人人都应得善终

这是iHeart播客节目。我住在一位邪教领袖楼下，我担心自己惹怒了她。

This is an iHeart podcast. I live below a cult leader, and I fear I've angered her.

等一下，索菲亚。

Wait a minute, Sofia.

你怎么知道她是邪教领袖？

How do you know she's a cult leader?

好吧，达科塔，幸运的是，现在正值'Okay Story Time'播客的'不怕恐怖故事周'。我们很快就能知道答案。这位听众写道：我的邻居每天大声播放音乐，进行泥土仪式，现在我的天花板开始塌陷。我试图举报他们，但情况变得越来越诡异。我觉得他们可能是

Well, Dakota, luckily, it's I'm not afraid of a scary story week on the Okay Story Time podcast. So we'll find out soon. This person writes, my neighbor has been blasting music every day and doing dirt rituals, and now my ceiling is collapsing. I tried to report them, but things keep getting weirder. I think they might be part of

邪教成员？等等。现实中的邪教？泥土仪式又是什么？

a cult? Hold up. A real life cult? And what is a dirt ritual?

不知道，达科塔。想知道结局如何，请在iHeartRadio应用、Apple播客或任何你收听播客的平台收听'Okay Story Time'播客。

No clue, Dakota. Find out how it ends. Listen to the okay story time podcast on the iHeartRadio app, Apple podcast, or wherever you get your podcasts.

大家好，我是卡尔·佩恩。在我的新播客《历史重演》中，我们将探讨当下趋势和头条新闻，并追问：为何历史不断重演？每周我都会邀请比尔·奈、莉莉·辛格、皮特·布蒂吉格等朋友，从太空竞赛到电影翻拍再到致幻剂，无所不谈。

Hey. I'm Kal Penn. And on my new podcast, here we go again, we'll take today's trends and headlines and ask, why does history keep repeating itself? Each week, I'm calling up my friends like Bill Nye, Lilly Singh, and Pete Buttigieg to talk about everything from the space race to movie remakes to psychedelics.

换句话说，你是不是嗨了？

Put another way, are you high?

听着，现在的世界可能看起来很可怕，但我的目标是让你听完后对未来感觉好一些。请在iHeartRadio应用、Apple Podcasts或任何你获取播客的地方收听并订阅《Here We Go Again with Cal Pen》。

Look, the world can seem pretty scary right now, but my goal here is for you to listen and feel a little better about the future. Listen and subscribe to Here We Go Again with Cal Pen on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.

欢迎收听《Stuff You Should Know》，iHeartRadio出品。

Welcome to Stuff You Should Know, a production of iHeartRadio.

嘿，欢迎收听本期播客。我是Josh，还有Chuck，Jerry也在这儿。所以这是一期老派又热闹的《Stuff You Should Know》节目，我们要聊聊一个必须讨论的话题，Chuck。好吗？

Hey, and welcome to the podcast. I'm Josh, and there's Chuck, and Jerry's here too. So this is an old fashioned rootin' tootin' episode of Stuff You Should Know about something we need to talk about, Chuck. Okay?

好的。

Okay.

你还记得大约02/1011年那会儿吗？那时候死亡话题特别流行。人们举办死亡咖啡馆，制定生前遗嘱，这是当时人人都在谈论的大事。具体是什么时候？大概是2009到2011年左右吧。

Do you remember back in, like, the, like, about, like, the 02/1011 era when, like, death was all the rage? People were having, like, death cafes and, like, creating living wills, and it was just a big thing that everybody talked about? When was this? Like, 2009 to 2000 maybe '11.

我不记得有这回事，但我相信你说的。

I don't remember that, but I'll take your word for it.

这确实真实存在过，除非我完全疯了，凭空捏造了整个美国文化的一个时代。我不认为我疯了。但那个时代已经自行消亡了。就像，这个话题又回归到死亡，又变成了某种禁忌话题，至少在美国这里是个令人不适的话题。

It was a real thing, for sure, unless I've just completely lost my marbles and I just made up a whole era of American culture. I don't think I did. But that has died itself. Like, it's gone back to death has gone back to being a bit of a taboo topic, an uncomfortable topic at least at least here in The United States.

我也不知道这个。

I didn't know that either.

这...这是真的。我想我只是在凭个人经历讲述自己的观点。

It's it's true. I guess I'm just speaking for my for myself anecdotally.

哦，好吧。这样就合理多了。

Oh, okay. That makes a lot more sense.

那好。我们直入主题吧。有个概念叫'善终'。

So okay. Well, let's just cut to the chase here. There's this concept of a good death.

嗯。

Yeah.

对吧？你大概能想象出这个概念的含义，至少对你而言意味着什么。但研究发现，其实它包含一些具体要素，这些要素反复出现，大多数人都认同这些能构成善终。比如有机会与亲友道别，在愿意时让这些人陪伴身旁，所以对临终过程有一定控制权很重要。还有无痛苦、不受折磨。

Right? And you you can probably fill in a lot of the blanks of what that means and what it means to you at least, but there's actually like some components to it that studies have found like kind of bubble up to the top, that most people can agree this makes a good death. There are things like getting to say goodbye to friends and family, having those people at your side if you want, so a certain amount of control over the dying process is something. K. Being pain free, not suffering.

好的。

Sure.

身处一个环境，有机会去接受自己即将离世的事实——这些都是人们常说的最重要的事，对我来说这就是善终。巧合的是，这正是我们今天要讨论的临终关怀机构旨在提供的服务。他们的服务就是给予个人善终的机会，这不是富人专属的权利，也不是受过教育者才能享有的特权。

Being in an environment and having a chance to, like, kinda come to terms with the fact you're about to expire. Those are some of the top things that people say, like, this to me is a good death. And not coincidentally, those are the kind of things that hospices, which we're about to talk about today, are intended to provide. That's the service they provide is to give you, the individual, a good death, and it's not something that's relegated to the rich. It's not something that's relegated to the the educated.

这是面向所有人的。每个人都值得善终，这基本就是临终关怀的座右铭。实际上我见过一条标语说：如果你无法为生命增添更多日子，那就为日子注入更多生命。

It's for everybody. Everybody deserves to have a good death, and that's pretty much the motto of hospice. And in fact, I ran across one motto. It said, if you can't add more days to life, add more life to days.

这...这很棒。听起来有点企业口号的味道，但我喜欢这个理念。

That's that's great. It sounds a little too corporate slogany, but I like the sentiment.

对，还有个吉祥物叫'死人路易'。

Yeah. There's a mascot, Louis the dead guy.

好吧。哦，

Right. Oh,

天啊。这家伙总爱说那句话，最近还莫名其妙和家得宝搞了个合作。

man. Who who's like always saying that And he did a partnership with Home Depot for some reason recently.

哦，天哪。好吧，这就解释了为什么有橙色床单之类的东西。对。好吧。这可能是我们开的最后一个半开玩笑的玩笑了。

Oh, boy. Well, that explains the orange bedsheets and things. Right. Alright. So that's probably the last semi joke we're gonna make.

你得原谅我们刚才那样。我们做了一整期关于死亡的节目，我甚至不记得那期里有没有开过一个玩笑，所以

You'll have to forgive us for that. We did a whole episode on dying, and I don't even know if we made one joke in that one, so

当然开过。你觉得呢？是的，我绝对认为开过。

Sure, we did. You think? Yes. I absolutely think.

好吧。我们会把这期和那期搭配起来，因为关于死亡那期我们收到了很多积极的反馈，说它如何帮助了人们。是的。也许这期也能起到同样作用。我们或许该回溯一下历史，解释临终关怀的起源，因为它的历史其实非常短暂。

Alright. Well, we'll pair that with this one, and because we got a lot of great feedback on the dying episode and how that kinda helped people out. Yeah. Maybe this will do the same. We should probably go back in time a bit and explain the history of hospice, because it is very recent.

如果你看看人类死亡方式的时间线，临终关怀以我们现在所知的形式存在，其实只从上世纪六七十年代才开始。在那之前，基本上整个医学史都在说：'我们是来治愈病人的'，如果最终无法治愈你，直到最后——就像我说的，直到六七十年代之前——医院甚至医生都会可耻地把这视为他们无力挽救的提醒，所以不会在你身上花太多时间。有很多著名记载描述医护人员匆匆走过医院里濒死病人的房间之类的场景。

If you look at sort of the timeline of people in the world dying, hospice has only been around since like the sixties or seventies in in the form that we know it. Because previous to that, for all of time, basically, medicine was like, hey, we're here to cure people, and if if it turns out that we cannot cure you, and that the end is near for a very, very long time until the last, like, you know, like I said, since the sixties or seventies, very shamefully, hospitals and even doctors would sort of like it was a reminder that they couldn't save you. So they didn't spend a lot of time with you, and there are a lot of, you know, well known reports of people kind of like scurrying past rooms where people were in their final days in a hospital and stuff like that.

是的。他们让那些无法治愈的垂死者基本上孤独地死去。他们撤回了支持。当时就是那么做的。就像你说的，这是医学失败的提醒，而现代医学在那个时代根本不愿被提醒失败——毕竟二十世纪对医学来说是捷报频传的世纪。

Yeah. They left the dying who who were incurable now to basically die alone. They they withdrew support. That was just what they did. Like you said, it was a reminder of the failing of medicine, and this was a time when modern medicine was not in any kind of mood to be reminded of failings because, I mean, the twentieth century was pretty triumphant for it.

我是说，我看到婴儿死亡率在那个世纪下降了90%。有了卫生设施、清洁饮用水、脊髓灰质炎疫苗...科学似乎无所不能，而那些无法治愈的患者就成了这种全能幻象的界限提醒。

I mean, I saw the infant mortality rate decline by ninety percent over the century. There's like sanitation, clean drinking water, polo vaccine, like science could do anything, and people who were incurable were just a reminder that there were limits to that whole thing.

没错。还有另一件事，说起来也挺可耻的——好吧，也许不算可耻——但后来他们重新审视了疼痛管理的理念。

That's right. And another thing that was going on, and this is also pretty shameful, well, guess not shameful, but they've since revisited how they look at pain management.

你

You

以前必须疼得厉害才能得到止痛治疗，然后药效过了，还得再次疼到不行才能获得更多止痛措施。他们当时担心阿片类药物成瘾之类的问题，但如今观念明显转变了：'在生命最后的日子里，我们根本不担心你会对止痛药上瘾，只想让你好受些。'

had to really be in pain to get pain management, and then that had to wear off, and you had to be really in pain again for them to administer more pain management. They were worried about opioid addiction and stuff like that, but these days it's definitely more like, hey, we're not worried about you getting addicted to opioids in the final possibly days of your life. We just wanna make you feel okay.

是的。这绝对是临终关怀的理念——不必等前一次止痛药失效才能用新剂量。关键是让患者持续保持舒适，这就是姑息治疗的意义。

Yeah. That's definitely the hospice philosophy, is you don't have to wait until one pain killer wears off to get another dose. You can, you know, stay comfortable. That's the point, is to make the person comfortable. That's called palliative care.

