The Three Sufferings of Old Age: Aging, Illness, and Death
The Buddha taught that life has eight sufferings; the three most closely bound up with old age are aging, illness, and death. When people are in their twenties or thirties, their impression of old age, sickness, and death is not deep, and so they can hardly truly understand what these three of the eight sufferings feel like.
I have lived in my residential community for 16 years. We bought our home here in 2009, and after moving in, my parents came to live with me. My mother is a very affable person who easily builds relationships with the neighbors. My father had practiced martial arts when young and, even in old age, kept up the habit of rising early to practice boxing in the small garden of our community. I also kept a pet dog and often walked it around the neighborhood.
All of these things encouraged socializing within the community, so it was not long before we had built very friendly relationships with several families here; those good-neighbor ties have remained strong to this day.
Soon after we moved in, three elderly couples of the same generation as my parents quickly formed close neighborly bonds with us. One couple's home was right at the community entrance; they had converted the windows of their balcony into a small shop, and we would sometimes stop by to buy things. They also kept a dog, which later became inseparable from ours as a canine pair.
Three years ago, the elderly man in that household took a fall—reportedly while moving something heavy on the balcony. The fall was quite serious; he used a wheelchair for nearly two years, and only in the most recent year did I see him finally set it aside. After the fall his health declined markedly, though thankfully his mind remains sharp. Now he still walks around the community morning and evening; we often run into each other, and each time I greet him, he responds with the same great kindness he always has.
Another elderly couple lives directly across the hall from us; both the old man and his wife are very kind-natured. When my son was small and came home from school while my wife and I were out, the old lady would take him into their home to look after him and sometimes even make him something to eat. Sixteen years have passed, and they too have aged at a pace I can see with my own eyes.
In 2020 I found a small vegetable plot at the foot of Xiangshan and began growing my own vegetables. Each year the harvest is more than we can eat, so when the vegetables ripen, we often knock on the door of the couple across the hall and share some of our produce. They accept it cheerfully, and the old man has more than once begged me to take him along to do some gardening.
But his body simply cannot manage the work; he is stooped and moves with the frailty of advanced age. The plot is slippery, and I am especially afraid he might fall there, so I have always refused. The old lady is understanding; whenever he asks me to take him, she says, "Old man, don't impose on this young man; your body can't take the strain."
Last year this old man also fell—at home. It must have been a hard fall, because from the beginning of the year until now I have not seen him step outside. I did see him when the delivery courier brought a wheelchair to their home; I even helped the old lady unpack and assemble it. His daughter and son-in-law, whom I rarely saw before, now come back frequently; sometimes his sister and brother-in-law also arrive to look after him.
The third elderly couple came from Anhui but had settled in Beijing for decades. The old man shares my hobby of gardening; he had come to Beijing as a young soldier and later settled in our community. During the pandemic, the two of us together turned an unused platform in the community into a balcony vegetable garden, dividing it down the middle. We often exchanged tips and took delight in gardening together.
But this old man has been away from Beijing for over a year now; the property management staff told me he went back to his hometown after falling seriously ill. A few days ago, his brother saw me tending the balcony garden alone and struck up a conversation. I asked after him and learned that his days are numbered. Since he left, the balcony plot we created has essentially become mine alone. I now manage more than 50 growing pots of various sizes here; when I water, fertilize, and weed, there is no longer a kind old man beside me chatting and laughing, and I cannot help feeling the loneliness.
The day before this year's national college entrance exam, my father took a fall; he still has to use a wheelchair and a walker. Last year, to prevent such a fall, I carried out a series of fall-prevention renovations on our old family home. But man proposes and heaven disposes—my father fell not at home but outdoors. He said this was a destined ordeal he could not avoid.
My father is 77; my mother has been gone for 13 years. The wives of those three couples still look reasonably well, but they too have aged a great deal since we first moved in.
Before this year's college entrance exam I had a grand plan: over the next seven years, to study medicine full-time at a university and, after graduating, become a general practitioner who integrates Chinese and Western medicine and is expert in psychiatry. But the moment I carried my father on my back to the hospital after his fall, I realized whether this plan can be completed smoothly depends on his health.
My father already shows early signs of Alzheimer's disease, and now he has also had a fall. In a few more years I may have to devote a great deal of energy to caring for him. He himself takes death philosophically; many of his peers have already passed on.
