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A chapter into Thomas McGuane's latest novel, I found myself thinking, not for the first time, that no living American novelist provides greater pleasure - sentence by sentence, paragraph by paragraph, page by page - than this Montana icon. A voice of '60s counterculture, he has grown into a chronicler of contemporary life for all cultures and generations: dashingly satirical, armed with a stealthy humanist streak, possessed of deep melancholic insight and unsurpassed in defining our inner lives against the mighty backdrop of God's green Earth.

One of McGuane's loosest efforts, Driving on the Rim (Knopf, $26.95), is narrated by one Irving Berlin "Berl" Pickett, a misfit from a crazy Montana family who finds escape and meaning - and unexpected conflict - as a doctor. This upwardly mobile, picaresque novel rolls through offbeat characters and odd incidents, gathering emotion and insight as it goes. It's no accident that Berl is as off-kilter and ill at ease as he is. His mother is a fanatical holy roller, his father a war veteran with extreme views. He was introduced to sex at 14 by his voracious aunt in Idaho. She isn't the last older woman to administer to him.

Not that he has any lack of younger women dragging him into adulthood. They include a Texas beauty who falls from the sky when her plane crashes near his fishing spot, a quietly attractive friend with a 1940s look who teaches him about commitment and bird-watching, and, most hauntingly, a childhood girlfriend who is brought into the ER having stabbed herself in the stomach and whose death is wrongly blamed on his negligence. He is also haunted by having talked a wife abuser into shooting himself after he fatally batters another girl Berl knew.

Expelled from the medical establishment, Berl finds meaning in redefining his role as a caregiver. He also is boosted by the network of human connections he has made and his proximity to the mysteries and wonders of the landscape: "You could say I believe in that vast entirety that is not me and I find it a suitable destination for prayer. I also pray to those manifestations of the natural world that catch my eye. I have prayed to clouds, canyons, springs, at least one hillside, birds, Swimming Woman Creek, the town of Martinsdale, the Jefferson River, and so on. I've prayed to my old 88. After a rain, I've prayed to a mud puddle."

Citing Sancho Panza, who thought "death was a lady with no flesh on her bones," Berl addresses life after 9/11: "I don't know if the Trade Center bombing just pushed this sort of thing to the surface, but since then we seemed to have lost a layer of skin." In the face of that loss, though, he is lifted by "the fabulous range of hope entertained by humanity." It's a tribute to McGuane, long a poster boy for Montana's Big Sky Country, that he shares those hopes with the rest of us, and makes us feel them just as strongly.

Chicago free-lance writer Lloyd Sachs writes about books for Kirkus Reviews.