华裔医生: 我回国陪父亲走完最后一程

我读这篇文章时感觉中文翻译得不流畅，就试了《华邮》网站，找到英文版如下：

link

I chased the American dream. It brought me back to my father’s deathbed in China

Feb. 26, 2021 at 11:31 a.m. EST

I thought for sure he was dead: Whenever I cannot reach my father, now 86, I am convinced the day has come and that he has died alone in his apartment. It was nearly midnight in Shenzhen, China. I tried calling him on WeChat, on his cell, on his landline. No answer. I called his friend to check on him. He answered the doorbell that night and seemed okay, she reported. The picture she sent, though he was smiling, did not reassure me. I’m a cardiologist in Portland, Ore. One look at my father’s ashen color told me his end was near. A week later, he was hospitalized and diagnosed with metastatic colon cancer.

This event had a cruel symmetry, echoing what happened in 2003 when my mother suffered a fall and massive brain bleed. Same apartment. Same hospital. Even the pandemics, then and now, involve related viruses: SARS and the novel coronavirus. My mother had gone into a coma by the time I reached her bedside. After months of hospitalization, she was discharged home, comatose. My father kept her alive in a persistent vegetative state for five more years, with hired help and tube feeds, nearly bankrupting himself. Throughout that time and long after, I was overtaken by guilt. Thirty-four years ago, my parents supported their only child to pursue her education in the United States. It pained me to realize that as a physician, I was unable to save my mother’s life, and as a U.S. citizen, I never gave her the good American life she had asked of me.

This time, I was determined to do right by my father. Though I managed to leverage my connections as an established American cardiologist to get him VIP treatment in his local hospital, he adamantly declined further diagnostic testing or care. My father, a retired university professor, is fiercely independent, a loner. He told me he had lived a long, good life and wanted to die on his own terms. When I gently suggested getting a colonoscopy, tissue biopsy and perhaps advanced cancer therapy, he got mad: “I am fine, I can walk to the crematorium myself!”

For 92 years my father buried his feelings. Then he started Zooming.

Palliative and hospice care are not widely supported in China. When loved ones fall ill, spouses and children often show over-the-top devotion, fearing judgment by other family members and by society at large. In cases of terminal illness, the patients themselves almost never participate in discussions about the severity of the condition (a situation depicted in the 2019 film “The Farewell”). Family members are expected to pursue more aggressive treatment, even if medically futile, espousing blind optimism. The higher the price tag, the better the demonstration of filial piety. Dying at home is generally avoided because of superstition. In China, my father faced intimidating cultural stigma against his wish to stop treatment and die peacefully at home.

I wanted to support him, but it would mean figuring out his end-of-life care on my own. After consulting an oncologist friend, I packed my suitcase full of over-the-counter comfort care medicines. I also had to make arrangements to put my life on indefinite hold — applying for family medical leave, rescheduling appointments, asking colleagues to cover my patients and administrative duties, saying goodbye to my husband and children with no set return date.

Decades ago, I was fortunate enough to attend college in America on a full scholarship. Now it would take every inch of my immigrant success — leaning on all my resources and institutional affiliations — to take the return trip on which I would probably lose my remaining parent and sever my last tie with China. Travel during the pandemic is dauntingly difficult: I needed a special family emergency visa, two negative coronavirus tests within 48 hours of my flight and a time-stamped health clearance bar code from the Chinese Consulate. There were only a handful of flights between the countries each day; it was impossible to buy tickets online. With the help of a childhood friend’s wife, who runs a travel agency in China, I got one. The plane was packed. Everyone wore N95 masks, some with double masks, others with goggles, face shields, hazmat suits and gloves. The flight attendants wore disposable surgical gowns. People hardly ate or drank during the 15-hour flight, trying to minimize bathroom trips.

For two weeks, I was quarantined in a hotel room in Xiamen after landing. The first night, on a sleepless high, I made grandiose plans for catching up on emails and work. By day five, I started exercising by putting all 20 hotel-provided bottles of water into a backpack and pacing the room: 14 steps long, six steps wide, over and over. By day seven, each banging of the door by the hotel staff, announcing meals delivered to a chair outside, made me jump — as did the twice-daily temperature check. Finally, after 14 days and 11 negative coronavirus tests, I was released into the world.