我们稍后会详细讨论，但本质上就是通过症状管理让人保持舒适。

We'll talk a little more about that, but it's essentially just taking care of symptoms to keep people comfortable.

确实。修女们很早就开始提供情感支持了。当然她们不能配发止痛药这类东西。但很多时候确实是宗教组织率先行动，在六七十年代就开始从事后来被称为临终关怀的工作。这部分要归功于当时出版的几本里程碑式著作。

Yeah, for sure. Nuns were kind of on the scene early on providing emotional support. They couldn't dose out pain medication, of course, and stuff like that. But they, you know, was a lot of times it was religious organizations that were stepping forward, that were kind of doing the hospice type work that would come along in the sixties and seventies. Thanks in part to a couple of big landmark books that came out.

对。六七十年代有股叛逆风潮席卷社会，挑战某些原本不容置疑的体制，医疗系统和医院就是其中之一。精神病学家伊丽莎白·库伯勒-罗斯在她1969年出版的《论死亡与临终》中提出了著名的悲伤五阶段理论。除了这个成就，她还采访了芝加哥医院ICU里的临终患者，发现他们完全被忽视了。

Yeah. There was this whole thing in the sixties and seventies that was kind of this rebellious streak that went across, like, or against some of the just unquestioned institutions, and one of those was medicine and doctors and hospitals. But there was a psychiatrist named Elizabeth Kubler Ross who very famously came up with the five stages of grief. That was in her 1969 book on death and dying. And in addition to being famous for coming up with the five stages of grief, she also basically interviewed people in Chicago hospitals ICU, who were dying and just found that they were just being totally neglected.

她确实积极倡导要让临终者及其家属的声音被倾听、得到关怀，而非被忽视。

And so she definitely lobbied for dying and and dying people and their families to be listened to and to be treated, rather than just ignored.

是的。我们在关于临终的节目里讨论过她和那本书。嗯。虽然没提到1973年出版的《拒绝死亡》，但那是由人类学家欧内斯特·贝克所著——他本人就是在濒死状态下完成写作的，所以能提供非常动人的第一手叙述。

Yeah. We talked about her and that book in our dying episode. Mhmm. I don't think we talked about the denial of death from 1973, but that was from an anthropologist named Ernest Becker. And he was writing this as he was dying himself, so he was in a position to really give a good, you know, pretty moving first person account.

他探讨了如何坦然接受死亡必然性等话题。这些思潮涌动之际，西塞莉·桑德斯女士——后来成为伦敦圣克里斯托弗临终关怀院的创始医疗总监——彻底改变了游戏规则，开创了现代临终关怀运动。

And he talked about sort of, you know, a good death and accepting the inevitability and stuff like that. So these things were sort of happening in the cultural movement when a woman, hero, I think, named Cicely Saunders came along, eventually the founder and medical director of Saint Christopher's Hospice in London, and she really changed the game and kind of birthed the whole sort of modern hospice movement.

她自幼患有背疾，这让她无法实现成为护士的梦想，转而从事社会工作——当时被称为'施善女士'或'救济分发员'，这称呼现在听起来很复古。

Yeah. She had a bad back from a young age, and apparently it kept her from her her desired career of nursing. So she instead became basically a social worker, What at the time, they called a lady almaner or distributor of alms. Right? So it's pretty old timey.

这其实是对十字军时期罗马天主教会创办的最初临终关怀院的致敬。讽刺的是，桑德斯原本是无神论者，却在与基督徒朋友全家度假时皈依了福音派基督教。促使她创立临终关怀运动的关键经历，是她与几位临终者建立的深厚友谊——这些情感触动让她决心让更多人获得同样温暖的临终陪伴。为增强话语权，她甚至特意去读了医学院，这很能体现她的为人。

But it does kind of it's a nod back to the original hospice, which were founded in the crusades by the Roman Catholic church. Ironically, Cicely Saunders was raised an atheist, but she had a conversion to Christianity, evangelical Christianity even, when she went on vacation with a Christian friend and her family. And one of the other big experiences that led her to found found the hospice movement essentially was she had, like, some friendships with some people that she helped essentially as they were dying and really kind of was moved by these friendships and wanted to make sure that other people had that same experience. So she did something that, I mean, just kind of, I think, really gets across the kind of person she was, and she went to medical school to make her voice a little more credible.

没错。她33岁考入医学院——那可是1950年代——毕业后顺利成为执业医师。嗯。

Yeah. She started medical school at age 33. This is in the nineteen fifties, and she finished medical school. She was able to work as a physician. Mhmm.

她开始撰写相关文章，探讨医生对濒死患者的疏于照护问题，主张必须建立身心灵全方位的临终关怀体系。为此她不仅取得医学学位，还在医院获得研究职位，通过疼痛管理等领域的数据研究来夯实理论基础——她明白光有善良意愿不够，必须用专业医疗知识和实证研究才能真正推动变革，而她确实做到了。

She started writing articles and stuff about this, about people being deserted or feeling like they'd been deserted by their doctors, like the closer they got to death, like we were talking about, and said, hey, there's gotta be a better way to take care of people, not only physically, but emotionally and spiritually, as they as they near death. So she, you know, got that medical degree, got a research job at a hospital, started studying. You know, she wanted to have a legitimate sort of background for this, so people didn't think she was just some Right. Some some wacky empath trying to do good, which, you know, should be enough. But she figured she was armed with medical training and real data and and on, like, pain management stuff that she would go a lot further, and she did.

是的。她亲自去研究疼痛管理，以便制定自己的治疗方案。其中一项真正具有开创性且违背常规的方案是，不仅给临终病人大量吗啡以确保他们无痛，还使用可卡因防止他们余生都处于昏沉状态。她会了解病人偏好的酒类并确保供应。这一切听起来完全鲁莽且不负责任。

Yeah. She went and studied pain management firsthand so she could come up with her own protocols. One of those protocols that was really groundbreaking and went against the norm was to give dying patients not just heavy doses of morphine to make sure that they weren't in pain, but also cocaine to keep them from just being kind of doped up the for the rest of their lives. She would find out what liquor they preferred and would make sure that they had their liquor. And all of this sounds like just completely reckless and and careless.

但她有这些人的前后对比照片——那些晚期癌症患者在采用她的新疼痛管理方案（也可以说是情绪管理方案）之前，状态非常糟糕，看起来就是典型的晚期患者。而治疗后，他们能在床上坐起身，精神焕发，有些人甚至重拾了编织等爱好。她在全球推广临终关怀理念时，就用这些照片作为例证。仅凭这些对比照片，她每次演讲都能赢得支持者。

But she had before and after pictures of these people, terminal cancer patients who in the before pictures, before they had been treated with her new protocol of pain management, and I guess mood management too, if you think about it, they did not look very good. They looked like terminal cancer patients, and afterward, they were sitting up in bed, perked up. Some had taken up hobbies like knitting, and she would show these before and after pictures when she went around the world speaking on behalf of hospice as she was trying to found it. And like, she would get converts at every every talk she gave just from the the before and after pictures alone.

确实，这非常了不起。这一切在1967年达到高潮——她在伦敦创立了圣克里斯托弗临终关怀院（如前所述）。成立之初她就宣布：‘我们有一种新的疼痛管理方式，将取消探视时间限制，家属可以根据自己方便随时来访。’

Yeah. It was it was pretty remarkable. This all culminated in 1967 when she founded Saint Christopher's Hospice, like I like I mentioned earlier, in London. And kind of right off the bat, said, alright, we have a new way to deal with pain management. We're gonna get rid of visiting hours, and people, family can come and go when it's convenient for them.

我们不仅关注身体疼痛，还要解决她所说的‘整体疼痛’——包括情感支持、社会支持以及人们面临的精神痛苦。与她密切合作的美国护士弗洛伦斯·沃尔德后来在美国推行相同理念，于1973年在康涅狄格州布兰福德建立了美国第一家临终关怀院，比伦敦的晚了六年。

And we're gonna not talk about just physical pain, we're gonna talk about what I call total pain, or what she called that. You know, like we mentioned, emotional support, social support, spiritual suffering that happens with people. And one of the people that she worked a lot with was a nurse in The US named Florence Wald, who ended up doing the same thing in The US. She said, I think we need this over here. She started up the very first hospice in Branford, Connecticut in The United States, and that was six years later after the one in London in 1973.

是的，美国第一家临终关怀院命名过程很有趣——他们考虑过‘临终关怀我们造’、‘麦当劳式临终’等名字，最后选了个直白的名称。

Yeah. That first American hospice, they tried a few names out before they settled on the the final one, Hospice R Us, McDying, and then they just kinda went with the straight name.

哇，好吧。

Wow. Alright.

所以临终关怀理念传播得很快。圣克里斯托弗1967年成立，布兰福德那家1973年就跟进——作为全新理念，能在英美两国迅速落地并推向全球很不容易。我记得你说过，圣克里斯托弗虽然具有宗教/灵性色彩，但属于非教派机构。

So, yeah. So hospice, that spread pretty quickly. Think you said Saint Christopher's opened up in 1967, and the one in Branford opened up in 1973. That's pretty good traction to to create a brand new idea in both The UK and The US and start spreading it around the world. And one of the things I think you said about Saint Christopher's was even though it was religious or at least spiritual, it was nondenominational.

关于临终关怀的一个重要观点常被许多人忽视。我认为很多人仍将其与宗教团体联系在一起。比如，如果你不是基督徒，你可能不会想去基督教临终关怀机构。但这完全误解了临终关怀的运作方式。事实上，有许多无神论者也在接受临终关怀服务。

And that is a huge point about hospice that is lost on a lot of people. I think a lot of people associate it with religious groups still. And, like, if you're not, say, Christian, you wouldn't really wanna go to a Christian hospice. That is not at all the way that hospices work. And in fact, there's plenty of people who are atheists.

他们是人文主义者，就像你之前提到的那些富有同理心的行善者。这些理念并不冲突，因为它们都指向一个共同点：临终过程中重要的是一种精神性体验，或者说至少是某种我们与灵性相关联的平静。实现方式并不重要，我们共同努力只是为了让每个人都能获得这种体验。这常常是人们对临终关怀的重大误解。

They're humanists, and they just are like those empathic do gooders that you were speaking about earlier. And none of these philosophies clash because they all come together to essentially say one of the big parts of dying is some sort of spirituality or at least some sort of peace that that we associate with spirituality. It doesn't matter how you get there. We're all just kind of coming together to make sure that everybody can experience that. It's a big misunderstanding of hospice sometimes.

确实如此。在美国，临终关怀最初通常是在家中进行的，这与英国早期的住院模式不同。最初是预算问题导致无法建立专门设施，但后来发现人们更希望在家中离世。而且美国人对机构长期存在的不信任感也起了作用。早期工作几乎完全依靠志愿者完成。

Yeah, for sure. In The US, it's usually, or at least at first it was done at home, That was the difference from the early ones in The UK. They were inpatient facilities, but in The US, you know, it was sort of a budget issue at first because they couldn't get these facilities and pay for them, but I think they also realized that people wanted to die at home. And there was also this sort of long running institutional distrust that Americans had. And it was a lot of volunteer work at first, like almost entirely volunteer early on.

