Gratitude (graceful essays on death) Book Notes

Gratitude [public library] is a collection of 4 essays written by Oliver Sacks, the famous neurologist/writer, shortly before he dies of cancer.  These essays include reflections on how he feels as an 80 yr old, vignettes from his life, things he appreciates, his hobbies, finally coming to terms with some of his wobbly bits (i.e. publicly coming out), how he came to be who he is, what his interpretation of the meaning of life is, etc.  It’s a very short but charming read (pair with Insomniac City), and reminds me a bit of When Breath Becomes Air [public library] in its approach to death.


  • Everything in life should be appreciated because it has an upside and a lesson, including death (bringing clarity/urgency on what’s important in life) and old age (wisdom, perspective)
  • One should take a Stoic approach to death, no hysterics, just accept the facts and do the best with what is within your control
  • In the end, what is important is your tribe (family, friends, work peers, and in this case book readers) and your relationships, and the sense that you have given back to the world with your work
  • Recognize how you cope with loss, what your brand of escapism is, and embrace it (turn it into a strength–addictive personalities can achieve six sigma results if passionate about the right things; relatedly, find things to obsess about)
  • Think about your death, the transience of life, and the immensity of the universe (and your small place in it); this will prompt you to appreciate the beauty of fleeting moments, to put your troubles in perspective, to allow you to focus on the bigger picture, and to lend more urgency and willpower to your actions
  • Consider introducing a rest day into your life where you focus on meditation, no media/electronics, long walks in nature, introspection, thinking/reading/writing, and napping


Book notes:

On gratitude to be alive:

“At nearly eighty, with a scattering of medical and surgical problems, none disabling, I feel glad to be alive–’I’m glad I’m not dead!’ sometimes bursts out of me when the weather is perfect. …I am grateful that I have experienced many things–some wonderful, some horrible–and that I have been able to write a dozen books, to receive innumerable letters from friends, colleagues, and readers, and to enjoy what Nathaniel Hawthorne called ‘an intercourse with the world.’”

[meaning and significance from writing and correspondence with his tribe about his work]


When he was 41, he broke his leg mountaineering alone and thought he would die, had these memories: “Most were in a mode of gratitude–gratitude for what I had been given by others, gratitude too that I had been able to give something back.  Awakenings, my second book, had been published the previous year.”


Old age does not cure all of our foibles and insecurities and shortcomings:

“I am sorry I have wasted (and still waste) so much time; I am sorry to be as agonizingly shy at eighty as I was at twenty; I am sorry that I speak no languages but my mother tongue and that I have not traveled or experienced other cultures as widely as I should have done.”


But old age does have some benefits:

“My father, who lived to ninety-four, often said that the eighties had been one of the most enjoyable decades of his life.  He felt, as I begin to feel, not a shrinking but an enlargement of mental life and perspective.  One has had a long experience of life, not only one’s own life, but others’ too.  One has seen triumphs and tragedies, booms and busts, revolutions and wars, great achievements and deep ambiguities.  One has seen grand theories rise, only to be toppled by stubborn facts.  One is more conscious of transience and, perhaps, of beauty.  At eighty, one can take a long view and have a vivid, lived sense of history not possible at an earlier age.  I can imagine, feel in my bones, what a century is like, which I could not do when I was forty or sixty.  I do not think of old age as an ever grimmer time that one must somehow endure and make the best of, but as a time of leisure and freedom, freed from the factitious urgencies of earlier days, free to explore whatever I wish, and to bind the thoughts and feelings of a lifetime together.”


On the things that matter most to him/what gives meaning and significance to life:

“Perhaps, with luck, I will make it, more or less intact, for another few years and be granted the liberty to continue to love and work, the two most important things, Freud insisted, in life.”


“…I want and hope in the time that remains to deepen my friendships, to say farewell to those I love, to write more, to travel if I have the strength, to achieve new levels of understanding and insight.

This will involve audacity, clarity, and plain speaking; trying to straighten my accounts with the world.  But there will be time, too, for some fun (and even some silliness, as well.”


“And now, weak, short of breath, my once-firm muscles melted away by cancer, I find my thoughts, increasingly, not on the supernatural or spiritual but on what is meant by living a good and worthwhile life–achieving a sense of peace within oneself.”


On how to face death:

“When my time comes, I hope I can die in harness, as Francis Crick did.  When he was told that his colon cancer had returned, at first he said nothing; he simply looked into the distance for a minute and then resumed his previous train of thought.  When pressed about his diagnosis a few weeks later, he said, ‘Whatever has a beginning must have an ending.’  When he died, at eighty-eight, he was still fully engaged in his most creative work.”


After finding out his cancer had returned and that he had only a few months to live:

“It is up to me now to choose how to live out the months that remain to me.  I have to live in the richest, deepest, most productive way I can.”