The nursing home crisis shows how we dismiss the joys of old age

When I finally got to my father’s bedside, suitcase in tow, it was almost anticlimactic. For a surreal second, I felt I was rounding on an elderly patient, as I do every day in my hospital. Reunion in Chinese style, even in such weighted circumstances, is restrained. No matter how many times I had cried in private, there would be no embrace, not even a handshake, no tears in front of him. I instinctively checked on key physical exam findings: Was his neck vein elevated, and legs swollen, suggesting congestive heart failure? I stopped myself just short of probing his abdomen. My hand went, instead, to tuck him into his comforter. At this moment and going forward, I wanted to be only his daughter.

A few days later, I brought my father home. Together with a friend of his, I took care of him: shopping for and cooking his favorite meals; helping him shower and dress; dispensing his few remaining pills. Back in his own environment, my father instantly began feeling better, eating more. We still don’t use the word “cancer” or talk openly about his prognosis, but this feels like neither denial nor forced optimism. Instead, we focus on the concrete tasks at hand. When he has energy, I sit by his bed listening to him talk about his life, about history, philosophy and technology. I tell him about his grandsons and their girlfriends, my work and my life.

I began this journey initially stricken by grief, and by fear of reliving the guilt my mother’s death had induced. But I came to appreciate an unexpected symmetry: Years ago, my parents sacrificed to set me free and allow me to pursue a new life in America. In returning to China, I sacrificed to set my father free and help him have a good death. The first choice is relatively common and often celebrated; the latter is unconventional, even frowned upon — seen as almost unnatural in a culture that prioritizes extending life. But the limbo of quarantine, and all the hurdles I had to surmount en route, brought me to a realization: how important it is, for the living and the dying, to share a moment of peace. In that moment, love is no longer measured by the quantity of pills, the number of CT scans or the extent of heroic medical interventions, but by time spent together.

多谢边君分享！
令尊看来身体还不错，至少脑袋清楚，且想得开。
我有的朋友父母老年痴呆，惨。

现在这种情形，回国探亲确实不大可行。但愿疫情尽早结束。

房价高涨确实不是什么好事。

转贴：人口断崖式下跌：和你有什么关系？人口危机影响的还不仅仅是养老金问题，还涉及到伦理、心理以及老年人的护理问题等等。它和我们每个人都有关系，会对我们的生活造成重大影响。



与此同时，“老龄化”问题不断加剧。2009年，中国60岁及以上老人的数量为1.67亿，占人口总数的12.5%。2019年，中国60岁及以上老人的数量已快速攀升到2.54亿，占总人口的18.1%（其中65周岁及以上老年人口为1.76亿，占总人口的12.6%）。



老龄化+少子化带来的一个直接冲击，就是国民的养老问题。所谓的养老保险，名义上叫“保险”，但本质上是一种转移支付，是从劳动人口中征收一笔钱，支付给同一时期已经退休的人。说到底，我们现在每个月上交的养老保险，其实是在供养这个时代的老年人，而不是为自己将来的养老存钱（我们未来的养老钱，很大程度上需要下一个年代的年轻人来提供）。未来如果没有足够的年轻人缴纳社保，那么老年人的退休金来源也将慢慢枯竭。根据IMF的人口模型预测，预计到2050年，每3.3个中国人中就将有1个是65岁以上的老人。而2050年恰恰是第一批85后退休的年份。所以，人口危机如果无法得到及时解决，80后、90后们将受到巨大的冲击（00后们自然也无法幸免）。这直接关系到你我的切身利益。而且人口危机影响的还不仅仅是养老金问题，还涉及到伦理、心理以及老年人的护理问题等等。它和我们每个人都有关系，会对我们的生活造成重大影响。在这个问题得到解决之前，它值得我们年年提，反复提，一遍一遍地去讨论，去纠正。接下来我会结合我过去的文章和新了解到的信息，再次和你探讨这个问题，并给出一些建议。

