Isobel slept until 8am. She breakfasted, took her medication and bathed, somehow this took until 11.30am. Iona came in at lunchtime. Isobel was again not able to stand without assistance. She was able to walk ten yards to the bathroom with a lot of support and assistance but was very tired afterwards. Lifting her on and off the commode is still tiring. The appointment for the MRI scan came, the 27th October, we had hoped it would be sooner.

Using a method suggested by the crisis team I took Isobel's blood pressure while lying flat then after standing. If the standing problem was being caused (or made worse) by the sedation, a fall in blood pressure would be expected after standing up. The readings showed systolic pressure hardly changed and diastolic pressure raised after standing. The conclusion is that the sedation is not causing the standing problem, there is some other cause, this is presumably disease progression.

The meeting planned for 2pm had somehow been rescheduled to 2.30 without my knowledge. Several people were unable to attend owing to other events and crises, but it was disappointing that in the end it consisted of only Sarah Parker from the Ellenor Trust and Seywag from the Mental Health Crisis Team. It was agreed that Isobel needed respite care. It was also agreed that the mild sedation had worked remarkably well, I said that it had not only calmed Isobel down but also made her happier. Seywag wondered whether the already low dose could be reduced further. I said that sedation was not preventing Isobel being alert but was producing very beneficial effects, I suspected lowering the dose would lead to a re-occurrence of the violence and unhappiness of last week. Sarah accepted that taking account of the effect of the sedation, Isobel could be looked after by the hospice, but at present all beds were full in the Cottage Hospice. She would investigate other possibilities available through the Ellenor Trust but was not optimistic about coming up with anything in the short term. Sarah was also concerned about problems at discharge after, say, two weeks respite break. We agreed that the deterioration in her symptoms would result in her care needs being greater on discharge than on admission. Various technical fixes such as hoists were discussed but it was unclear that these could produce a safe solution. The normal referral route from the crisis team is through the district nurse to Social Services. To save time I will self refer tomorrow direct to Social Services, I foresee this not being straightforward. As he left Seywag said that he could see respite care turning into long term residential care, because of Isobel's deteriorating condition.

After Sarah and Seywag had left, June arrived bearing delicious home made muffins, we ate them all within an hour! June stayed for an hour and a half.

Isobel had Chicken Kiev, chips, broccoli and carrots for dinner, followed by rice pudding and caramel shortbread. She was asleep by 10pm.