正如我们提到的，几个世纪来神职人员一直在从事这类工作。还有利用业余时间想要帮忙的医生。这个运动显然在不断发展，当政府发现它能节省医疗开支时就开始重视起来——不仅因为运动规模扩大和民众满意度提升，还因为它能间断性地减少住院需求。最终美国政府和里根政府决定将其纳入医保覆盖范围。

It was sometime, like we mentioned, people in the clergy still doing this kind of work after centuries of doing so. Doctors that were moonlighting that wanted to help out. And a movement was was, you know, clearly growing, and it made government sit up and take notice when they realized that it was saving money on health care because not only was the movement growing and people were just feeling better about it, but it was keeping people out of the hospital sort of off and on, off and on, off and on. And so much so that the US government and the Reagan administration said, you know what? We should should get this covered.

1982年通过的临终关怀医保福利法案，突然让专业团队提供的付费服务能够通过医疗保险报销了。

And in 1982, the hospice medic Medicare benefit went through, which allowed people all of a sudden to be able to pay from a staff run by professionals that were also paid, and get it covered through Medicare.

是的。这为那些想在人生最后阶段帮助他人的人打开了职业大门——以前这不算正式职业，现在你可以专门从事临终医疗领域了。这个改变很棒，不过我猜节省开支才是主要推动力。

Yeah. Which opened up the door for people who wanted to help people during the final days or weeks of their life, but there wasn't a career associated with it. Now there was, so you could you could pursue that kind of medicine, end of life medicine. That's pretty cool that that was a huge change. I suspect that the saving money had a lot to do with it though.

确实，通常都是这样。

Yeah. That's usually the case.

让我们明确说明原因。之所以能节省费用，是因为你将病人从一条极其昂贵的治疗轨道上移开——这条轨道涉及大量不同的医疗程序和疗法——转而告诉他们：我们决定不再采用治愈性治疗方案。我们要带你离开这个疯狂混乱的医疗世界，将你安置在一个更宁静祥和的天地里，让你能以更快乐的心态度过余生，而不是感觉自己像只被实验的小白鼠。正如你能想象的，这样做成本也低得多。

And the reason why let's just spell it out explicitly. The reason why it saves money is because you're taking a patient off of a very expensive track, which is a lot of different medical procedures and treatments, and saying, we're like, you're not going to go for the curative treatment route anymore. We're gonna take you out of this crazy, nutso medical world and put you in a much more peaceful, tranquil world where you can end your days as a happier person rather than feeling like a guinea pig being experimented on. And it's just much cheaper to do that too, as you can imagine.

感觉是个不错的停顿点。庆祝一下？

Feels like a good breakpoint. Yay?

庆祝。

Yay.

好的。我们稍后会回来继续讨论现代医疗体系的运作方式。

Alright. We'll come back and we'll talk about how the the modern system works right after this.

我住在一位邪教领袖楼下，恐怕已经惹恼了她。

I live below a cult leader, and I fear I've angered her.

等等，索菲亚，你怎么确定她是邪教领袖？

Well, wait a minute, Sofia. How do you know she's a cult leader?

达科塔，幸运的是，现在正值《OK故事时间》播客的'我不怕恐怖故事周'，你马上就会知道了。这位听众写道：我的邻居每天大声播放音乐，举行泥土仪式，现在我的天花板开始塌陷。我试图举报他们，但情况越来越诡异。我怀疑他们可能是...

Well, Dakota, luckily, it's I'm Not Afraid of a Scary Story Week on the Okay Story Time podcast, so you'll find out soon. This person writes, my neighbor's been blasting music every day and doing dirt rituals, and now my ceiling is collapsing. I tried to report them, but things keep getting weirder. I think they may be part of

一个邪教。等等，索菲娅。现实生活中的邪教？泥土仪式又是什么？

a cult. Hold up, Sofia. A real life cult? And what is a dirt ritual?

不清楚。但据这个人说，承包商正在拆除露台以查明天花板的问题，而她的邻居们很不高兴。很不高兴。

No clue. But according to this person, contractors are tearing down the patio to find out what's going on with their ceiling and her neighbors are not happy. Happy.

嗯，需要尽快举报他们。

Well, needs to report them ASAP.

她举报了。现在他们一直以非常诡异的方式找她麻烦。

She did. And now they've been confronting her in really creepy ways all the time.

所以我们能知道这个人是否从社区邪教中幸存下来吗？

So do we find out if this person survives their neighborhood cult or not?

想收听爆炸性结局，请在iHeartRadio应用、苹果播客或任何你获取播客的地方收听《Okay Storytime》播客。

To hear the explosive finale, listen to the Okay Storytime podcast on the iHeartRadio app, Apple podcast, or wherever you get your podcasts.

《狼来了》播客讲述了两个被不公束缚的男人、一座被秘密困扰的城市，以及不惜一切代价寻求救赎的故事。

The Crying Wolf podcast is the story of two men bound by injustice, of a city haunted by its secrets, and the quest for redemption no matter the price.

白人受害者，女性，漂亮，富有，黑人被告。

White victim, female, pretty, wealthy, black defendant.

芝加哥，一名白人女性被谋杀，一名黑人男子因未犯之罪入狱。

Chicago, a white woman's murder, a black man behind bars for a crime he didn't commit.

我因杀害一个素未谋面的人被判九十年。

I got ninety years for killing somebody I have never seen.

他说警察是他的朋友，然后就这样了。他们转而针对他。

He says the police are his friends, and then that's it. They turn on him.

一名腐败的侦探。

A corrupt detective.

他们是如何用那些审讯手段对付他的。太疯狂了。

How he was interrogated with techniques. That's crazy.

一个告密者和被偷走的人生。

A snitch and a life stolen.

他们抓错人了。

They got the wrong guy.

但在监狱内部，李·哈里斯在他的狱友罗伯特身上找到了盟友，罗伯特发誓要说出发生在李身上的真相并解救他的朋友。

But on the inside, Lee Harris finds an ally in his celly, Robert, who swears to tell the truth about what happened to Lee and free his friend.

如果你跟我一起，你的目标就是——我会照顾你的。

And if you're with me, your goal is to I'll take care of you.

我会和你在一起。你这辈子都甩不掉我了。

I'm gonna be with you. You stuck with me for life.

请收听《狼来了》播客，10月22日起在iHeartRadio应用、Apple Podcasts或任何你获取播客的平台上线。

Listen to the crying wolf podcast starting on October 22 on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.

我们开始吧。

Here we go.

嘿，我是卡尔·潘。在我的新播客《历史重演》中，我们将聚焦当下潮流和头条新闻，追问：为何历史总在重复？你可能知道我是《猪头逛大街》系列电影里第二性感的演员，但我同时也是作家、白宫职员，以及——大约十五秒前刚成为的——播客主持人。这一路上，我结识了许多科学、政治和流行文化领域的专家朋友。每周都会有一位嘉宾加入，解答我那些亟待解决的问题。

Hey. I'm Kel Penn, and on my new podcast, here we go again, we'll take today's trends and headlines and ask, why does history keep repeating itself? You may know me as the second hottest actor from the Harold and Kumar movies, but I'm also an author, a White House staffer, and as of, like, fifteen seconds ago, a podcast host. Along the way, I've made some friends who are experts in science, politics, and pop culture. And each week, one of them will be joining me to answer my burning questions.

我们是不是又要遭遇像08年那样的金融危机了？开放式关系又流行起来了吗？为什么航班提前两分钟降落时永远没有登机口可用？我们请到了皮特·布蒂吉格、斯泰西·艾布拉姆斯、莉莉·辛格和比尔·奈这些嘉宾。

Like, are we heading towards another financial crash like in o '8? Is non monogamy back in style? How come there's never a gate ready for your flight when it lands like two minutes early? We've got guests like Pete Buttigieg, Stacey Abrams, Lily Singh, and Bill Nye.

当你开始将外太空武器化时，事情可能会变得非常糟糕。

When you start weaponizing outer space, things can potentially go really wrong.

听着，现在的世界看起来确实很可怕，因为它确实如此。但我的目标是让你在听完后对未来感觉好一些。请在iHeartRadio应用、苹果播客或任何你获取播客的平台收听并订阅《Here We Go Again with Cal Pen》。

Look, the world can seem pretty scary right now because it is. But my goal here is for you to listen and feel a little better about the future. Listen and subscribe to Here We Go Again with Cal Pen on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.

在美国，查克，临终关怀通常由联邦医疗保险（Medicare）支付，这是为退休人员或残障人士提供的联邦保险，有时也由医疗补助（Medicaid）支付，后者覆盖低收入美国人。这一切的结果是，如果你选择接受临终关怀，你不需要为此付费。这是联邦政府做的一件很棒的事。显然，英国的情况非常相似，但大部分资金来自捐赠而非政府，尽管政府也会提供部分支持。但英国有资格要求，基本上是说，如果你不符合这些条件或在任何时候不再符合，你就不能再接受临终关怀了。

So here in The United States, Chuck, hospice is usually paid for by Medicare, which is federal insurance coverage for people who are retirees typically or maybe disabled, and then also sometimes Medicaid, which covers lower income Americans. And the upshot of all this is that if you are dying and choose to go on hospice care, you are not charged for this. And that is a wonderful thing that the federal government does. Apparently, The UK is very much like that, but a lot of it is donation driven rather than paid for by the government, which does chip in, but the lion's share is paid for by donations in The UK. But there's eligibility requirements that basically say, like, if you don't check these boxes or if you stop checking these boxes at any point, you can't be in hospice anymore.

是的。具体来说，你必须有两名医生证明你患有——这是针对联邦医疗保险的，你知道，为了获得覆盖，而不仅仅是进入临终关怀。

Yeah. And those boxes specifically, you have to have two doctors certify that you have a and this is for Medicare, you know, to get it covered, not just to get into hospice.

对。

Right.

你必须患有绝症，预期寿命不超过六个月，并且不能寻求治愈性治疗。我们会讨论一些——我甚至不知道是否有例外——但有些人可能认为某些治疗是治愈性的，其实不是。这并不意味着你什么都不能要求。

You have to have a terminal illness. You have to have six months or less to live, and you cannot be going after curative treatments. And we'll talk about some, I don't even know if there are exceptions, but some things that some people might think are curative treatments and aren't curative treatments. That doesn't mean like, right, don't ask for anything at all.

只是，你要知道你不能用创可贴。

It's just, know you can't have a band aid.

是的，你得靠自己。我们会讨论这些，但现行制度的一个症结在于，医疗保险是按日付费给临终关怀机构的，而不是根据他们提供的具体服务——这与你将获得的其他所有医疗治疗方式都不同。这种护理分为四个等级，不同等级和地区对应不同费率。

Yeah, you're on your own. So, we'll get into those, but, and this is gonna be a sticking point that kinda comes up later in some of the failings of the current system, but Medicare pays hospice companies and agencies a daily rate, instead of for specific services they provide, like basically all the other medical treatments you're ever gonna get. And there are four levels of that care, and they're gonna be different rates depending on the level that you're gonna get, and also where you are.

