Juan's story: The slow decline (video)

Sometimes Hector Garcia has to hide his emotion in another room.

He's a big guy who does not want to display tears. Not now when his family needs him. When he must stay strong and man up.

But these days, tears well without warning, born of stress, fatigue and love.

They come, too, when his brother-in-law Juan Viera Colon, asks to go to Puerto Rico with him. Colon wants to know if he can take his radio and whether his family will be there.

"I tell him yes, to all of these things," Garcia said. "I know he will be going. I know he won't be alive when he does."

Colon is 49 and is dying. He decided in recent weeks to discontinue dialysis, a treatment for people with kidney failure. Colon isn't eligible for a kidney transplant

because he has other health issues including chronic high blood pressure and heart problems.

His choice: Doctors say Colon's decision is reasonable, that dialysis will not improve his life, only prolong it.

Colon also has mild mental retardation; dialysis has triggered emotional outbursts that at times have resulted in cooling off periods in a psychiatric ward.

These days, Colon seems calm and at peace with his decision, although he has in recent days begun to feel the discomfort of his decision as his lungs fill with fluid, as his kidneys fail to flush toxins from his body.

He moved two weeks ago from his father's East Philadel-
phia Street apartment to Garcia's second-floor efficiency on North Pine Street. Garcia

shares the apartment with his wife, Nilda Garcia, who is Colon's sister. She insisted Colon stay with her so she could spend time with him and provide good care until he dies.

The family has split caretaking duties, making sure that Colon has around-the-clock assistance. The apartment links via a hallway to an apartment where Nilda Garcia's mother and stepfather live. Doors are left open most of the time, giving family members more space and giving Colon options in his daily routine.

A hospital bed is placed in one corner of the Garcias' main room -- a 15-by-20-foot space -- beside an open window overlooking a tree-shaded balcony.

Take care:And Nilda Garcia's 18-year-old daughter, Abby Laboy, is staying at the apartment to help her mother and uncle. Each morning, Laboy has deflated an air mattress and tucked it beneath the hospital bed. The reverse occurs each night.

The family has fallen into a routine centered on Colon. Nilda Garcia wakes about 3 a.m. for her part-time job at a medical laboratory. She arrives home by 8 a.m., by which time her husband has helped Colon out of bed and with morning rituals of a shave and shower.

The couple splits the cooking, which is a duty Colon has handed over to them in recent weeks. He likes eggs -- scrambled, fried, over easy or boiled -- and toast.

But on this day, he ate half of his breakfast, walked outside to the balcony, sat in his chair and listened to salsa on his boom box. He dozed most of the day, waking for a couple of hours to talk with Darlene Baronsky of Visiting Nurse Association.

She or another hospice nurse stops by twice weekly to check on Colon. They ask how he is feeling, how much he eats and sleeps and urinates. They ask the Garcias and Laboy if they've noticed changes that would indicate what stage of the "last stage" he is in. Colon answers via a Spanish interpreter, replies but does not converse.

Slow decline: Nilda Garcia and Laboy tease each other, telling Baronsky who gives Colon healthy and unhealthy food to eat; Laboy says she only brought him a "little" ice cream the other day.

"It was only, like, two spoonfuls," she says to her mother.

"And who brings him all the hamburgers and french fries?" Garcia asks her.

Colon watches Laboy, taking in her every move. He has known her since she was an infant, had always called her his baby. Now, Laboy says it's her turn to comfort him.

Like Hector Garcia, Laboy says it's not easy to watch someone die, to let him go. Some days are better than others and she says she knows those to come will become increasingly difficult. She gains strength from Colon, from her mother and stepfather.

Baronsky told them Colon's decline appeared very slow, which is easier on the system. She said toxins that the kidneys no longer eliminate would build slowly. He will come to a point, Baronsky said, that he'll sleep more than being awake and at that point will not be in a great deal of pain.

He managed over the weekend to enjoy July 4 celebrations, sharing for the first time with his sister the sights and sound of fireworks in a night's sky from a spot near the York Fairgrounds. But his mood turned as his body began its visible betrayal.

Hospitalized: Nilda Garcia called VNA for advice to alleviate his pain, and stop the frightening sounds she heard. She, her husband and Laboy remained awake Sunday night as doctors at York Hospital made Colon comfortable, easing his pain with morphine.

He returned home Monday evening; doctors said the pain likely caused an elevation in blood pressure and shortness of breath. Doctors sent him home with medication to alleviate his pain. His physical condition will continue being monitored by hospice nurses' visits.

The banter between mother and daughter has slowed, for now. Both are tired from events of recent days.

Talk of Puerto Rico, too, has quieted. They'd hoped they might take him to that tropical place of blue water and rain forests before his death, but he might be too weak to make that trip.

"As long as the last thing he sees or hears is his family's voice," she said. "We want him to be comfortable and to know that he is loved."

-- Reach Kathy Stevens at 505-5437 or ksteven s@yorkdispatch.com.