01

说到人口危机，首先要提到的是著名的翟振武教授，他将被钉在中国生育政策的耻辱柱上。早在2011年，学者巴曙松（中国银行(601988,股吧)业协会首席经济学家、北京大学汇丰商学院金融学教授）发表文章称，根据2011年的第六次人口普查数据分析，中国的人口红利窗口将提前关闭，原因是中国少儿抚养比的下降速度大大快于此前的预测。2012年，人口学家梁建章分析了中国的人口结构和低生育率趋势，全面批评了计划生育政策，并号召放开生育。还有不少学者也都表达了对中国人口形势的担忧，并呼吁政府做出改变。然而就在2014年3月，著名人口学家翟振武在权威期刊《人口研究》上发表论文称：如果全面放开二孩，中国每年出生人口峰值将达到4995万，总和生育率将达到4.5。翟振武是中国人口学会会长，中国人民大学人口与发展研究中心主任，曾获得过中国人口学界的最高成就奖——中华人口奖。作为中国最“顶尖”的人口学专家，翟振武旗帜鲜明地反对全面放开二孩，还告诉决策者（如果放开二孩）每年的出生人口将达到近5000万。

2014年7月，国家卫计委官员杨文庄在新闻发布会上也采纳了翟振武的数据，认为如果全面放开二孩，将会累计多生出9000余万人，对经济社会的发展将会造成很大影响。卫计委（2018年已调整为卫健委）以前的全称是“卫生和计划生育委员会”，从名称就可以看出，如果废除计划生育，这个机构存在的价值将受到动摇，所以翟振武教授的观点自然是获得了卫计委官员的坚定支持。2000年，国家统计局的人口抽样调查结果显示，当年的总和生育率仅为1.22。所谓的总和生育率，是指一个国家（地区）的女性，在育龄期间（国际传统上一般以15岁至44岁或49岁为准）生育子女的平均数量。一个国家想要完成正常的世代更替，总和生育率一般不能低于2.1（之所以是2.1而不是2.0，是考虑到了疾病、事故等原因造成的人口损失）。1.22这个数字不仅低于欧洲发达国家，甚至比“少子化”现象严重的日本还要低。然而，计划生育部门以存在大量黑户（漏报瞒报人口）为由，强行将总和生育率上调到1.8。当时的计划生育委员会主任张维庆说：“根据大多数学者的意见，我们国家目前的总和生育率应该在1.7—1.8之间，这是经过科学测算的数据，不是哪个人说的，更不是我个人说了算的数据。当然有个别专家认为中国生育率不是1.7—1.8，是1.5，当然这毕竟是个别人的观点。”

2010年，第六次人口普查结果显示，当年的生育率只有1.18（其中“城市”为0.88210，“镇”为1.15340，“乡村”为1.43755），接近此前抽样调查的1.22，即便考虑到存在瞒报漏报，其比例也不可能占到50%，但计划生育部门依然将中国的总和生育率强行调高到1.8 ！2016年1月1日，中国好不容易全面放开了二孩政策。然而为时已晚。2016年10月，《中国统计年鉴2016》 公布的2015年全国1%人口抽样调查显示 ， 中国2015年的总和生育率仅为1.05 。梁建章随后发表了《中国生育率1.05可信吗》一文表示，如果1.05的生育率属实，那中国的生育水平就是全球最低，而不是最低之一。对于卫计委的漏报瞒报一说，梁建章是这样评论的：由于都是基于抽样，再加上各种宏观因素影响，各年生育率会有一定波动性，但不可能会相差1/3。问题并不是国家统计局抽样调查的漏报，而是计划生育部门以漏报为理由一而再、再而三地大幅调高生育率数据，严重误导决策层和民众。对于中国未来的人口形势，梁建章也作出了这样的预测：考虑到2016年年初全面两孩开始实施等因素，综合判断，2016和2017年的生育率会显著反弹。特别是，随着堆积生育意愿的释放，2017年将出现生育小高峰。但在此之后，由于堆积效应弱化，尤其是未来十年育龄高峰期女性萎缩超过40%，出生人口将面临雪崩。

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事实确实如梁建章所言，2016和2017年中国的生育率显著反弹，然而梁建章也只说对了一半。因为中国的“少子化”形势比梁建章预测的还要严峻。中国的生育率在2016年就达到了顶峰，2017年就已掉头向下。