没错。如果你经营临终关怀机构，政府会为接受常规家庭护理的病人支付固定费用——这类病人虽处于临终状态但情况稳定，通常每周只需探访几次，主要是确保用药正确，可能还包括营养支持，本质上就是定期检查。

Right. So, that you, if you're running a hospice, you would get a flat fee paid by the government for a patient who's in routine home care, which is you're not in crisis, you're still dying, but you're doing okay, and that usually is just a visit maybe a couple of times a week. They're coming by to make sure that their meds are going down right. They maybe have, like, their nutrition going. They're just essentially just checking on you.

这是常规家庭护理。还有持续家庭护理——当病人突发危象时，比如出现无法控制的呕吐、药物无效的剧烈疼痛或意识改变，就能立即获得24小时居家临终看护。

That's routine home care. There's also continuous home care where if that patient slips into a crisis, like maybe they start vomiting uncontrollably, they start suffering uncontrollable pain that their meds aren't doing anything for anymore, changes in consciousness, all of a sudden now they have twenty four seven hospice access at home.

对，还有几种。比如住院暂托护理，病人需要离家到实体临终关怀中心住最多五天，这通常是为了让照护者获得喘息——生命末期对家庭而言是残酷的负担，我指的不是麻烦，而是实实在在的重压。

Yeah. There's also, there's a couple more. There's inpatient respite care. That's when a patient goes into, like, know, they have to leave home to go into a physical hospice center for up to five days. A lot of times this is to give their caregiver time off, because that's one of the brutal parts about end of life is, and I say burden on the family, not like, oh, what a hassle, but it is a burden on the family.

嗯。

Yeah.

除了承受情感上的煎熬，家属往往还要调整工作安排，有时甚至需要辞职来全职照料。这对家庭而言确实是沉重的负担。

People have to, besides the emotional devastation they're going through, a lot of times have to to rearrange their jobs, and like even leave jobs sometime to do this kind of thing full time. So it can be quite a heavy burden on a family.

是的。实际上，查克，如果你查阅临终关怀的弊端，这几乎是首要问题——它将照顾临终患者的责任从医院转移到了家属身上。这确实是件大事。

Yeah. Actually, Chuck, that that's a if you look up downsides of hospice, that's pretty much the number one issue with it, is that it it transfers responsibility for caring for the dying patient from, say, like a hospital to their family. And that's a that's it is. It's a very big deal.

对。最后一种是普通住院护理，当你需要处理疼痛控制或任何无法在家进行的症状管理时，就必须去特定场所接受治疗。姑息护理是重要组成部分，就是我们之前提到的，让人们在生命末期感觉好些。

Yeah. And then the last one is general inpatient care, and that is when you're addressing pain control or any kind of symptom management that you can't that you have to go in and take care of at a specific place. It's not the kind of thing you can do at home, generally. And then, you know, palliative care is a big part of it. That's what we kind of mentioned earlier, just making people feel better toward the end.

我提过那些不算治愈性治疗的情况，比如突发心力衰竭时可以尝试逆转，或是感染严重的褥疮需要处理——这些都不会让你失去临终关怀的覆盖范围。

You know, I mentioned things that don't count as curative treatment, like if you're if you have heart, like active heart failure, they can try and reverse that. Or if you have some, like, nasty bedsore that gets an infection, that's not gonna boot you off covered hospice care to get that taken care of.

不。医保覆盖临终关怀的关键在于你不寻求治愈绝症的治疗。就像你说的，如果患有心脏病但那不是致命原因（比如你患的是晚期癌症），他们可以治疗你的心脏问题。

No. The key to being covered for hospice under Medicare is that you're not pursuing treatment to cure the thing that's got you terminally ill. Yeah. Right? So like you said, if you have developed a heart condition, but that's not what's killing you, you have terminal cancer, they can treat your heart condition.

即便你确实患有晚期癌症，若出现癌症引发的恶心、疼痛，他们仍会治疗这些症状，因为他们不试图治愈癌症。你需要放弃的是放疗或化疗这类治愈性治疗。但认为他们会直接放弃你、让你卧床等死的观念是完全错误的。

And even if you do have terminal cancer, if you have nausea from cancer, pain from cancer, they're gonna treat that because they're not trying to cure the cancer. You have to give up things like radiation or chemotherapy, those are curative treatments. But there's the idea that they're just like, nope, sorry, we're just gonna put you in bed and basically let you lay there, that's not at all what what you have to give up in order to enter hospice.

没错。临终护理人员的工作远不止让你感觉好些或陪你梳头这类事情。他们帮你洗澡、有时做家务、协助配药给药，承担着各种工作。

Yeah. And, you know, the hospice workers are doing a a lot of stuff for you that goes above and beyond just making you feel better, or maybe sitting with you, and like, you know, brushing your hair. Like, there's all that stuff that they're doing. Bathing you, housekeeping sometimes, you know, helping out with gathering and administering the medications. But, you know, they're doing all kinds of stuff.

他们可能帮你购物、临时照看你的家人——就是那些照顾你的亲属——让他们喘口气。还可能协助筹款。如果需要治疗资金，他们会组织音乐喜剧表演到临终中心，甚至有理发志愿者来帮人做发型。我记得艾米丽祖母临终前特别在意发型，这种细节能极大安抚患者情绪。

They might be shopping for you. They might be babysitting for your family to give, you know, the the like we mentioned, the people in your family that are caring for you, like, to give them a break. They may help with fundraising. If you have, like, you know, money you need raised for your treatment, they may bring in music and comedy performances to hospice centers, people that cut hair, like volunteers that will come in and style somebody's hair even. I remember that was a big deal for Emily's grandmother near the end is, you know, that she wanted her hair done and and to look like she looked, and that stuff goes a long way to just putting people at ease, you know?

哦，当然。志愿者可以做的另一件事是照顾病人的宠物，确保当病人选择居家临终关怀时，他们的宠物不必因为主人无法继续照顾而另寻去处。你可以去帮忙喂食宠物、遛狗、清理猫砂盆。甚至只是简单地陪病人看电视就足够了。而且，这只是美国和英国的志愿机会。

Oh, for sure. Another one that volunteers can do is take care of the person's pet to make sure that if the person is opting for in home hospice, that their pet doesn't have to go live with somebody else because they can't care for it anymore. So you can go and feed somebody's pet, take them for a walk, change the litter box. And then something as simple as just sitting with somebody and watching TV with them is enough. And, like, this is just a volunteering opportunity in The United States and The UK.

基本上，只要有临终关怀机构的地方，他们都非常欢迎志愿者去陪伴。作为志愿者的资质，基本上就是能开车去别人家的人就行。这就是你需要做的全部，之后他们会告诉你具体该怎么做。但没人会指望你去给病人打针之类的——事实上如果你真这么做了可能会惹上大麻烦。

Basically, anywhere there's hospice, they would very much like you to volunteer to just basically be there. And just being a human being who can drive a car over to somebody's house is essentially the qualifications. That's that's basically all you need to do, and they'll tell you what to do from there. But no one would expect you to, like, you know, inject the person. As a matter of fact, you'd probably get in big trouble if you did inject the person with anything.

你只需要在场陪伴。正如你所说，除了陪伴病人外，这还能让主要护理人员有时间去洗个澡、处理些事情，暂时卸下护理者的角色几个小时。

You just need to be there. And in addition to just being there for the person, the patient, like you said, that gives the caregiver some time to just go take a shower, do something, just stop being a caregiver for a couple of hours too.

是的。虽然现在很多从业人员都是专业人士，但仍有大量志愿者在做这类工作。嗯。我提到的1982年医疗保险法规定，临终关怀机构必须有至少5%的患者护理时长由志愿者提供——这也是原因之一。

Yeah. And you know, even though a lot of them are professionals, like most of them now, there's still quite lot of volunteers that that do this kind of thing. Mhmm. That Medicare law that I talked about in 1982 that stipulated that hospice facilities have at least 5% of the patient hours provided for by volunteers. So that's one of the reasons.

还因为世界上有些人...比如亲历过家人临终过程后想要回馈社会的人，有些天生共情能力强就想帮助别人的人，也有些是准备进入医疗行业的人。我觉得在临终关怀机构经历最极端的情况，对今后应对各类病患都是很好的准备。

And also just because there are people in the world, you know, some people have maybe gone through this with a family member and then they wanna give back. Some people are just wired this way as empaths to wanna help people. And then sometimes it's people that are preparing for a career in healthcare. And getting in a hospice and kind of going through the worst of the worst situations is, I imagine, pretty good preparation on dealing with any kind of patient.

没错。选择这个职业方向是因为——如你所说——临终关怀机构不仅有专业护士和医生，还有社会工作者、丧亲咨询师、神职人员等组成多学科团队，共同应对西塞莉·桑德斯提出的'整体疼痛'概念：心理疼痛会加剧身体疼痛，反之亦然。当病人状况越差，亲友可能越不愿探望，这时又会产生社交疼痛。当所有专业人员共同缓解病人的整体疼痛时，就能让临终过程更平静祥和。

Yeah. And you would prepare for a career in that because hospices, like you said, they are professionally staffed, and not just with nurses, not just with hospice doctors, but social workers, bereavement counselors, some of those clergy, and just general aids who can come together and help with that that thing that Cicely Saunders started kind of seeing clearly, the total pain where, you know, if you have psychological pain, it's gonna make your physical pain exacerbated and vice versa. And the worse off you are, the more hesitant people might be to come visit you because they feel hopeless or they're just freaked out or something like that. So now you have social pain. So if you have all these people coming together to treat the person's total pain, you have a much calmer, happier, again, good death.

这在临终关怀行业被称为跨学科团队，他们会为每位患者组建专门团队，制定个性化方案来帮助患者获得内心的平静与安宁。

And those are called in the hospice industries interdisciplinary groups, and they they do. They form a team for each patient to figure out what to do for each of the patients to help them basically find peace and comfort and calm.

是的。这是一个，你知道的，如今在美国蓬勃发展的行业，我们稍后会谈到其中的弊端。但从统计数据来看，从2001年的2000家临终关怀中心增长到如今的约5700家，二十四年、二十五年后，这个行业确实发展迅猛。2013年至2022年间，临终关怀使用率增长了32%。医疗保险受益人数增加了25%，显然随着婴儿潮一代老龄化，但这并不能完全解释32%的增长与25%之间的差距。

Yeah. And this is a, you know, it's a booming industry now in The United States, and we'll sort of get to the downsides of that in a little bit. But statistically, from 2,000 hospice centers in 2001 to about 5,700 today, 20, you know, twenty four, twenty five years later, it's really grown a lot. Utilization grew by 32% between 2013 and 2022. There was a 25 increase in Medicare beneficiaries, obviously, as the boomer generation is aging, but that doesn't account for all of it, you know, 25 compared to thirty two percent.

