End of life realities. Learning about life.

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Grandpa Sasha finally went in for surgery to have his leg amputated yesterday.

Various doctors have found different things wrong with him. They could not agree on what they were or what to treat first.

He has had chronic kidney problems for quite some time. There were several months' dispute on whether to treated with medication or dialysis. Dialysis won temporarily. The surgeon put an access in his arm and he went weekly. At some point they took the access out and said he could come home and simply rely on medications.

His leg has hurt for years. Six months ago the doctor said they would have to amputate. Then another doctor said there was no need to do that – they would put an artificial veins to the tune of about $1000. He went in the hospital to get ready for that.

The surgeon said that he could not operate because Sasha's hemoglobin level was way too low. They would need to raise it. Medications didn't do the trick. They would have to give him a blood transfusion before the operation, so his body would be able to handle the surgery. Blood is scarce on account of the war – Oksana somehow managed to get donors lined up through her online networks.

A month ago another surgeon – I've never met any of them, I don't know how many there are – said that the operation would not succeed because he has constricted arteries. One is down to 25% of capacity, the other 10%. He would need to have a stent implanted to improve his circulation. Another thousand dollars.

Last week we heard that it was $1000 per stent and he would need two of them. But they would have to amputate the leg in any case. Right away. It was becoming gangrenous.  I expect I will hear today that it happened.

The last couple of months nobody has mentioned kidneys. I am sure that they have not improved, they are just on the back burner.

Grandma Nadia is not an educated woman. She doesn't understand what the doctors say and is not in able to make medical decisions. Oksana is a little bit better positioned. She is the voice of reason, her mother's calming influence. I in turn am Oksana's calming influence.

Grandpa Sasha is matter-of-fact about losing his leg. The doctor told him it was the result of a lifetime of smoking, expecting to hear some words of regret. He did not. They tell me Sasha is also matter-of-fact about the fact that the end may be near.

Thank God the medical procedures are inexpensive here. I can afford to reassure Oksana that cost is not the issue. She should think first of her father's comfort.

The quality of care might not be up to a United States standard.  Even there I'm not so sure – my father died from an ill-advised, unnecessary colonoscopy that punctured his gut.  After observing the American medical profession at work during the Covid crisis I think I would trust the Ukrainians just as much.

Oksana has heard about hospice care, but none of the medical professionals she's dealing with have suggested it. I proposed that one alternative was to let Sasha come home and spend his last days in peace. Get him some narcotics – further research shows that oxycodone appears to be available here – or let him go back to drinking which he only reluctantly gave up.

Witnessing the end of somebody's life always makes one think of their own mortality. I have used this opportunity to stress to Oksana and Eddie that when my time comes I want them to simply let me go. When I'm uncomfortable, not going to get better and no longer of any use to anybody, let nature take its course.

I am sure these issues were easier to talk about a couple of centuries ago when death was a more immediate reality. Kids on farms witness birth and death day in and day out. There were births and deaths every year in extended families. We moderns are antiseptically isolated from both. They have become rare events in extended families, the cause of much ado.

I am pleased to recall the calm when Oksana's grandmother passed away at the age of 95 perhaps three years ago. The family took it in stride. Grandmother Nadia surely saw to it that there was a church service, but our family was not involved. I do not even know whether she was cremated or buried.

Yesterday I took all three children to music lessons with Miss Maria. We know the route pretty well by now. The one mile walk to the bus stop takes about 20 or 25 minutes. Leaving right at nine, with me carrying Marianna who didn't feel like walking in the light drizzle, we got to the bus with 10 minutes to spare. It was an excuse to duck into a coffee shop so the kids could warm up with some hot cocoa.

Eddie and I have half an hour to kill while we wait for Zoriana's lesson. With Marianna in tow we decided to spend it in the park as it would have been awkward to take her with us as we went shopping. Eddie took Zoriana up to Miss Maria's while Marianna and I waited at the playground.

Marianna enthusiastically climbed on the sailing ship motif jungle gym and found that the slide was delightfully fast on account of the rain. The downside was that her pants got wet and she got cold. We went inside Miss Maria's building and warmed her up while we waited for Zoriana. She and I left with Marianna - Eddie takes the bus home by himself.

I didn't want to subject Marianna to the 25 minute walk under what was now serious rain. We took a bus down to the Metro and rode to our Livoberezhna station. Zoriana needed some underpants. The stall that sells them had been closed on Monday, but the lady at the neighboring stall said to come back during the week. It worked – she got two pairs of pink ones, one with strawberries and another with little horses.  With no other customers to serve, the lady at the store had a lot of time to help Zoriana with the decision.

Marianna was again in a good mood, having warmed up as we were inside shopping. We got home and Zoriana dove into the the sweet yogurt we had just bought for lunch.

That's the news from Lake WeBeGone, where the strong men are called on to make decisions that neither they nor anybody else is truly prepared for, the good-looking woman accept our limitations and ask anyhow, and the above average children are becoming familiar with the realities of life.

Graham