These years, every Qingming Festival when I return to the village to tend the graves, I always see several new mounds on the hillside. My father points out each new grave and tells me which elder it belongs to. Those elders were all very familiar to me; after I left the village at 18 for university I saw them rarely, and the images I retain are of them in their prime.
I also still have vivid memories of my father in his prime. I was born when he was 31; thirty-one years ago he was at the height of his strength and held enormous prestige in the village. Our home was one of the liveliest places in the village; growing up, I watched him handle all sorts of knotty village problems and mediate disputes between villagers. Back then he was energetic, sharp-minded, broad-minded, reliable, and widely respected.
After this latest fall, his physical strength declined noticeably. His memory has worsened year by year; although his reasoning ability remains outstanding, because memory errors keep cropping up, his analysis of things tends to go astray and he is no longer as crisp as he once was.
These elderly gentlemen and my father have given me a very direct look at aging, illness, and death. Sometimes I think that, by the laws of genetics, thirty-one years from now I may be much as my father is today. That is why in recent years I have grown interested in geriatrics, studying the common diseases of older people. I hope this will help me care for my father and, at the same time, help me better prevent age-related illness in myself.
Young people need not dwell on aging and death; for them life is still long and they are as vibrant as the morning sun. But middle-aged people cannot but face the question squarely. We must care for our aging parents, and in doing so we inevitably project ourselves into our own later years. I know death is unavoidable, but I do not want a low-quality old age. I very much want to avoid those common late-life problems.
Whether I can avoid them depends both on my own efforts and on fate. Whether I too will fall in old age is unclear. Looking at the older men around me, most take a fall once past 75, and after the fall aging accelerates. A fall seems to be a hurdle heaven sets for proud men; through a fall, heaven teaches these self-assured old men humility before the laws of nature. My father and the two elderly men in my community who fell—every one of them refused to acknowledge that he had grown old, insisted on doing work meant for strong young men, and that is why they fell.
But together with this lesson come late-life depression and anxiety, which are also among the most common geriatric conditions. There is an old Chinese saying, "No filial son stays by a long-sickbed"; although elderly people may not say it aloud, they are deeply aware of it in their hearts. For several years now my father has constantly worried that no one will care for him in old age. Although we strive to look after him, providing financial support and devoted care whenever he is unwell, he still fears being rejected. Even when he is not sick, he worries that the "old-person smell" on his body will make his children turn against him. Nearly every elder I see around me has this worry. I have also read monographs in geriatric psychiatry and know it is a universal problem.
A peaceful death in bed at a ripe old age has always been the ideal ending Chinese people aspire to; we call it a "good death." But most people are not granted that fortune. There is a saying popular in medical circles, "No fortune can buy death by myocardial infarction." Myocardial infarction is indeed a disease, but because this mode of dying is relatively painless, swift, and spares the sufferer a long ordeal, in the eyes of doctors who have seen much life and death, it is a rare kind of good death.
From a biological standpoint, 45 is the watershed of life. Before 45, our life is on the upswing; after 45, it begins to decline. Confucius said that at forty one is free from doubt, and at fifty one knows the will of heaven. Once past the age of freedom from doubt, one is less attached to worldly matters; as one approaches the age of knowing the will of heaven, one understands all the more that natural law cannot be altered by human effort, and that we can only follow it.
Of course, although natural law cannot be changed, it can be known and used. Through observation and study we can come to understand these natural laws and learn how to lessen the harm and damage they inflict, and this can improve our quality of life. Preparation ensures success; lack of it spells failure. Preventing geriatric disease beginning in midlife can effectively improve the quality of our later years and reduce the burden on our children.
A few days ago I bought two paperbacks to keep close and browse often: one is Years Gone By Like Water: The Centenarian Memoirs of Zhou Youguang, and the other is Japanese doctor Shigeaki Hinohara's Living Well: How I Lived to 105. Both books were written by centenarians who remained sharp-eyed and clear-minded past their hundredth year. I may not live to 100, but imitation is humanity's most basic capacity; I personally believe that drawing on the life experience of these two long-lived elders will help me plan my own old age better.
Since the journey home is unavoidable, let us at least make that journey a smoother one.