first met John in late February when he was referred to my office for surgery. I suggested to him that we get him into a hospital right away since I was going on vacation, and I thought that with a rapidly advancing cancer he ought to have surgery immediately. He looked at me and said, "You forgot something." "What did I forget?" I asked. "It's springtime. I'm a landscape gardener, and I want to make the world beautiful. That way, if I survive, it's a gift. If I don't, I will have left a beautiful world."
    Two weeks after my vacation, he returned to the office, saying, "The world is beautiful, I'm ready." He looked incredibly well the night after his surgery, with no pain or discomfort. The pathology report revealed: "Adenocarcinoma,  poorly differentiated, invasive through gastric wall and into perigastric adipose tissue. Proximal margin involved by tumor, seven of sixteen lymph nodes positive to tumor." That simply meant he still had a lot of cancer left in him after the operation. I explained to him that he ought to consider chemotherapy and x-ray therapy to deal with the residual cancer. "You forget something," he said. "What did I forget this time?" "It's still spring. I don't have time for all that." He was totally at peace, healed rapidly and was out of the hospital well ahead of schedule. (His granddaughter, an oncology nurse at Yale, was fully aware of the findings and his choice.)
    Two weeks later he was back in my office, complaining that his stomach was upset, and I thought, "Aha, it's the cancer again." It turned out to be a virus, which I treated symptomatically, and he left my office.
    In March of 1987 I arrived at my office and saw John's name in the chart rack. "You must have the wrong chart," I said to the nurse. "No that's the right chart," she said. "Then there must be two people with the same name." "No, no," she insisted, "he's sitting in there." Then I showed her his pathology report to explain why I assumed she had made a mistake. If you think pathology reports predict the future of an individual, it wouldn't seem possible that I could be seeing John four years after his operation. But that's who I saw when I walked into my examine room.
    I again feared that his visit would be related to cancer. Before I could ask him anything, the  first words out of his mouth were "Don't forget, this is only my second post-operative visit." I think he wanted to make sure the insurance would cover it. "But why are you here?" I asked. "I have a question," he said. "I'd like to know what you can eat after a stomach operation." "Four years after, anything! But tell me, why are you here?" I asked. "I have a question," he said. "I'd like to know what you can eat after a stomach operation." I have a hernia from lifting boulders in my landscape business." Since he refused to be admitted to the hospital, I repaired it under local anesthesia on an outpatient basis, and he was off and running again. If he rested at all I'd be surprised, even though he promised to have two young men do his normal work the first few weeks after surgery.
    John is one of those exceptional patients who seem to most clinicians to defy understanding. But I have learned that all of these exceptional patients have stories to tell and lessons to teach. It's not just a matter of being lucky or having "well behaved" diseases (slow growing tumors, "spontaneous" remissions and so forth). What you have to understand is that there is a biology of the individual as well as a biology of the disease, each affecting the other. On the day of diagnosis we don't know either well enough to use a pathology report to predict the future.
    It is now six years after his surgery, and John celebrated his eighty-third birthday recently. You have to wonder - what has happened to his cancer?
    I don't know if his immune system eliminated it or if it's still in there, enjoying  John's life so much that it's going along for the ride. What I do know is that when you look at John what you see are signs of his ability to live and love. Still passionate about his life's work, he sends me letters with clippings about the therapeutic value of the outdoors and an article about himself in the local newspaper that quotes him as saying "If I find a little marigold just lying there, I feel so sorry for it I just put a hole in the ground with my finger and plant it." The article ends by saying "Today  ....  John is still on the job, planting and pruning. He loves it. And like the legendary cowboy who proudly professes he wants to die in the saddle with his boots on, he says when his turn comes 'I always pray that I'll die at work, gardening.' "
    Working outdoors, John maintains what I call a celestial connection, and, like patients in the hospital who have been shown to heal faster when their room has a view of the sky, he is healthier because of it. John is too busy living to be sick. That's his real secret. But how, in scientific terms, do we account for him? What can we learn from him? Is there really a philosophy of optimism, love and joy?