如今美国约半数人会在去世前登记接受临终关怀。如果你患有癌症，或者身为女性、受教育程度更高、年龄更大，选择临终关怀的几率会大得多——虽然这起初看起来理所当然，但值得注意的是，若你在年轻时不幸罹患此类疾病，选择临终关怀的可能性就小得多。

About half of people now in The United States enroll in hospice before their death. If you have cancer, you're far more likely to to do so, as well as being female and more educated and also older, which at first seemed like a like a well, of course, but just so far as to say, if you're someone very tragically in in your younger life that is stricken with something like this, you're far less likely to enroll in hospice.

没错。人们不选择临终关怀其实有很多原因。大多数人要么不了解它，要么存在误解。临终关怀还背负着污名——比如有人认为选择临终关怀就是放弃求生意志，这完全不是事实。

Yeah. And there's actually a lot of reasons why people don't enroll in hospice. A good majority of them just don't either aren't really aware of it or don't understand it. And there's stigmas about hospice too. Like there's a whole idea that if you go into hospice, you're giving up on fighting for your life, you're giving up on living, and that's just absolutely not true.

当你患有绝症且确实无法治疗时，负责任的医生会说：'我们已无能为力延长生命，继续治疗只会让最后的日子痛苦不堪。我们建议你接受临终关怀，与亲友共度美好时光。'

Like if you have a terminal illness and it's really no longer treatable, a good doctor will say, like, there's nothing more we can do for you. There's plenty of stuff we can do for you, but none of it is going to extend your life. It's gonna make your last days pretty miserable. We recommend that you go into hospice and have, like, good last days. Hang out with your friends and family.

平静地离开——美国临床肿瘤学会认为，这正是良好癌症护理的标志：在生命最后阶段，当医疗团队确认进入不可治愈期时，转介临终关怀。但问题在于，许多医生视此为放弃治疗，往往过晚推荐，导致患者仅在临终关怀中心度过最后两三天，无法实现所谓的'善终'。

Like, be peaceful. That's actually as far as the, American Society of Clinical Oncology is concerned, that's a sign that you've had good cancer care, that toward the end in the last, you know, few weeks, your cancer team says you've reached the, you know, incurable stage. There's nothing we can do for you anymore except let's put you into hospice. The problem is is there are plenty of doctors out there who do see that as quitting, do see that as giving up, and are known to steer people into hospice too late to where essentially they just spend like the last couple or few days in hospice and they don't have a chance to actually develop what, again, is referred to as a good death.

是的。甚至有证据表明，停止治愈性治疗转而接受临终关怀可能延长生命。原因很多：更密切的监护、更好的症状管理，以及我们讨论过的非生理层面——情绪等各方面得到舒缓后，研究表明生存期可能小幅延长。

Yeah. And there's even evidence that going, like trying to cure yourself, and sort of ceasing that process, and starting up with hospice, can actually make people live longer. A lot of reasons, maybe you're being monitored a little more closely, maybe your symptoms are being managed a little little better, and just everything that goes into the non physical, you know, sick and dying part that we've been talking about, the emotional part and everything else. Like, if all of that is eased, studies show that you can you can make it a little bit longer.

没错。由美的父亲就经历过这种情况。他当时在临终关怀中心

Yeah. That actually happened to Yumi's dad. He was in hospice and

哦，我想起来了。

given Oh, I remember.

确实不太乐观。那是一段相当艰难的时期。医生当时说他没多少时间了，大概就几天吧。但他并没有走，由美开始注意到他实际上在好转——吃得更多了，情绪也开始改善。她说服了临终关怀医生相信他已不再濒临死亡。这让我们清楚地看到，家庭临终关怀能改善健康：获得更好的营养、良好的睡眠、亲友随时陪伴而非只能在医院探视时间见面——而这些在医院里都处理得很糟糕。

Not very yeah. There was just a a pretty raw time. He was given not much time to live at all, think, like days. And he didn't didn't pass, and Yumi started to notice he was actually kind of, he was eating more, his mood was starting to improve, and she convinced the hospice doctor that he was not dying anymore. And one of the things that became really clear that being in hospice at home can do to improve your health is that you're getting better nutrition, you're getting good sleep, you're surrounded by people who don't have to come see you in the hospital setting during visiting hours, and all of those things are terribly managed in the hospital.

所以在家休养能让人逐渐康复。由美的父亲最终离开了临终关怀项目，活着出院了，之后又活了三年。

So at home, you can just get better and better, and Yumi's dad eventually left hospice, was discharged alive, and went on to live for another three years.

老兄，我记得整件事的经过。当时杰瑞和我们所有人都觉得这次恐怕真的不行了。而你带来的消息总是让人惊叹。后来我们都以为他随时会走，结果他又撑了几年。真是...真是个奇迹般的故事。

Man, I remember all that going down, and Jerry and I, all of us being like, oh, man, this is like, this seems like it's it. And you were bringing reports, were like, man, the darndest thing. Yeah. And then I just, I think we all suspected it was just gonna happen again right after that, and it was, yeah, it was a few years. It was just, what a what a story.

是啊。我...我从未像为由美那样为任何人感到如此骄傲。她是唯一察觉到...

Yeah. I'm I'm I'm I've never been more proud of anybody than I am of Yumi. She was the only one who saw, like

嗯。

Yeah.

她察觉到了，还得说服包括我在内的所有人。她确实把他从鬼门关拉了回来。

She saw it, and she had to convince everybody else, including me, he's And she brought him back for sure. Yeah.

多么珍贵的礼物啊。

What a gift.

这确实是份礼物。是的，我...我真的很为她骄傲。

It really was a gift. I'm yeah. I'm very proud of her.

好的。我们再休息一下？

Alright. Shall we take another break?

我觉得应该休息会儿，老兄。

I think we should, man.

好的。我们马上回来，之后将继续讨论临终关怀的话题。

Alright. We'll be right back, and we're gonna finish up with hospice right after this.

我住在一位邪教头目楼下，担心自己惹怒了她。

I live below a cult leader, and I fear I've angered her.

等等，索菲亚，你怎么确定她是邪教头目？

Well, wait a minute, Sofia. How do you know she's a cult leader?

好吧，达科塔，幸运的是这周是‘我不怕恐怖故事周’在《Okay Story Time》播客上，所以你很快就会知道。这个人写道：我的邻居每天大声播放音乐，还进行泥土仪式，现在我的天花板塌了。我试图举报他们，但事情变得越来越诡异。我觉得他们可能是一个邪教组织的一部分。

Well, Dakota, luckily it's I'm not afraid of a scary story week on the Okay Story Time podcast, so you'll find out soon. This person writes, my neighbor's been blasting music every day and doing dirt rituals and now my ceiling is collapsing. I try to report them but things keep getting weirder. I think they may be part of a cult.

等等，索菲亚，现实生活中的邪教？泥土仪式又是什么？

Hold up Sofia, a real life cult? And what is a dirt ritual?

不知道。但根据承包商的说法，他们正在拆除露台以查明天花板的问题，而她的邻居们对此很不满。

No clue. But according to contractors are tearing down the patio to find out what's going on with their ceiling and her neighbors are not happy.

嗯，她需要尽快举报他们。

Well, she needs to report them ASAP.

她举报了。现在他们一直在用非常诡异的方式骚扰她。

She did. And now they've been confronting her in really creepy ways all the time.

那我们能知道这个人是否能从邻居的邪教中幸存下来吗？

So do we find out if this person survives their neighborhood cult

还是不能？想听爆炸性的结局，请在iHeartRadio应用、Apple播客或任何你获取播客的地方收听《Okay Story Time》播客。现在开始吧。

or not? To hear the explosive finale, listen to the Okay Story Time podcast on the iHeartRadio app, Apple podcast, or wherever you get your podcasts. Here we go.

嘿，我是凯尔·潘。在我的新播客《历史重演》中，我们将探讨当今的潮流和头条新闻，并追问：为何历史总在不断重演？你可能知道我是《哈罗德与库马尔》系列电影中第二性感的演员，但我同时也是作家、白宫幕僚，以及——大约十五秒前刚成为的——播客主持人。这一路上，我结识了许多科学、政治和流行文化领域的专家朋友。

Hey. I'm Kel Penn. And on my new podcast, here we go again, we'll take today's trends and headlines and ask, why does history keep repeating itself? You may know me as the second hottest actor from the Harold and Kumar movies, but I'm also an author, a White House staffer, and as of, like, fifteen seconds ago, a podcast host. Along the way, I've made some friends who are experts in science, politics, and pop culture.

每周都会有一位嘉宾加入节目，解答我迫切想知道的问题。比如：我们是否正走向像08年那样的金融危机？非一夫一妻制又流行起来了吗？为什么航班提前两分钟降落时登机口永远没准备好？我们的嘉宾阵容包括皮特·布蒂吉格、斯泰西·艾布拉姆斯、莉莉·辛格和比尔·奈等人。

And each week, one of them will be joining me to answer my burning questions. Like, are we heading towards another financial crash like in o '8? Is non monogamy back in style? How come there's never a gate ready for your flight when it lands like two minutes early? We've got guests like Pete Buttigieg, Stacey Abrams, Lily Singh, and Bill Nye.

当你开始将外太空武器化时，事情可能会变得非常糟糕。

When you start weaponizing outer space, things can potentially go really wrong.

听着，这个世界现在看起来确实很可怕——因为它确实如此。但我希望通过这个节目，能让你在聆听中对未来多一分信心。请通过iHeartRadio应用、苹果播客或任何你获取播客的平台订阅收听凯尔·潘主持的《历史重演》。

Look, the world can seem pretty scary right now because it is. But my goal here is for you to listen and feel a little better about the future. Listen and subscribe to Here We Go Again with Cal Pen on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.

《狼来了》播客讲述的是两个被不公命运捆绑的男人，一座被秘密纠缠的城市，以及不惜代价寻求救赎的故事。

The Crying Wolf Podcast is the story of two men bound by injustice, of a city haunted by its secrets, and the quest for redemption no matter the price.

白人受害者，女性，貌美，富有，黑人被告。

White victim, female, pretty, wealthy, black defendant.

芝加哥，一名白人女性被谋杀，一个无辜的黑人男子为此锒铛入狱。

Chicago, a white woman's murder, a black man behind bars for a crime he didn't commit.

我因杀害一个素未谋面的人被判了九十年。

I got ninety years for killing somebody I have never seen.

他说警察是他的朋友，然后就这样了。他们转而针对他。

He says the police are his friends, and then that's it. They turn on him.

一个腐败的侦探。

A corrupt detective.

他们用那些审讯手段对付他，太疯狂了。

How he was interrogated with techniques. That's crazy.

一个告密者和被偷走的人生。

A snitch and a life stolen.

他们抓错人了。

They got the wrong guy.

但在监狱里，李·哈里斯找到了盟友——他的狱友罗伯特，罗伯特发誓要说出发生在李身上的真相并解救他的朋友。

But on the inside, Lee Harris finds an ally in his celly, Robert, who swears to tell the truth about what happened to Lee and free his friend.

如果你与我同行，你的目标就是我会照顾你。

And if you're with me, your your goal is to I'll take care of you.

