I went in to see Isobel at 2pm. She was asleep when I arrived. She had eaten all her breakfast, mid-morning pot of balanced supplement and lunch. She had also been drinking well today. After a short while I woke Isobel without any difficulty and she drank a beaker of tea with no difficulty. I massaged her right arm and manipulated it, I think this may have becme a bit easier since the steroid dose was increased. After the carers changed her pads, she went back to sleep and I let her sleep on.

Dr Mohan arrived at 3pm. We discussed the effect of the two increases in steroid dose. He believed that there was not likely to be any further significant improvement in Isobel's condition as a result of the steroids. There is no scope to increase the dose further. There is no other drug option available. Myself and the nurses agreed that there had been a significant improvement in Isobel's swallowing. I expressed disappointment that her speech had not improved significantly, although it was just a little better than the almost total loss that had suddenly occurred. The doctor confirmed he did not anticipate any recovery of the power of speech. He thought the stomach tube was essential to maintain nutrition in the future and confirmed that he had requested that arrangements be made for this after the previous discussion but had still heard nothing (it is of course graded as a non-urgent surgical procedure). We agreed that nutrition was not a problem at the moment but this could change at any time. The matter of the throat collar to support Isobel's head during feeding remains outstanding. We all agreed she is comfortable and not in pain at the present; there is nothing else we can do to improve her condition. The matter of a "Do not resuscitate" note on Isobel's file was, for the third time, postponed to a later time. The doctor was of the opinion that the future course for Isobel was not possible to predict with any confidence; in particular he could not guess at the timescale. Something could happen at any time, the growth of the tumour in the brain was unpredictable, it was not possible to know what damage might occur in the near future, the option of increasing steroids to reduce fluid pressure in the brain cavity was no longer available - on the other hand there might only be gradual change for a while.

After the doctor had left, I woke Isobel up. I did not feel like discussing much of what had been said with Isobel and did not feel doing so would help her. I merely mention the points about speech and the stomach tube. Isobel wanted some of her book read to her and I did this for about half an hour until she fell asleep again. Although Isobel was tired today, she was in a contented mood. She only spoke a few single words, no phrases or sentences. I went home at ten past four.