Gratitude

Gratitude is a collection of four short essays by the neurologist and author Oliver Sacks, written during the final two years of his life. The essays trace Sacks's evolving relationship with aging, terminal illness, and mortality. The first was composed on the eve of his 80th birthday; the remaining three were written after he learned he had terminal cancer.

In "Mercury," written just before his 80th birthday, Sacks opens with a dream about mercury, element 80 on the periodic table, and explains that he has linked chemical elements to birthdays since boyhood. He expresses disbelief at reaching 80: As the youngest of his mother's four sons and nearly the youngest in a vast extended family, he has always felt like the youngest person in any group, even though he is now among the oldest people he knows. He recalls a near-death experience at 41, when he broke a leg while mountaineering alone and had to lever himself down the mountain with his arms, flooded with memories colored by gratitude. At nearly 80, despite various medical problems, he feels glad to be alive and grateful for his experiences, his dozen books, and what Nathaniel Hawthorne called "an intercourse with the world" (7). He acknowledges regrets: wasting time, remaining painfully shy, speaking only English, not traveling enough. He reflects on what it means to complete a life, noting that some elderly patients express readiness to go, and states he has no belief in or desire for any afterlife. He cites the molecular biologist Francis Crick as a model: When Crick learned his colon cancer had returned, he paused, looked into the distance, and resumed thinking; Crick died at 88, still engaged in creative work. Sacks hopes to die similarly. He closes by echoing his father, who lived to 94 and called his 80s one of the most enjoyable decades of his life, and describes feeling not a shrinking but an enlargement of mental life and perspective.

In "My Own Life," Sacks announces that the rare ocular melanoma first discovered in his eye nine years earlier has metastasized to his liver. Though its advance may be slowed, it cannot be stopped. He declares his intention to live his remaining months as richly and productively as possible, drawing inspiration from the philosopher David Hume, who upon learning he was mortally ill at 65 wrote a brief autobiography in a single day. Sacks notes that his own 15 years beyond Hume's age have been equally rich in work and love, yielding five more books and a full-length memoir. Where Hume described himself as mild and moderate, Sacks calls himself a man of vehement disposition and extreme immoderation. Yet he finds especially resonant Hume's sense of detachment, describing his ability to see his life as from a great altitude, as a landscape with all its parts connected. This detachment does not mean he is finished with life. He feels intensely alive and wants to deepen friendships, write more, and travel. He resolves to abandon anything inessential, not out of indifference but because these concerns now belong to the future. He reflects on the deaths of his contemporaries, each felt as a tearing away of part of himself, and asserts the irreplaceable uniqueness of every human being. He closes by acknowledging fear but identifying gratitude as his predominant feeling: gratitude for having loved and been loved, for having read and traveled and thought and written, and above all for having been "a sentient being, a thinking animal, on this beautiful planet" (20).

In "My Periodic Table," Sacks describes the progression of his illness alongside his deepening attachment to the physical sciences. He discusses a Nature article by the physicist Frank Wilczek on the slightly different masses of neutrons and protons, a seemingly trivial difference essential to the universe's development, and expresses sadness that he will not live to see the advances in physics Wilczek envisions. He recalls a night in the countryside when the sky was dense with stars and he was struck by how little time he had left, the beauty of the heavens inseparable from a sense of transience. Sacks explains a lifelong pattern of turning to the nonhuman world in times of loss: Numbers became his friends when he was sent to boarding school at six during the Second World War; the elements and periodic table became his companions when he returned to London at 10. Now, with death immediate, he surrounds himself with metals and minerals as small emblems of eternity: thallium (element 81) for his 81st birthday, lead (element 82) for his 82nd, thorium (element 90) in a lead casket. He traces his treatment: embolization, a procedure to cut off blood supply to tumors, temporarily destroyed most of the cancer in February, but by July a CT scan confirmed the metastases had regrown and spread. He closes with bismuth (element 83), a modest metal for which he has a soft spot, paralleling his feeling as a doctor for the marginalized. He does not expect to see his 83rd birthday but finds something hopeful about having "83" around. At the far end of his table sits beryllium (element 4), reminding him of his childhood and how long ago his soon-to-end life began.

In "Sabbath," Sacks reflects on his Jewish upbringing, his rupture from religious life, and his late return to the idea of the Sabbath as a metaphor for peace. He describes his parents' Orthodox household in Cricklewood, Northwest London, where Shabbos, the Sabbath, was strictly observed: no work, no driving, no telephones or electric switches, though his parents, both physicians, made exceptions for emergencies. He recalls Friday preparations, Saturday mornings at the crowded synagogue, and afternoons visiting relatives who all lived within walking distance. The Second World War and postwar emigration decimated this community. Sacks chanted his portion for his bar mitzvah, the Jewish coming-of-age ceremony, in 1946, but this marked the end of his formal practice. The decisive rupture came at 18, when he admitted to his father that he was attracted to boys. His father told his mother, and the next morning she declared, "You are an abomination. I wish you had never been born" (34), likely drawing on the condemnation in Leviticus, a book of the Hebrew Bible. Her words made Sacks hate religion's capacity for cruelty.

After qualifying as a doctor in 1960, Sacks left England for the United States. In Los Angeles he found community among weight lifters and neurology residents but craved deeper meaning; its absence drew him into a severe addiction to amphetamines in the 1960s. Recovery began slowly when he found meaningful work at a chronic care hospital in the Bronx, the institution he would call "Mount Carmel" in Awakenings. He discovered his vocation as a medical storyteller and led a lonely but deeply satisfying existence for many years. In the 1990s, Sacks reconnected with his cousin Robert John Aumann, a mathematician and game theorist of deep religious commitment who saw no conflict between reason and faith. Aumann insisted Sacks keep a mezuzah, a small case containing parchment inscribed with Hebrew scripture, on his door.

In 2014, Sacks reversed a nearly 60-year decision to avoid Israel, a decision rooted in the region's politics and his sense of being out of place in a deeply religious society, when his cousin Marjorie invited him to her 100th birthday. The visit became a family reunion. Sacks had feared bringing his partner, Billy, to visit his Orthodox relatives, his mother's words still echoing, but Billy was warmly received; Aumann invited both of them to his family's Sabbath meal. Sacks felt the palpable peace of the Sabbath, a stopped world, a time outside time.

In December 2014, Sacks completed his memoir On the Move and, for the first time in his life, made a full and open declaration of his sexuality. Days later he learned of his metastatic cancer. In the essay's closing passage, he describes his current state: weak, short of breath, his body diminished by cancer. His thoughts turn not to the supernatural but to what it means to live a good and worthwhile life, to achieve peace within oneself. He finds his mind drifting to the Sabbath, the day of rest, the seventh day of the week, and perhaps the seventh day of one's life, when one can feel that one's work is done and may, in good conscience, rest.