After being caught in horrendous traffic on the way it was 8.25am before I arrived at Iona's house to pick her up and 8.45 before we arrived at the Centre. The ambulance arrived soon after 9am and we traveled to Maidstone through torrential rain and wind. Isobel was in her wheelchair, Iona and I were also in the ambulance. Having arrived almost an hour before the appointment time, we had a long wait as Dr Sadler fell more than forty minutes behind with her appointments.

Dr Sadler explained that it was not good news. The tumour had grown significantly. There was no further treatment. I examined the scans and saw that there was considerable enhancement indicating active tumour growth at the rear of the area originally occupied by the tumour before the debulking. This area is deeper within the brain. At the moment the tumour is restricted to the left hand hemisphere. It was clear from the scan that further surgery was not practicable as the most active part of the tumour was surrounded by normal brain tissue on three sides. We measured the tumour at its widest point, it was 2.5cm by 3.9cm - this is much more than the maximum size I had thought likely. We discussed the evidence for tumour growth, it seems very probable that the two earlier scans had not picked up areas where the cancer cells were infiltrating - this is a known problem with Glioblastoma and MRI scans. During the preceding months when symptoms were deteriorating, cancer cells were infiltrating healthy tissue and as they continued dividing and multiplying there was at first no sign of this on the scans until the cancer cells had displaced the bulk of the healthy tissue, We discussed Isobel's future care. Dr Sadler was not previously aware of the Peter Gidney centre but said that it sounded exactly the sort of place that Isobel should be, she did not believe that it would be possible to look sfter Isobel at home. There is no point in Dr Sadler seeing Isobel again as she can offer no further treatment.

Isobel took the bad news well. She was a little upset in the ambulance on the way back to the centre, but this was understandable. We got back to the centre and they very rapidely produced lunch, Isobel had ham, chips and mushy peas. For afters she had rice pudding. I gave the nursing staff details of what had transpired. I saw Margaret Nicholas, the head of the centre, and agreed to convert Isobel's respite break into a permanent placement. Iona and I left at after 2pm and travelled home via Louisa's house.

I 'phoned Maggie Williams at Bexley Care Trust. She was on leave but i spoke to her deputy. I advised what had transpired at the consultants, she will convert Isobel's stay to a permanent one. She will speak to the district nurses regarding recovery of the home nursing equipment.