I went in to see Isobel at a quarter past five. On my way in I was intercepted by a nurse who said that they had been concerned about an increase in her sleepiness. Today they had to wake her for breakfast and for lunch. The doctor had seen her this afternoon and inquired whether she was due to see the consultant at Maidstone again - I confirmed that she would not and that from now on it was just a matter of palliative care as no further treatment was possible (I have of course advised the Centre of this before).

Isobel was sitting up in bed awake but looking rather sleepy. She did not have the television on and possibly may have been dozing and recently woken up. The most obvious change was to her speech. She spoke much less than usual and words were not well formed or clearly spoken. She seemed to have a slight cough again.

Tea soon arrived and I fed Isobel corned beef and chips followed by fruit salad and cream. Feeding tea normally takes about five minutes, it is rarely more than ten even if we chat a lot. Today it took over twenty minutes. Drinking a beaker of tea after the meal took almost ten minutes. This is very unusual. Isobel was taking much longer than usual to chew each mouthful and only took small sips of tea with long breaks between them. I think she may have a little bit of a cold that may be making things more difficult for her.

After tea we chatted for a while and Isobel's speech became noticeably better, although still much worse than the previous days. Isobel had a banana to eat. She was certainly tired and I left her soon after half six.

On the way out I had a chat with the male nurse. He has previous experience of glioblastoma patients and confirmed that there was nothing much unusual about Isobel. This fluctuation in ability from day to day may be expected to recur. Eventually the proportion of time spent sleeping will occupy all the day but before this there will be an unpredictable pattern of changing symptoms. We discussed the tumour regrowth and I confirmed again that the consultant had concluded no further treatment is possible, just palliative care. It was agreed that I would come back in just before noon tomorrow to see how Isobel was at lunchtime.