First of all, I am so very sorry to hear of your BIL's diagnosis. My thoughts are with you all as you go through this.
I've read through everyone else's replies, and I also have to say how sorry I am that all of you have had to go through this hell, as well. It's something that I wouldn't wish upon my worst enemy.
I want to give you truth.. which is what I wish so much that others had given us, so that we could prepare our hearts and minds for what was about to come. If you don't want to hear the painful details, please don't read this post.
I don't wish to scare you or add to your hurt. I know that we all deal with this process very differently. Some of us will need to know details, others don't.. both are completely understandable.
My father was diagnosed by exploratory laparoscopic surgery with a very aggressive form of metastatic pancreatic cancer on September 22nd, 1999, which was his 45th birthday. It had already metasticized to his liver, colon, and part of his stomach. He was given less than 6 months to live. Sadly, yet thankfully, his dying process went rather fast. He passed away at home with us on November 7th, 1999.. which unfortunately, was his youngest sister's birthday.
Dad was a very dedicated worker.. I think he took maybe 5 sick days in all of his 28 years of working as a mechanic. He was a very heart strong man.. never one to cry unless he was extremely hurt or as we soon learned, was very scared. (I am telling you this because how your BIL was in life may directly explain anything he may do near the very end. Is he a fighter by nature? Headstrong or stubborn? He may fight death a little harder than some.) The two weeks directly following his diagnosis, he cried quite a lot. So many times, he said that he didn't want to die. He felt out of control of what was left of his life. He said he didn't want his children to have to take care of him. He was claustrophobic and was petrified of "drowning in his own fluid" and made us swear not to let that happen (I have to mention this because of the week preceding his death). We promised to do whatever he wanted. Dad was completely coherent for those two weeks, but the pain was getting horrendous and he began vomiting A LOT.. and was no longer able to digest even the softest of food. "Ensure" became the only thing he could tolerate, and even that didn't like to stay down.
On the third week, he developed a large blood clot in his right leg and was again hospitalized. Things went downhill extremely fast from there. While in the hospital, his kidneys began shutting down and the pain was no longer bearable, even though he was being pumped with dilaudid almost continuously. He was very incoherent at this point. There were lots of hallucinations. He fought the air a lot.. he would swing his arms and make motorcycle noises.. he worked on cars in the air and would ask us to hand him tools and if we didn't hand him something, he would get angry and yell. We had to hand him pencils or straws.. just anything to pacify him. At one point, he had a moment of clarity after he was handed yet another pencil.. he opened his eyes wide, stared at it for a minute and said, "what the hell am I supposed to do with a damn pencil!!?!". It was first time we'd laughed in weeks.. and it turned out that those would be the last words that dad ever spoke to us.
Dad slipped in and out of conciousness over the next few days. Everything became very fast paced and just.. too clinical.. or something. Dad hated hospitals with a passion... and we knew the end was coming. This is when we decided to put him on Hospice care and bring him home. He came home in an ambulance and up until that point, was the most difficult thing I'd had to witness. My big strong daddy was brought into the house on a stretcher. That's when I lost it a bit.
He woke up a bit when we told him he was home.. but he went back under pretty quickly.
Hospice came at least twice daily, but the majority of the care was left up to us. We bathed him, put cool compresses under his armpits and groin when his fever would spike to extremes, wiped away his stool, and learned to suction his nose and mouth when his lungs began filling with thick red fluid. This was what dad was afraid of.. the drowning. He was afraid he would feel it. He moaned a lot.. from the pain, I think, even though he was heavily sedated.
Family and friends came to say their goodbyes. He was never left alone.. someone was always holding his hand. They say that the last thing that goes is your hearing.. even if you can't understand the words. We talked to him and told him that we loved him and that it was ok to let go. I trimmed his mustache and beard for him.. he would have wanted that. It was one of the sweetest, yet most difficult moments of my life.. and I will cherish it always.
Dad began to swell severely since his kidneys had stopped working. His stomach was very large. His breathing became extremely labored.. he would gasp suddenly and would gurgle as he breathed out. There were times that he would go 30 seconds or more between breaths. Those last moments with him were very difficult. With every outward breath, ours hearts felt like they had stopped until he took another. And then.. he just didn't. He was gone. His pain was over.
Wow, that was difficult to write.. but if it helps even one person prepare for what may come, it's well worth it.
My only real piece of advice to you and your family is to talk to each other. Tensions will be high until the end. When you're faced with cancer, there are so many varying emotions at every moment. Be gentle with each other. I'm truly sorry that you all are going through this. Many hugs to you and your loved ones.