The Living and Dying of Oliver Sacks

The threat of death can help us live more richly, deeply, and productively.

Posted Sep 19, 2020

Human finitude remains the most inexorable yet ignored fact of life in the West. But those brave enough to confront their mortality are transformed by the experience. Such was the case for Oliver Sacks, the beloved physician and storyteller, who died in 2015, at age 82.

But Sacks was 32 the first time he faced death squarely. He had severed ties with his native England and moved to California, where he sold his soul to drugs. He nursed festering wounds with speed, sex, bodybuilding, and amphetamine-fueled motorcycle jaunts that lasted days on end. To outside observers, he wandered aimlessly—a physician who could not heal himself.

And then Sacks glimpsed his finitude.

“On New Year’s Eve 1965, I looked at my emaciated face, and I said, ‘Oliver, you will not see another New Year’s Day unless you get help,’” Sacks recounts on camera in Ric Burns’ new documentary titled Oliver Sacks: His Own Life.

“In the irresistible thrall of amphetamines,” Sacks tells us, “sleep was impossible, food was neglected. I gave little thought to what this was doing to my body. And my brain. I did and did not realize that I was playing with death.”

Or perhaps it is fairer to say that he did not realize he was playing with death until death stared him in the face. That very real threat of finitude forced a reckoning—a reckoning that would prompt him to leave behind his corporeal recklessness.

Facing finitude gave Sacks a new lease on life and launched a fruitful career famously characterized by prolific writing and compassionate care of neurologically complex patients. The threat of death brought him a new life. And live he did—exuberantly, passionately.

In January 2015, Sacks’ doctors discovered that an earlier melanoma cancer had returned with brutal force. At age 81, he faced death a second time. But this encounter with finitude would not give him a new shot at life. Instead, it occasioned the opportunity to consider how to live out his remaining days. Part of that included making the film with Burns.

Death’s threat forces people to consider what matters most. In the book The Lost Art of Dying: Reviving Forgotten Wisdom, I describe how the mid-14th century outbreak of bubonic plague brought this sort of intentional living into focus. Up to two-thirds of Western Europeans succumbed to the plague, and mass death gave rise to a series of handbooks on the preparation for death. Known collectively as the ars moriendi (“art of dying”), the handbooks taught that you die the way you live. In order to die well, you must live well.

Although Sacks may not have read the ars moriendi, he lived into his dying as though he had. A month after receiving the bad news, he wrote that his diagnosis had prompted him to “choose how to live out the months that remain . . . to live in the richest, deepest, most productive way.” If his former confrontation with death was life-giving, this latter one was life-refining. “I feel intensely alive,” he continued, “and 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.”

Sacks was speaking the language of the ars moriendi, whether or not he realized it.

The ars moriendi handbooks were enormously popular in the West for more than 500 years. They were embraced by the religious and non-religious alike. They offered concrete advice—reconciling with family members, attending to unfinished business, working out existential or religious beliefs.

On the religion question, Burns’ film is remarkably silent—which caught my interest. As a medical doctor, I have cared for many patients who renewed their interest in religion as death approached. Although Sacks was born into an Orthodox Jewish family, it seems that his terminal diagnosis did little to prompt a turn toward religion. In fact, he wrote that his bar mitzvah in 1946 signaled the end of his formal Jewish practice, and he never adopted “the ritual duties of a Jewish adult.” Late in life, he publicly endorsed the Freedom from Religion Foundation and described himself as “an old Jewish atheist.”

In an essay published just before he died, Sacks said he found his thoughts to be dwelling “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.” Sacks’ focus was on living well in order to die well. Living well, apparently, did not require religion. Or did it?

In that same essay, Sacks recounts a trip to Israel to celebrate his cousin’s 100th birthday. He hadn’t been to Israel in nearly 60 years, having long felt that he’d be out of place in such a religious country. He was delighted when his Orthodox family warmly received him and his partner, Bill Hayes. And he was surprised to discover that it was the practice of religion—specifically Sabbath observance—that caused him to reflect on the arc of his life:

The peace of the Sabbath, of a stopped world, a time outside time, was palpable, infused everything, and I found myself drenched with a 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?

The pause of Sabbath gave Sacks pause—a pause pregnant with reflection.

Although Burns’ film says little about Sacks’ Judaism, Sacks seemed to think it important enough to publish his essay “Sabbath” just before he died. He recalls his Nobel Prize-winning cousin Robert John Aumann once telling him, “The observance of the Sabbath is extremely beautiful and is impossible without being religious.”

And then Sacks writes:

And now, weak, short of breath, my once-firm muscles melted away by cancer . . . I find my thoughts drifting to the Sabbath, the day of rest, the seventh day of the week, and perhaps the seventh day of one’s life as well, when one can feel that one’s work is done, and one may, in good conscience, rest.

A man twice transformed by the threat of finitude, perhaps Sacks didn’t “get religion” in the conventional sense. But maybe religion got him.