我会一直陪着你。你这一生都离不开我了。

I'm gonna be with you. You stuck with me for life.

10月22日起，在iHeartRadio应用、苹果播客或任何你获取播客的地方收听《Crying Wolf》播客。

Listen to the crying wolf podcast starting on October 22 on the iHeartRadio app, Apple podcasts, or wherever you get your podcasts.

有件事我们该简单提一下，不必深入讨论，但临终关怀与死亡权及协助自杀这两件事，你知道，本不该相提并论，但显然在很多方面确实相关——因为面对的是同一群体。甚至在法律允许死亡权的地方，必须由医生证明患者生命不足六个月且无法治愈，这与临终关怀的标准几乎同步。但这并非同一概念，因为...世界卫生组织明确定义姑息治疗既不加速也不延缓死亡。

One thing we should mention kind of briefly, we don't have to get too much into it, but hospice and right to die and assisted dying, these are two things that, you know, don't go together, but they obviously kind of do go together in a lot of ways because you've got a group of people that are it's the same group of people mainly. It's even, I think, legally designated in places where you do have the right to die. You have to have doctors sign off that you're within six months and there is no cure, and it kind of is in lockstep with hospice. But it's not the same thing because the, you know, it's it's just not. The World Health Organization very much defines palliative care as something that neither hastens nor postpones death.

嗯。临终关怀的宗旨绝不是去找个共情者来帮你加速死亡。嗯。如果你住在那些州，我认为能选择这个方式是种莫大的恩赐，虽然存在这样的途径，但这不属于临终关怀范畴。

Mhmm. It is not the point of hospice to go in and, you know, find an empath who will who will help assist you along a little quicker. Mhmm. If you live in one of those states, I think it's an amazing gift to be able to do that, and there are there's a track for doing that, but it's not hospice.

不。这之所以激怒反对医疗协助自杀的临终关怀从业者，是因为人们选择这种方式是为终结痛苦，而临终关怀者会说：不，我们能在不结束生命的前提下缓解痛苦。是的，这正是让他们如鲠在喉的原因。

No. And the reason why it riles up hospice people who are against that is because there are one of the reasons that people do choose medically assisted dying is to end their suffering, And hospice people are like, no. We know how to end their suffering without them having to die. Yeah. And that's why it really gets under their skin.

不过话说回来，很多临终关怀从业者（可能是人文主义者）认为：选择死亡方式或时机是每个人不可剥夺的权利。

Although that said, there are plenty of hospice people, probably humanists, who are like, it's it's anybody's inalienable right to choose how or when they die.

是啊。

Yeah.

所以，这确实有点复杂，但我认为临终关怀通常被不公平地与之关联。即便是姑息治疗，我们也没有明确说过，它主要是处理和缓解症状、疼痛、恶心等伴随绝症而来的问题。这是临终关怀的一部分，但并非所有姑息治疗都属于临终关怀。在寻求治愈性治疗的同时，你同样可以获得这些帮助，对吧？是的。

So, yeah, it is kind of a tricky thing, but it it isn't I think it is generally unfairly associated with hospice. And even palliative care, I don't think we said explicitly, that is to treat and manage symptoms, pain, nausea, that kind of stuff, symptoms that come along with terminal illnesses. And that is a part of hospice, but not all palliative care is hospice. You can get that same stuff as you're pursuing like curative treatments, right? Yeah.

所以并不是说，你在接受癌症的治愈性治疗时，他们就对恶心症状束手无策。它在两者中都有其位置，与协助他人死亡无关，而是帮助他们在自然死亡时舒适离世。

So it's not like they're gonna be like, you're getting curative treatments for cancer, sorry, we can't do anything about the nausea then. It makes it it has a place in both of them, and it has nothing to do with assisting someone in dying. It has to do with helping them die comfortably when they die naturally.

是啊。而且你知道，现在他们会给你吗啡之类的强效药物，嗯哼。如今都是吗啡加强版了。但可卡因和烈酒就别想了。

Yeah. And it you know, you're not gonna get you'll get morphine and you'll get like the good stuff Mhmm. These days. Morphine plus. But you're not gonna get the cocaine and the liquor.

除非你有认识人的家属。

No. I mean, unless you have a family member who knows somebody.

是啊。我是说，总有人能搭上线，或许吧。或者碰上一个特别善解人意的，那种低调行事的临终关怀工作人员。

Yeah. Mean, there's somebody's got a guy, maybe. Yeah. Or if you just have like a, you know, pretty empathic, like really empathic, like on the down low hospice worker.

没错。即便你真给他们弄到了，他们可能也不想要。比如我试图给由美的父亲一堆可卡因，他却说：不用了，我现在用的止痛药就挺好。

Right. And I mean even if you do score for them, they might not even want it. Like I tried to give Yumi's dad a bunch of cocaine, and he's like, no, I'm good with the pain stuff I'm on now.

是啊，然后拿它怎么办呢，你懂吧？嘿看，我们又发现了一个笑话，真神奇。就在黑暗面出现之前。

Yeah, and then what to do with it, you know? Hey look, we found another joke, amazing. Right before the dark side.

没错，因为这事确实有阴暗面，再说一次，临终关怀的一个缺点就是它把负担全压在了护理人员身上。我们稍后会详细讨论这点。但普遍认为临终关怀的阴暗面在于存在营利性临终关怀机构。与我们在私募股权专题中提到的主题相反，必须说明确实有许多运营良好的营利性临终关怀机构。是的。

Yeah, because there is a dark side to this, and again, the one downside to hospices, it puts it's just the burden on the caregivers. We'll talk a little bit more about that in a second. But the the kind of generally agreed upon dark side of hospices is that there's such a thing as for profit hospices. And contrary to our private equity theme in our private equity episode, we should say that there are plenty of for profit hospices that are perfectly well run. Yeah.

那些有亲人在那里离世的家属们都非常满意，给予了高度评价。作为临终关怀机构，营利性质本身未必是坏事。但当它们成为上市公司的一部分时——比如某家临终关怀机构最终上市了——它们的评分就开始低于其他类型的临终关怀机构，特别是非营利性质的。

The people who the family members who have patients and family dying there are totally happy. Give them great reviews. Being for profit as a hospice isn't necessarily a bad thing. Where they start to get lower marks than other kinds of hospices, specifically nonprofit hospices, is when they are part of a publicly owned corporation. Like a hospice went with the IPO at some point.

对，就像连锁店那样。

Yeah. Like a chain.

正是。或者出人意料地——也可能不意外——私募股权收购了这家临终关怀机构。问题在于支付机制的结构性缺陷，这天然激励着营利性机构偷工减料、压缩成本。

Exactly. Or surprisingly, or not, private equity owns the hospice. And the reason why it's problematic is because the way that payment is structured has a built in incentive for for profit hospices to cut corners and cut costs.

是啊，2024年有调查显示，美国25%的临终关怀机构现在由私募股权公司控股。

Yeah. There was a survey in 2024 that 25% of hospices in The US are owned by private equity firms now.

嗯。

Mhmm.

你可以参考那期节目了解具体内容。但正如我之前所说，关于支付结构要暂停讨论——他们不是通过医疗保险获得报酬，也不是按每次治疗或特定治疗收费，而是统一收取固定费用。显然，如果是一家以营利为目的的临终关怀连锁机构，且已完成IPO流程需要向股东负责，可悲的是很多时候这些机构拿到固定费用后就会削减人员，患者只能得到法律要求的最低限度护理。

So you can refer to that episode as to exactly what goes into that. But, you know, I said earlier to put a pin in the payment structure, which is they don't get paid through Medicare. They don't get paid out per treatment given or per specific treatments given. It's just this flat fee. And obviously, if you have a chain, a hospice chain that is for profit and has gone through the IPO process and has shareholders to answer to, very sadly, many times, you're gonna get hospice centers that that get that flat rate, but they're cutting staff, and people are getting the bare minimum treatment required by law.

没错。我看到有资料说联邦法规要求对居家临终关怀患者的探访每月不得少于两次。

Right. And I saw there's a there's a a thing where it's supposedly federal regulations say that you have to visit an in home hospice patient no less than twice a month.

是啊，每月就两次？

Yeah. Just twice a month?

对。很多营利性临终关怀机构真的就只做最低要求。多数人都认同，如果患者出现危机情况，探访次数会增加；但若情况稳定，他们就会减少探访以平衡成本。可事实证明这是个误解。

Right. And then a lot of for profit hospices, like, just basically do that minimum. And if you most people agree, if you are in some sort of crisis, you're getting more visits. But if you're not in a crisis, you're getting fewer visits because they need to balance that out to cut costs, right, or keep costs down. It turns out that's a myth.

联邦政府根本没有每月至少两次探访的要求，对于居家临终关怀的探访频率完全没有硬性规定。

Federal government doesn't require two visits a month at minimum. The federal government doesn't have any requirements for how often or how little a hospice has to visit a patient at home.

是完全没有要求，还是他们没执行任何规定？

They have no requirements or they're not enforcing anything?

他们没有任何要求，这本身就是问题。现有很多规则本身就存在漏洞，他们也不执行。这个体系简直是为滥用而设立的。幸好大多数临终关怀机构的经营者并非为了钻空子，他们真心想帮助人。但这个体系确实给不良从业者留下了榨取资金、超额收费的空间。

They don't have any requirements, and that's another problem too. They don't enforce a lot of the rules that there are, and there's already a lot of rules that have loopholes. So this is a system that is just set up for abuse. Luckily, most of the people who run hospice companies, they're not in it to abuse the system. They're in it to help people, but there it's there is a a place for bad actors to milk the system, overcharge.

虽然情况极其复杂，但确实存在方法可以让你每天收取高于固定费率的费用。我记得2021年《老年护理杂志》上有项研究发现，营利性临终关怀机构向医保收取的费用通常比非营利机构高出34%。这个体系里可操作的空间实在太多了。

Like, there's it's extremely complex, but there are ways that you can charge more than the flat rate per day. And I guess a study from, I think, 2021 in the Journal of Geriatric Care, I think, found that for profit hospices tend to charge Medicare 34% more than non profit hospices. There's just a lot of stuff you can do to game the system.

没错。需要说明的是，临终关怀机构整体口碑都不错——就连营利性机构也普遍获得好评。但深入调查后发现，护理评分最低的往往是那些上市公司，以及被私募股权公司收购的机构。所以如果你有这方面需求，一定要做好功课。全美有5700家这类机构，希望你能找到附近那家更用心的。

Yeah. And to be clear, hospice in general gets good marks from people. Even for profit hospices generally get good marks from people, but they've drilled down and they found the ones that get the lowest ratings for care are the ones that are publicly traded corporations and owned and or owned by private equity firms. So Yeah. Do your research, you know, if you're getting into this, because there's there are all, like we said, there's 5,700 of them in The US, and hopefully there's one near you that will take care of you a little bit better.

要持续接受临终关怀服务，还必须遵守所谓的'活体出院'相关条款。

To remain on hospice, there's also, you know, all kinds of rules as far as what's called live discharge.

