ON THE MOVE is Oliver Sacks’s most revealing book to date. It is the summation of a life lived with so much breadth and depth that it serves as a primer for how to navigate human existence with humor, humility, passion, speed, intelligence, and ongoing grace — the tale tying together all the stories Sacks has published in his lifetime. It’s a work crafted by a man who didn’t know, but must have sensed, that he was nearing his end and, looking over some serrated edge, weaves a tough-twined tapestry of travels, scalpels, and sex.

The memoir begins where the man began, in England. Feeling an inchoate “imprisonment,” likely rooted in the fixed class system of mid-20th century Britain, the young boy Oliver longed to bust out and up, to travel a furling road with no observable end in sight. From the very beginning, Sacks describes himself as a child who keenly felt the limits of natural life: the boy Oliver set up his own chemistry lab to plumb those limits, filling his parents’ home with noxious gasses as his test tubes bubbled away. “It was,” he tells us, “especially the physiology of the senses that fascinated me — how did we see color, depth, movement? How did we recognize anything? How did we make sense of the world, visually?”

Sacks was “on the move,” a seeker of knowledge. He left home for Oxford, where he immersed himself in the sciences, reading like a glutton, marinating in books and bindings and words, which he so passionately loved, he soon realized he too wanted to do this … this thing: to make the leap from reader to writer and become a storytelling scientist. Sacks practiced his craft in journals, which piled up by bedsides and beaches; he scribbled ideas on tatters of napkins, a young man overflowing on the one hand, while on the other struggling to get his sentences right. He claims he was not a born writer. Often he searched fitfully for a particular port of entry. And, as often as not, that entry eluded him. In this book, Sacks reveals himself as a writer, laying bare the process, which was sometimes exquisitely painful and sometimes straightforward; it’s a rare behind-the-scenes glimpse into how one of this country’s most beloved physicians and authors actually plies his craft. For instance, he includes a sketch from an early journal, written in 1961 when Sacks was in his 20s. It is filled with deftly drawn characters and captures what it was like to be the young Oliver Sacks traveling the tarmac with truckers, crushed cups of coffee, cigarette smoke, and sticky condoms littering the pit stops where Sacks, itinerant and ever curious, slept with fellow passengers. What we see in the sketch is raw talent for sure, but more than that too.

We see what turns out to be one of the book’s overarching themes: a man divided. To the right, he is a physician in a clean white coat. And to the left, he is a rugged and ragged man in motorcycle leathers drunk on speed — who loves men and seeks out the solace of sex with men in a time and place where it was a sin. Sacks has secrets, although the book is the opposite of secretive; at the same time, it is not a confessional or a tell-all. It is, rather, an emptying. Sacks pours himself onto these pages, describing the doctor he became by day and the gym rat and motorcycle maniac he was by night. He brings to life the weightlifting culture he found in California: the men on Venice Beach buffed and oiled and hoisting hundreds of pounds onto their glistening backs, thigh muscles straining against skin as they squatted. This is a memoir about many things, but the theme that cuts through is how to be two in one: how to be an upstanding physician on Monday morning and part of a motorcycle gang on Monday night; how to get dressed for work and then undressed for sex, which, when it first happened on a visit to Amsterdam when Sacks was in his 20s, was fueled by so much alcohol that he could not remember the actual encounter. He only remembers awakening the next morning to find himself in a strange man’s bed — luckily for him, a kind man who after “buggering” him, and, once Sacks came to consciousness, told him that, yes indeed, he seemed to enjoy the encounter thoroughly.

Some of the book’s best scenes are of the nighttime Sacks: Sacks in leathers straining against limits; Sacks in love with speed; Sacks bearing down on his beloved bike as he races across cities and states; Sacks relishing the classless societies he finds in the West, especially in California; Sacks shrugging off Great Britain. He brings to life what the coast of this country looked like to a British boy used to tea and biscuits. He finds vast vistas, ghost lands, the sea teething at its rocky shore, mountains mantled with white, frost putting pewter on expanses of fields, Highway 1 and Highway 49. Sacks sees Las Vegas “in those unpolluted days, from fifty miles away, like a glittering mirage in the desert.” Some of the book’s most powerful writing revolves around the bikes he so loved and on which, with which, he explored this country:

I would ride through the night, lying flat on the tank; the bike had only 30 horsepower, but if I lay flat, I could get it to a little over a hundred miles per hour, and crouched like this, I would hold the bike flat out for hour after hour. Illuminated by the headlight — or, if there was one, by the full moon — the silvery road was sucked under my front wheel, and sometimes I had strange perceptual reversals and illusions. Sometimes I felt that I was inscribing a line on the surface of the earth, at other times that I was poised motionless above the ground, the whole planet rotating silently beneath me.

