Keith and Liz went in to see Isobel just after lunch. She was awake when they arrived, no doubt because she had just eaten. They sat and chatted to her, but were uncertain how closely she was following their conversation as she did not make a lot of responses (I suspect she was listening, I find when reading to her that she may seem as if she is not listening and may even shut her eyes and appear to be asleep, but can usually answer questions about the text I have read to her). They noted the swollen right arm and neck which they had not seen before. They also confirmed something which has only shown up in the past few days, that Isobel's eyes do not seem to focus on what she is looking at. They have not seen Isobel for several weeks and felt that her condition was noticeably worse. Isobel did not want anything to eat or drink while Keith and Liz were there. They stayed until 1.35pm.

At 2.10pm I arrived with Jackie Manhire who had come up from the isle of Wight. Jackie used to work with us in the tax office at the Elephant. She has known Isobel for thirty five years and this is probably the last time she will see her.

When we arrived Isobel was fast asleep. I spent a few minutes manipulating her right arm. The arm was very much the same as yesterday apart from a little more swelling on the hand, the second finger was very swollen indeed. When I was moving the arm, lifting it and flexing it at the elbow, Isobel did not wake. She woke when I massaged the hand and tried to gently straighten the fingers apart from the second one. When she was awake we talked about trying to straighten the second finger, but it was so painful that I did not persist with attempts to straighten it.

We chatted for a bit and Isobel's speech was almost inaudible unless she was reminded to try and speak up. We talked about the old times and mutual friends; Isobel listened, but did not say a lot herself. Isobel ate a banana and drank her mid-afternoon tea. There is no doubt in my mind that she is finding drinking more difficult, when using a straw she needs reminding to suck the drink up. There was a stain on her top where tea had been spilt earlier today.

I left Jackie talking to Isobel and had a chat with the nurses and carers. They agree drinking is more difficult but don't think Isobel is having trouble swallowing. They are inclined to feel that the reason eating and drinking is taking longer is because Isobel is sleepy and takes a long time to wake up for meals.

Isobel's neck was much the same as yesterday, with rotation better than a few days ago. Jackie fed Isobel some grapes. Iona joined us at about ten to four. Iona helped Isobel drink a beaker of blackcurrant squash, she used the spout and not a straw and had no difficulty with it. By the time Iona arrived Isobel was showing signs of being tired, not surprising as with lunch and visitors she had only a half hour break between about a quarter to twelve and four o'clock. We still stayed chatting for another half hour and although tired Isobel had no difficulty staying awake. We all left at half four.