This posting covers both Friday and Saturday.

As soon as Isobel awoke on Friday morning she refused to eat or drink. She would not bath, wash or allow herself to be otherwise cleaned up. There was a limited amount of shouting and swearing but no violence. After she had persisted with this attitude for almost two hours I 'phoned Wendy Lethem at the Ellenor Trust. Wendy believes that Isobel's behaviour is too extreme for the hospice to deal with as an inpatient. She was not sure what alternative solutions were available but would discuss them by 'phone with Dr Shah (the duty GP at the Albion Surgery). I had a chat with Dr Shah at the surgery; she was not certain about what provision would be best or was available. In the first instance the Bexley Crisis Intervention Team would call and weigh up the situation. We agreed that mild sedation might calm Isobel enough to make management of her needs possible in the short term. I said that in any case, bearing in mind that it was Friday afternoon, we would be able to get through to Monday apart from the refusal to drink problem, but could not sustain this next week if the behavioural problems continue. After I returned home I got Isobel to drink a mug of coffee, her first fluid since Thursday night, but she would not drink any more afterwards. Iona was here after finishing early at school.

The crisis team (a doctor and a mental health worker) arrived in the late afternoon and Isobel came downstairs in her dressing gown to talk to them in the back room. They gave Isobel the usual array of questions, she was not able to say what day of the week it was, or the month or the year, but she could name her children (she has been calling Iona Jess almost all the time over the past two weeks!). She was not able to coherently describe how she saw her conditions or what she felt the major problems were. The doctor was able to convince her to drink, she drank over a pint during the meeting. Isobel took today's medication during the meeting. A mild sedative was prescribed and arrangments made for further visits during the weekend. Iona went home after the team had left.

Isobel ate a large plate of curry for dinner, and had rice pudding afterwards. She drank several mugs of tea during the evening. Isobel took the first sedative tablet. There was some resistance to changing pants but this was eventually done. The mental health worker came by at 10pm and dropped off some paperwork and contact details. Isobel went to sleep at about 11pm.

On Saturday morning, Isobel was very drowsy when she woke. She ate breakfast, drank and took her medicine but did not want to bath or wash. She was very quiet, presumably the effect of the sedative. Iona came and stayed until late afternoon when Jon came back from playing football; they took the death certificate for Jon's grandmother's brother who had disappeared in the 1970s; he had died of TB in a hostel for the homeless in 1994.

There were no major problems for the rest of the morning. Isobel stayed in bed and apart from the washing refusal generally went along with our care for her. Isobel had chicken nuggets for lunch.

A different crisis team called in the afternoon and we were able to report that care was easier to achieve. Isobel had pizza and garlic bread for dinner and continued to drink tea. She went to sleep just before 11pm.