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In the sentence below we have added three items together, "sunken, blue eyes", "dry blond hair" and "bruises on her skin". I wonder if I need to add "and" just before "the bruises on her skin". As there is one other "and" joining the two sentences, it is really confusing for me which the right way is.

"I look at those sunken, blue eyes, her dry blond hair, the bruises on her skin and I try to imagine her without all those horrible features, finally recognizing Lily Din."

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In the first phrase you have a list of items:

sunken, blue eyes, her dry blond hair, the bruises on her skin

and in the second phrase:

I try to imagine her without all those horrible features

The list needs a concluding and. Then you need another conjunction between the first and second phrases.

I look at those sunken blue eyes, her dry blond hair, and the bruises on her skin, and I try to imagine her without all those horrible features, finally recognizing Lily Din.

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An "and" within a list isn't necessarily necessary, though omitting it isn't very common outside of literature. That being said, the sentence you proposed does sound literary and omitting the "and" in the list could be appropriate.

With the and, it would look as follows, and using an "and" there is definitely not wrong because the second "and" is just joining the two clauses. (The italics is the list in question.)

I look at those sunken, blue eyes, her dry blond hair, and the bruises on her skin, and I try to imagine her without all those horrible features, finally recognizing Lily Din.

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The author of the quote was correct to omit the "and" from the list.

It would make sense to insert the "and" into the list if the list were not followed by another "and".

The following "and" is important:

  • It joins the two clauses.
  • It establishes that the sentence is informal.
  • It shows the time relationship between the two clauses. (The second clause occurs very slightly after the first clause.)
  • It implies a "therefore": The author's imagining happened because of what the author noticed.

The following "and" is more important than whether or not the preceding list included an "and" before the last item.

Including both the "and" in the list and the "and" after the list would be confusing. It would also be considered poor style in written work. (This is one reason people avoid starting written sentences with "And".)

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