对。

Right.

患者需要在重新认证时证明病情持续恶化——前六个月每90天一次，之后每60天一次直到去世或出院。所谓出院就是字面意思，和医院出院一样。可能是你想再次尝试治愈性治疗，这很好，完全合理。

You have to demonstrate ongoing steady decline at recertification intervals every ninety days for the first six months, then every sixty days after until death or discharge. And discharge is is basically exactly what it sounds like. You're discharged like you're discharged at a hospital. Mhmm. It may be because you wanna try curative care again, which is which is great, and you're right.

也可能是因为突发急症必须转院，这会导致强制终止服务（确实很糟糕）。虽然出院有明确指南，但有些条款并不公平。

It could be because of an emergency that you have to go to the hospital for, which will boot you off, which really stinks. But there are guidelines about discharge, and not all of them seem fair.

想象一下：当你因绝症濒临死亡时，却被从临终关怀机构转到医院继续治疗，或是回家后因症状反复要频繁跑急诊。这种在不同机构间辗转的体验非常痛苦，对家属也是巨大负担——护理责任又从专业人员转回家庭。更根本的问题是，所有疾病恶化轨迹本不相同，却都被套用癌症患者的标准来评判，这种前提设定本身就是错误的。

Yeah. And you can imagine if you're dying of a terminal illness being moved from a hospice to a hospital to to continue treatment, maybe home where you have a bunch of emergency room visits ahead of you because your symptoms are gonna flare up. It's not a comfortable thing to be discharged from one place to another. It's also a huge burden on the family too because, again, the care is being transferred from medical professionals to the family. But also, the the whole premise of it is just faulty because not all diseases follow the same trajectory in the decline of the person, and yet they're all held to the same standard, which is essentially the standard that cancer creates a decline in a patient too.

简单来说，如果你的绝症状态经医生确诊，并且每六十天重新认证一次，你就不必面临活着被终止临终关怀的情况。你可以一直留在临终关怀机构直到去世。你的死亡不必符合联邦指导方针。这将是一个重大变革，对临终关怀规则来说其实很简单，但显然目前还没有实现。

So essentially just saying, if you have a terminal illness that's certified by doctors, that doctors recertify, say, every sixty days, you don't have to face a live discharge. Like, you can stay in hospice until you die. Your death doesn't have to cooperate with federal guidelines. That would be a huge change, and a really simple one to to hospice rules, but apparently that is not, that's not happening right now.

是的。即便没有被送回家，假设你转到了另一家机构——因为不同地方床位不足确实是个问题——家属至少能逐渐建立起日常照料流程。

Yeah. And even if, you know, you aren't moved home, let's say, let's say you move to a different facility, because there definitely is a problem with like, you know, not having enough beds at different places, and the family gets can get ideally into a routine at least.

嗯。

Mhmm.

而且他们慢慢就适应了。以艾米丽祖母为例，当所有人都适应了日常流程、一切安排就绪时，突然又会因为玛丽需要转院而出现变动。然后探视时间要重新调整，地点也换了，这些压力都落在家人身上。正如你所说，对病人而言转院本身就是巨大负担。我认为整个系统还有很大改进空间，对吧？

And, you know, they kind of figure it out. And then with Emily's grandmother, it seemed like once everyone got into the routine and everything had kind of been figured out, then all of a sudden some change would where Mary would have to go somewhere else. And then all of a sudden, it's new visiting hours, it's in a different place, and everyone and, you know, that's just on the family, of course, just like you mentioned, the move for the patient is really burdensome. So there's still so much they can do, I think, to clean this whole system up, you know?

确实。查克，就算不是住院病人，只是居家临终关怀，机构也会为你搭建全套支持体系。比如提供医疗设备，定时配送药物等等。

For sure. And even, Chuck, if they're not inpatient, just at home, hospice basically overlays the support structure for you, the hospice patient, in your home. Right? So you have, like, medical equipment. You have medications that are, like, delivered to you at times.

需要助行器就给助行器，全套支持服务都有。丧亲顾问会上门探访，社工通过远程医疗跟进。但这些服务都会突然中断。

If you need a walker, you got a walker. Just all of this support. Like, you've got bereavement counselors dropping by. Have a social worker you're doing telehealth visits with. All well, like, all it just stops.

当你在世时被终止临终关怀，他们会收走医疗设备，收回助行器，停止药物配送。如果是临终关怀医生开的处方，你可能连药都续不到了。这真是非常糟糕的困境。

When you're discharged from hospice alive, they come and they take the medical equipment. They take your walker away. You stop getting your medications delivered to you. You might not even have those prescriptions any longer after that if they were prescribed by the hospice doctor. It's a it's a really bad jam.

关于医疗保险经常被诟病的另一点是，他们对居家临终关怀的支付严重不足。居家非紧急临终关怀的报销评级是最低的。这意味着如果你想在家度过最后时光，要么得有一群愿意奉献生命的家人照顾你，要么得有足够钱财雇人做同样的事。如果两者都没有却想在家中离世，那你就无计可施了——因为既没有足够的报酬吸引临终护理人员定期上门，也缺乏志愿者来持续满足你的护理需求。

And the other thing about it too that Medicare is often taken to task for is they don't really pay enough for in home hospice. Like, that's the lowest pay rating, I guess, is in home non crisis hospice care. And that means that if you are trying to stay at home, you either have to have a bunch of family members who are willing to commit their lives to taking care of you in your final days, or you have to have a bunch of money to pay somebody to do that same thing. And if you don't and you wanna die at home, you're SOL because you have nobody to take care of you at home because there's not enough pay to pay people in hospice to come by and not enough volunteers to take care of you, take care of your needs on a regular basis.

你知道吗，玛丽奶奶——'军规必知部队'的前任三星上将——有件T恤上写着：'想拿走我的助行器？除非从我冰冷僵硬的手里撬出来'。

You know, grandma Mary, former foremost general in the Step You Should Know Army Mhmm. Had a t shirt that says, you can take my walker when you pry it from my cold dead hand.

就这样？天啊伙计我太爱这个设计了！这绝对会成为爆款T恤，我们一定要搞一件。

That's all. I would love that, dude. Oh my god. That would be such a great t shirt. We gotta get that one

你能想象专门去抢别人助行器吗？比如这居然是份正经工作？'对，你的任务就是去玛丽奶奶家没收她的设备'。

up Can you imagine taking a walker from somebody? Like, to for that that's your job? Like, you're the person, and you're like, yeah. Go over to grandma go Mary's house and take her stuff.

我知道。肯定不能和配送员是同一个人，这差事太缺德了，必须专门雇个看谁都不顺眼的专员，挨家挨户回收医疗设备。

I know. It couldn't even be the person who also delivers it, because it's such a mean job that there has to just be one specialist who doesn't like anybody who just goes around to houses and takes the medical equipment back.

没错。比如罗尼那种人。

Yeah. To Ronnie.

你还有别的料吗？

You got anything else?

不，我没有其他要说的了。希望这些信息对某些人有所帮助，你们可以四处看看，做好功课，找一个适合你和家人的地方。

No. I have nothing else. Hopefully, this serves some people, and, you know, just just look around and and do your homework and see if you can find a place that works for you and your family.

是的。另一个好建议是尽早行动。比如，向家人表达你的意愿。甚至可以更进一步，制定生前遗嘱或某种医疗文件，表明你希望在某个时刻停止治疗并进入临终关怀。然后，阅读评价，就像找找看如果这种情况即将发生，你会选择谁。

Yeah. And another good piece of advice is to do that sooner than later. Like, share your wishes with your family. Maybe even go so far as to create a living will or some sort of medical document saying, like, I do wanna go into hospice, I wanna stop curative treatment at some point. And then, yeah, do, like, read reviews, it's like, just find out who you would go to if it starts to seem like that might be a possibility coming down the the pike.

是啊。天哪，我的老天。立个生前遗嘱吧，不管你多大年纪。

Yeah. Oh, man. My god. Get a living will. I don't care how old you are.

这是件非常简单的事，生前遗嘱和遗嘱是你年老时能给家人的两大礼物。

It's a very easy thing to do, and it's that and a will are the two biggest gifts you can give your family as you grow old.

没错。你想让父母印象深刻而你才七岁？开始考虑生前遗嘱吧，开始和父母讨论生前遗嘱。他们一定会大吃一惊的。

That's right. You wanna impress your parents and you're seven? Start thinking about a living will. Start talking about a living will to your parents Yeah. And they will just be blown away.

完全同意。这听起来像是电视剧里早熟小孩会做的事。

Totally. That seems like something in a like a TV show about a precocious kid.

是啊，当然。就像亚历克斯·P·基顿那样，他肯定会这么做。

Yeah. For sure. Like Alex P Keaton, he would do that.

对，没错。哦，你知道他有一个。

Yeah. Exactly. Oh, you know he had one.

在结束前，我还想特别感谢Yumi父亲的临终关怀医生Pajjari医生。

So before we finish, I just also wanted to give a huge shout out to Yumi's dad's hospice doctor, doctor Pajjari

太棒了。

Awesome.

他毫无架子，完全愿意倾听Yumi的意见，并帮助她父亲脱离了临终关怀。

Who did not have any sort of ego and was totally willing to listen to Yumi and and helped get her dad out of hospice too.

我喜欢这样。

I love it.

致敬Pajari医生。既然我提到了Pajari医生，正如2008年符文预言的那样，我现在解锁了听众来信环节。

Shout out doctor Pajari. And since I shouted out doctor Pajari, as was foretold by the runes in 2008, I've just unlocked listener mail.

这里是《Z世代楼梯回响》。我要快速概括三封邮件的重点，因为我们收到了三种关于Z世代凝视本质的合理解释，现在我已经理解了。你知道吗？这可能不是我的菜，但也不需要是，因为我不必把我的X世代观念强加给Z世代。确实如此。

This is Gen z Stair Speaks Back. I have three emails I'm gonna try and sort of hit the highlights of because we got what I felt like was three really sort of legitimate answers as to what the Gen Z stare is all about that that now I understand. You know? It may not be my jam, but, like, it doesn't need to be my jam because I don't have to put my Gen X stuff onto Gen Z. That's true.

嘿，伙计们。22岁，Z世代，正处于Z世代凝视时代。我在客服部门工作，这是我最常使用这招的地方。但我们从小被教育‘如果没什么好话可说，就干脆别说’，所以就变成了凝视。我想他们是把这句教诲理解得太字面了。

Hey, guys. 22 years old, Gen Z, very much in the Gen Z stare era. I work in customer service, which is where I use it the most. But we were raised with, if you have nothing nice to say, don't say anything at all, so hence, staring. So I guess they took that very much literally.

没错。这招不仅对成年人用，这位网友指出他们对朋友也这样。至于电话嘛，根本没人打给我们。偶尔接到电话都是垃圾来电，人家总说‘双重问候’的人——我之前都不知道还有这种说法。

Yeah. It's not something just done to adults either, and this person points out that they do it for their friends. As far as the phone call, no one calls us. When they do, it's a spam call, which I was always told the double hello people. I didn't know that was a thing.

