I went in to see Isobel at a quarter past five. I fed her tea consisting of cheese and tomato omelette followed by a rather exotic fresh fruit salad and arctic roll. Isobel washed this down with a mug of tea, but her afternoon tea was sitting cold and undrunk on the table. I reminded the carer that Isobel needed to be either given the drink or supervised to start drinking it, even if Isobel said she would drink it in a minute, if it was put on the table she would forget about it within a few seconds.

Isobel was alert and cheerful. Her speech was rather vague and it was difficult to establish the subject of some conversations. We discussed the date and how it was the last day of 2009, but she was not able to name 2010 as next year. Some time after tea Isobel had a banana to eat and finished off the last few biscuits from the tin the girls from school brought in a month ago - there are at least three more boxes and tins of biscuits in the room! By this time Isobel was showing some signs of tiredness and I left at twenty five to seven.

I had a discussion with the nurse. She said that there was no doubt that Isobel was starting to sleep for longer periods. On several occasions she had needed to be woken for meals. Following our earlier discussions, the doctor had seen Isobel today and concluded that she was sometimes failing to mention headaches (not really any surprise in this). In the circumstances she had prescribed two paracetemol three times a day. It is very likely that the longer periods of sleep and intermittent headache are a reflection of tumour growth. Another nurse mentioned that Isobel had briefly been out of her bed on Boxing Day when the air mattress failed and had to be changed, I had not previously been aware of this.