I went in to see Isobel at noon. She was very soundly asleep and was still in the process of waking when lunch arrived ten minutes later. I checked her right arm and massaged and flexed it without attempting the straighten the fingers.

The carer reported that Isobel had been wide awake for breakfast and had eaten all of it with no problem at, she she also been drinking well.

The first course of lunch, liquidised meat, two veg and mashed potato was completely eaten, although it was a slow process. There were about half a dozen periods when Isobel would eat four or five spoonfuls of food quickly and efficiently, with intervening periods of very slow eating with long rests between mouthfuls. For desert Isobel ate half of a very large helping of bananas and cream, this was consumed fairly quickly but she became tired, in the sense that the muscles of the mouth and throat were not functioning as well. She drank a beaker of thickened orange squash very easily during the meal.

By the end of the meal, despite the fatigue with swallowing, Isobel was more alert. I chatted to her for a while and she was able to give one word responses, usually just "yes" and "no" but sometimes other words. She confirmed that she was not in pain and was comfortable. We agreed to postpone book reading until tomorrow and I left a little while after half one.

On the way out I spoke to the nurse who said that she was pleased with Isobel's condition today, they had been concerned by the difficulty getting fluid into her the previous two days. While we wait for the stomach tube to be inserted, if fluid intake becomes a crisis problem it may be necessary to use a nasal tube for hydration. On the whole Isobel was far more responsive during this visit than for several days.