对方接电话时，就会触发机器人应答队列。对。

When they answer the phone, it queues the robot. Right.

你知道这个吗？知道。

Did you know that? Yes.

好吧，我之前不知道。所以我接起电话就沉默，直到尴尬的‘这是乔西吗’环节出现。这是乔西·布泽尔的分享。再看另一个例子。

Okay. I didn't know that. So I just answer and sit in silence until the awkward is this Josie follows. And that is from Josie Boozer. This is another one.

嗨，Z世代的朋友。我觉得你想要的解释可能是：很多Z世代已经习惯了被打断。嗯。习惯不被当回事，或者讲完故事后得到奇怪的反应。比如有人讲完故事对方就呆站着，可能原因一是我对这个故事没什么有趣的回应，又不想随便编一个。

Hey, Gen z person. I think the explanation you're probably looking for is a lot of Gen z are using it to are used to being interrupted. Mhmm. Not taking taken seriously or have our responses to stories be given a weird look. The example of where someone finishes a story and the person just stand there can either be one, I don't have anything interesting to say about that story, and I don't wanna make something up.

嗯。原因二是我太习惯自己的意见不被重视，干脆懒得回应。我们很多人都有社交障碍，和不熟的人很难闲聊。还有个原因可能是我们多数对话都在线上进行，成长过程中一直如此，很多人对长篇大论就回个表情符号或笑脸，这样也算回应。这是山姆的分享。

Mhmm. Two, I'm so used to having my opinions not taken seriously that I'm just not even gonna bother responding. Many of us are socially awkward and have trouble creating small talk with people that aren't close to us. Another reason may be because most of our conversations are online and have been online as we as we aged, and many people will give an emoji reaction to a long story or just get a smile, and that's cool in response. That is from Sam.

好。

K.

所以基本上是沿着同样的思路在推进。

So it's kind of tracking along the same lines.

对。

Right.

这是凯瑟琳的来信，她23岁，已经听了五年节目。我听过人们归咎于疫情，但我不认为这能完全解释代际趋势，毕竟我们都生活在同一时期。我认为主要有两个原因：首先，我们这代人比以往任何世代花在屏幕前的时间都多，已经习惯了单向的内容消费。

And then this is from Catherine, who's been listening for five years as a 23 year old. I've heard people blame the pandemic, but I don't think it fully explains the generational trend since we all live through the same period. I think there are two main causes. First, my generation has spent much more time in front of a screen than any previous generations did. We've grown used to one-sided content consumption.

嗯。如果你像接电话或面对面交谈那样回应YouTube视频，别人会觉得你疯了。所以我们有点缺乏即时回应的练习，而只是习惯于观看。这完全说得通。确实如此。

Mhmm. You would look crazy if you responded to a YouTube video the way you would a phone call or an in person conversation. So we're a little out of practice with responding to prompts instead of just watching something. This all makes total sense. It totally does.

其次，Z世代似乎比前几代人更可能摒弃对话中那种虚假的礼貌。我认为部分原因是我们时刻被广告轰炸，对伪善的友好高度敏感，因为总有人试图操纵我们的情绪来推销商品。我们这代人似乎更偏爱真实反应——哪怕是负面的，因为在网络上这是唯一能确认某物不是广告的方式。天啊，这真是另辟蹊径。

And then secondly, Gen z seems to be more likely than previous generations to forego the fake politeness that used to be expected in conversations. I think this is partially because we're constantly inundated with advertisements, and we become highly sensitive to fake niceness because someone is trying to manipulate our emotions at every turn and sell us something. My generation seems much more likely to prefer genuine reactions even if they're negative because when we're online, it's the only way to know that something is not an ad. Man, this is something else.

是啊。这些观点很深刻。来自乔西、山姆和凯瑟琳的分享，对吧？

Yeah. Those are deep. From Josie, Sam, and Catherine. Right?

是的。而且我觉得它们都遵循相似的逻辑，这解释了很多现象。所以，如果一个Z世代的人只是盯着你看，也许他们认为你是个十足的混蛋，只是不想说出来。

Yeah. And I think they all sort of track along the same lines, and that that explains a lot. So, yeah, if a Gen Z person is just staring at you, maybe think maybe they think you're a real jerk and just don't wanna say anything.

对。他们当时就觉得你在耍手段。

Right. They assume you're manipulating them right then.

没错。或者刚才提到的其他原因。我认为从各自世代的角度来看都说得通。

Yeah. Or or the other reasons mentioned. I think they're all valid in their own generational way.

我觉得这很好地解释了为什么X世代被这样对待时会感到不适，因为我们习惯了假客气。

I feel like that really explains the discomfort that people, like, say, from Gen X get when we're treated like that because we are used to fake niceness.

我

I

懂。你知道吗？而且我们愿意配合这种表面功夫，就为了避免场面尴尬。

know. You know? And, like, we're willing to go along with that kind of thing just to keep from a situation being uncomfortable.

是啊。不过还有个快速建议：如果没什么好话，就干脆别说。我最近有个经历，找纹身师用我家狗狗的图案遮盖旧纹身。嗯。这人做得...我很感谢。

Yeah. Also, though, quick tip, the if you don't have anything nice to say, don't say anything at all. I recently went through an experience with a tattoo artist getting my my a tattoo covered up with my dogs. Mhmm. And this guy did a he I appreciate it.

他做得很好，但可以说我们不是一类人。他对很多事情都有有趣的理论。给我的Z世代朋友一个小建议：你不必保持沉默，只要点头附和说‘有意思’就行。

He did a great job, but he let's just say we weren't the same kind of person. He had a lot of interesting theories on on things. And here's a little tip to my Gen Z friends. You don't have to not say anything. Just keep nodding and go, interesting.

哦，是啊。

Oh, yeah.

我连续几个小时反复做这件事。

I did that over and over and over for hours.

这很管用。

It goes a long way.

是啊。‘有意思’和‘当然’。呃不，我甚至不确定自己是否在撒谎。那确实挺有意思的。

Yeah. Interesting and sure. Well, no. I don't even know if I am lying. It was interesting.

嗯，好吧。

Yeah. Okay.

只是不适合我罢了。

Just not just not for me.

对，没错。也许语气是假的。也许吧。那家伙确实干得漂亮。

Right. Exactly. Maybe the tone was a lie. Maybe so. Guy did do an amazing job.

你说他是徒手画的，对吧？

You said he did it, like, freehand too. Right?

哦，对。我会把照片发到‘播客老查’那里。他是个超厉害的艺术达人。没错。

Oh, yeah. I'll I'll I'll put pictures up You should. At chuck the podcaster. He's a sort of amazing artistic dude. Yep.

就像看着狗狗照片在我胳膊上画出来一样。不是先用模板描的。

Just like looking at pictures of dogs and drawing them on my arm. It wasn't like stenciled out on my arm first.

太疯狂了，老兄。再次感谢乔西、萨姆和凯瑟琳为我们解释。你们表现得太出色了，我们非常感激。我现在可不是假客气，是真心实意认真的。

It's nuts, man. Well, thanks a lot again to Josie, Sam, and Katherine for explaining that to us. You guys did a knockout job, and we appreciate it. And I'm not being fake nice right now. I'm being quite legitimate and serious and genuine.

如果想联系我们聊聊你们这代人的故事，我们很乐意听。可以发邮件到stuffpodcast@iHeartRadio.com。

If you want to get in touch with us and tell us about your generation, we love hearing that kind of stuff. You can send it off to stuffpodcast@iHeartRadio.com.

《你应该知道的事》是iHeartRadio制作的节目。想收听更多iHeartRadio播客，请访问iHeartRadio应用、苹果播客或任何你听节目的平台。

Stuff You Should Know is a production of iHeartRadio. For more podcasts to iHeartRadio, visit the iHeartRadio app, Apple Podcasts, or wherever you listen to your favorite shows.

我住在一位邪教领袖的楼下，我担心自己惹恼了她。等一下，索菲亚。

I live below a cult leader, and I fear I've angered her. Wait a minute, Sofia.

你怎么知道她是邪教领袖？

How do you know she's a cult leader?

好吧，达科塔，幸运的是，现在不是‘Okay Story Time’播客的恐怖故事周，所以我们很快就能知道答案。这位听众写道：我的邻居每天大声播放音乐，进行泥土仪式，现在我的天花板开始塌陷。我试图举报他们，但事情变得越来越诡异。我觉得他们可能属于某个邪教？等等。

Well, Dakota, luckily, it's I'm not afraid of a scary story week on the Okay Story Time podcast, so we'll find out soon. This person writes, my neighbor has been blasting music every day and doing dirt rituals, and now my ceiling is collapsing. I tried to report them, but things keep getting weirder. I think they might be part of a cult? Hold up.

现实生活中的邪教？泥土仪式又是什么？

A real life cult? And what is a dirt ritual?

不知道，达科塔。想知道结局如何，请在iHeartRadio应用、苹果播客或任何你获取播客的地方收听‘Okay Storytime’播客。

No clue, Dakota. Find out how it ends. Listen to the Okay Storytime podcast on the iHeartRadio app, Apple podcast, or wherever you get your podcasts.

芝加哥，一名白人女性被谋杀，一名黑人男子因未犯之罪入狱。

Chicago, a white woman's murder, a black man behind bars for a crime he didn't commit.

因杀害一个我从未见过的人被判九十年。

Ninety years for killing somebody I have never seen.

《哭泣的狼》播客讲述了一位腐败侦探、两个因不公命运相连的男人，以及不惜一切代价寻求救赎的故事。请在iHeartRadio应用、苹果播客或任何你获取播客的平台收听《哭泣的狼》。

The crying wolf podcast is the story of a corrupt detective, two men bound by injustice, and the quest for redemption no matter the price. Listen to the crying wolf podcast on the iHeartRadio app, Apple podcasts, or wherever you get your podcasts.

大家好，我是卡尔·潘。在我的新播客《历史重演》中，我们将探讨当下趋势与头条新闻，并追问：为何历史总在重演？每周，我会邀请比尔·奈、莉莉·辛格和皮特·布蒂吉格等好友，从太空竞赛到电影翻拍再到致幻剂，无所不谈。

Hey. I'm Cal Pen. And on my new podcast, here we go again, we'll take today's trends and headlines and ask, why does history keep repeating itself? Each week, I'm calling up my friends like Bill Nye, Lilly Singh, and Pete Buttigieg to talk about everything from the space race to movie remakes to psychedelics.

换句话说，你是嗨了吗？

Put another way, are you high?

听着，当前世界可能令人惶恐。但我的目标是让你在收听时对未来稍感宽慰。请通过iHeartRadio应用、苹果播客或任何播客平台订阅收听卡尔·潘主持的《历史重演》。

Look, the world can seem pretty scary right now. But my goal here is for you to listen and feel a little better about the future. Listen and subscribe to Here We Go Again with Cal Pen on the iHeartRadio app, Apple Podcasts, or wherever you get your podcasts.

这是iHeart出品的播客节目。

This is an iHeart podcast.