[a very Stoic approach to things–just focus on what you can control and don’t bother worrying about the things you cannot change, such as impending death]


On the detachment/clarity of thought that knowing you are about to die gives you:

“Over the last few days, I have been able to see my life as from a great altitude, as a sort of landscape, and with a deepening sense of the connection of all its parts.  This does not mean I am finished with life.”

“I feel a sudden clear focus and perspective.  There is no time for anything inessential.  I must focus on myself, my work, and my friends.  I shall no longer look at the NewsHour every night.  I shall no longer pay any attention to politics or arguments about global warming.” [How can one get this sense of urgency without that known death sentence/limited life span of months hanging over your head?]


On Sacks’ personality (sounds like he is one of those obsessive addictive personalities, so it was good that he found a passion/obsession in his work instead of stg less healthy):

“…I am a man of vehement disposition, with violent enthusiasms, and extreme immoderation in all my passions.”

“When I moved to Los Angeles, I found a sort of community among the weight lifters on Muscle Beach, and with my fellow neurology residents at U.C.L.A., but I craved some deeper connection– ‘meaning’–in my life, and it was the absence of this, I think, that drew me into near-suicidal addiction to amphetamines in the 1960s.

Recovery started, slowly, as I found meaningful work in New York, in a chronic care hospital in the Bronx…I was fascinated by my patients there, cared for them deeply, and felt something of a mission to tell their stories…I had discovered my vocation, and this I pursued doggedly, single-mindedly, with little encouragement from my colleagues.”


He deals with emotional loss/stress by escaping to science/#s (similar to Alan Turing):

“I have tended since early boyhood to deal with loss–losing people dear to me–by turning to the nonhuman.  When I was sent away to a boarding school as a child of six, at the outset of the Second World War, numbers became my friends; when I returned to London at ten, the elements and the periodic table became my companions.  Times of stress throughout my life have led me to turn, or return, to the physical sciences, a world where there is no life, but also no death.  

And now, at this juncture, when death is no longer an abstract concept, but a presence–an all-too-close, not-to-be-denied presence–I am again surrounding myself, as I did when I was a boy, with metals and minerals, little emblems of eternity.”

Sacks has a little coffee table that has a collection of metals and minerals that are the periodic table of elements (every birthday, he gets himself the relevant element)–Thallium is for 81st bday, lead for 82nd bday


Thoughts on death:

“There will be no one like us when we are gone, but then there is no one like anyone else, ever.  When people die, they cannot be replaced.  They leave holes that cannot be filled, for it is the fate–the genetic and neural fate–of every human being to be a unique individual, to find his own path, to live his own life, to die his own death.”

[If deaths leave holes, then perhaps a solution is to fill your life up with so many new people that your world keeps expanding, and there is always more warmth than holes.  You can’t replace people, but you can replace relationships to some extent.]


Looking at the stars in the countryside:

“It was this celestial splendor that suddenly made me realize how little time, how little life, I had left.  My sense of the heavens’ beauty, of eternity, was inseparably mixed for me with a sense of transience–and death.”

[Reminds me of Japanese haikus and their appreciation for the beauty of transience.]

Random aside–Sacks was friends with Auden!  And Crick of Watson and Crick fame!  I guess they were alive during the same era and were part of the British intelligensia set, but I am still charmed by the unexpected connections.

“Auden used to say that one should always celebrate one’s birthday, no matter how one felt.”


Final essay in the book is a lot more personal–about his family, coming to terms with and healing separations and divides.

Sabbath: holy day when you are not to work, drive, use the telephone, turn on the light, or turn on the stove

Ritual starts on Friday–evening meal is 1st meal of Sabbath, you wear special clothes, say prayers, light candels, etc.

On Sabbath/Saturday, you go to synagogue and then do family visits with tea since all the extended family lives close by

“‘The observance of the Sabbath is extremely beautiful…and is impossible without being religious.  It is not even a question of improving society–it is about improving one’s own quality of life.’”


Formative event in his life:

When he was 18, his father made him admit he was gay, and then told his mother against Oliver’s wishes.  Mother “came down with a look of horror on her face, and shrieked at me: ‘You are an abomination.  I wish you had never been born.’”

“…her harsh words made me hate religion’s capacity for bigotry and cruelty.”  Then once he qualified as a doctor, he immediately left England and all the life/family he had there, and went to LA where he knew no one.


Later, in his 80s, he goes back to visit family in Israel for a cousin’s 100th bday and brings his lover Billy, where they are invited to a Sabbath meal–his reconciliation with his Orthodox Jewish past:

“The peace of the Sabbath, of a stopped world, a time outside time, was palpable, infused everything, and I found myself drenched with wistfulness, something akin to nostalgia, wondering what if: What if A and B and C had been different?  What sort of person might I have been?  What sort of a life might I have lived?”


Reading recs:

Hume’s autobiography ‘My Own Life’

Sacks’ other books about his patients: Awakenings, The Man Who Mistook His Wife for a Hat, Musicophilia, Hallucinations

Sacks’ memoir: On the Move

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