Sacks deeply feels his division, his two separate selves, the personal and the professional, the white coat and the oiled leathers, the hospital where he learns to heal and the scent-filled motorcycle nights. He tells us about his relationships with his fellow interns and residents, none having any inkling of his “werewolf” nature — this image all the more intense for Sacks because his middle name is Wolf. Nor do his colleagues know he longs for the touch of a man. Such contact mostly eludes him, but sometimes surprises him by way of a sudden tryst — at a lake house with a handsome man who, after one glorious week, melts into the mist. No one in his life is solid. Sacks at one point confesses that he went 35 years without any sexual encounters at all. When they do happen, they are brief and sometimes unrequited, the terrible tumbling into love with men who turn out either to be straight or so afraid of their own homoerotic tendencies that they reject Sacks without regard for his feelings. One winces when reading this book. Sacks is so vulnerable, so naked, so exposed in the telling of his life that the reader wants to fall in love with him, because what else can you do when a person such as Sacks gives you the gift of such honesty? And because this man is so full of love for places and ideas and people, including his patients, we suffer with him. He’s a naked man, a disrobed doctor who, lying on an examining table beneath a relentless surgical sun, lets us see it all.

What we see: his examining rooms where, once again, we meet the patients he has so carefully described in prior books. But there is nothing repetitive here. He revives his old book Awakenings but doesn’t tell the same tale twice. Rather, this time around, he lets the reader see how that extraordinary piece of medical poetry was written. We see Sacks meeting his Parkinsonian patients; we see him forming loving relationships with people silenced by sickness. Awakenings was essentially a polished piece of portraiture; his goal in that book was to bring to life individuals in the context of their strange syndromes. But not here. This time his goal is to bring to life the process by which the book got written and to show how his relationships with patients were transformed by the publicity the book brought to those living at the far fringes of society.

Sacks also describes his ongoing intellectual pursuits, including his fascination with perception, time, and space. We meet a man on intimate terms with “theory,” a man unafraid of hypotheses and who shares insights with some of the top scientists of our time, including Francis Crick, Stephen Jay Gould, and Gerald M. Edelman. At times, Sacks’s book feels like a salon of sorts; we wander the corridors of great minds while leaning in to listen to the kinds of conversations that birth paradigm-shifting theories. Of one of his own theories, Sacks writes:

I had returned, in particular, to the question of whether the apparently continuous passage of time and movement given to us by our eyes was an illusion — whether in fact our visual experience consisted of a series of timeless “moments” which were then welded together by some higher mechanism in the brain.

Sacks’s mind is, clearly, a mind “on the move” every bit as much as his body.

But timeless moments? Might time be not a stream but a series of separate drops hovering like a hummingbird before our eyes as our brain, a giant loom, does its weaving work? If this is so, then can we live a full life inside each drop, our whole selves contained in discrete liquid spheres? Might we be able to live again and again, reborn in droplets, each second a second chance? Are we then constituted of a series of tiny little lives that we fill with bread and breath? I’d like to think so. Were Sacks’s theory to prove correct then the mantra “to live each moment to its fullest” would pass from cliché to total truth; we would be redeemed and resurrected each and every moment. It’s a generous theory of how we might see and live life, and, like so much in this book, it makes one pause, head tilted in thought, one eye out the window as a bird lifts from a branch.

On the Move can be read in many different ways. It’s a rollicking good tale filled with shea butter, neatsfoot oil, motorcycles, supple leather, and sex in berths and beds. It’s an explanation of sorts, a behind-the-scenes telling of how Sacks’s books were constructed and, as such, can serve as a primer about writing, far more useful than the actual how-to’s you might buy at your bookstore. It tells you the terrible truth that writing is horrifically hard and also as good and gratifying as life gets. The book can be read as an autobiography that spans the years of one man. It can be read as the story of a doctor or of a gay man in a certain time and place. It can be read as the second-by-second meditations of a scientist. In the end, though, what the reader walks away with, or rather, what this reader walked away with, was a field guide on how to live an excellent life, moment by moment, mile by mile, making each droplet count.

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Lauren Slater is the author of multiple books of both literary nonfiction and fiction.