2017年中国出生人口仅为1723万人，较2016年减少63万人，远低于卫计委此前预测的2100万左右（中值），更不用说翟教授预测的4995万了。

全文连接在这里

有没有用 walker? 我常看到老年人推着walker走路，一步一步很艰难。。。。

希望边君能够如愿。

多谢溪君。
父亲住进养老院一直是用拐杖的，几个月前他摔倒在地。听说后我建议给他买一个walker。好在国内现在这些东西也有。他用了不到两个月，一次体温、心跳不正常被送医院急诊，虽没有大碍，不过就此无法起床，健康情况急转直下。由于疫情家属不能进养老院病房看望，所以春节前决定把他接回家，请人上门护理。其实这也是出于子女们对他的“临终关怀”，这样可以给他有在家的感觉，这比躺在养老院全监护病房更加让我们心理上好一点。代价大一点，可是花钱买回一个“孝心”。

前几天家里送了几张病榻上父亲的照片给我，其中一张是他用吸管自己喝鱼汤的场景，我一看立即点赞、叫好。

中国有一个老话叫“老小”，它是说人“老”了，其实就是回到了“小”的时候。比如我们出生后一开始diaper不离身；自己不会走路；吃喝都要父母喂，等等。稍微再大一点时我们会用吸管来喝水，会说话了。而人老的过程就相当于是这逆行：开始不想说话了；下不了床了；要人喂食，等等。而吃流质时由于没有及时吞咽，弄得衣襟前斑斑点点，这样需要在下巴处垫块napkin了。

不过“老”和“小”还是有所不同，比如像我爸，虽然他生活不能自理，但他器官没病，所以思维仍然如同成年人，当需要有人为他提供生活便利时，这给了他精神上带来了压力、甚至难堪。这种心理变化从他的面部神色可以表现出来。这也就让他对身边来来去去的人和发生的事变得更加敏感。比如除了护工外，家里人需要协调商量怎样轮班来照看他。有时因为其他一些原因有人无法按时到，需要提前告知。他知道后会摆手说，有护工，你们就不要来了，......。我能够想象，哪个人都不会愿意自己日常起居让他人来料理的。可是人生的结果居然就是这样。

这也让我想到“久病床前无孝子”这句话。从表面上看，这千百年流传下来的老话没错，时间长了，耐心薄了，矛盾和冲突都会产生，子、女开始不“孝”了。可是我觉得我们中华文化里那个“孝”并没有确定的内涵，就是说，什么样的行为算是孝，谁能够概括？即使有人如果翻出《增广贤文》或者“四书五经”里面对孝字的定义，那么那些老旧的概念放到今天的社会条件和环境底下，那样的“孝”是否仍然应该提倡也还是问题。何况，过去人生七十古来稀，现在八十也已经不稀奇了，这样一来任何一个家庭需要承担的养老费用会越来越高。由于这些年中国一直实行强制的计划生育政策导致家庭子女的平均数越来越小，这让养老责任越来越重，而且情况会越来越糟。那么今天究竟什么样的“孝”既是合情理的，又是现实可行的？

24小时护理老人的工作非常艰巨，直系亲属由于各种各样的情况根本不可能承担，这样一来我们对护工的要求也就不能太高，过得去就行了。如果是住在养老院，那么我们就应该完全遵照养老院制定的程序，自己不能下床那么就只能让生命最后在病床上慢慢耗尽。没有其他更好的办法。问题是，这样的过程和结局能够算是（子女）不孝吗？我觉得不能。所以今天在一种特定文化群体下究竟什么是“孝”我们应该重新思考限定。

看到如今我爸的情况就不能不想到自己今后。人都要老的，在自己神志清楚的时候应该把遗嘱写好，这样到了最后一段时间可以按照自己的意志。比如坚决不要依靠器械或者输液来维持生命。如果那是一个自然的过程，那么该住进老年公寓，然后升级到养老院，总之千万不能依赖子女承担送终的责任。这不是孝或者不孝的事情。社会分工不同，人各有自己的职业和家庭。（生）养小是人性的自然需要，就像水往低处流那样。但是反过来要小养老，则似乎有悖这种天道。或者说养儿防老、养儿送终都是些陈旧的概念，尤其已经移居西方的华裔家庭，父母和子女之间应该形成一种共识，则养老只是一种义务，不是责任。