I went in to see Isobel just before half past one. She was asleep when I arrived. The nurses were concerned that the deterioration in her speech sometimes made it impossible to communicate with Isobel, this had caused problems this morning when they asked Isobel whether she would have a shower. I agreed that she should be given two showers a week (she is washed in bed other days) without a need for her to specifically agree to this - she will not object, it is just that she does not positively assent. I expect more problems of this sort to arise in the near future, it is very difficult to see her unable to communicate her own view on these everyday matters. The drop in verbal communication has been very sudden. For some weeks it has often been necessary to ask her to repeat some sentences and she has done so more clearly and louder; she no longer seems able to do this with just a few exceptions.

I woke Isobel very easily, but our conversation was limited. She indicated that she would like me to read to her from her book and I did so for more than half an hour. At one point she closed her eyes and I asked if she was still listening, she replied "Of course I am listening, did you think I wasn't?". This was the only long sentence she said clearly during the visit, most other replies were single words. I think the problem is physical control of the muscles used for speech, not a problem deciding what to say.

Isobel's right arm was not too bad today; there was only a small amount of swelling of the arm and puffiness on the back of the hand. I spent about ten minutes massaging and flexing it. The index and third fingers and the thumb were flexible. The little finger was curled up rigid but fairly easily straightened and flexed. The second finger was a problem as usual and I could not fully straighten it as it was hurting Isobel.

Isobel indicated that she was comfortable and not in pain. I read to Isobel for another ten minutes or so before going home just after half past two. There is no doubt that there has been a sharp deterioration in her condition over the past two weeks and I anticipate a lot more problems will arise in the near future. It is depressing to think that she may never eat the chocolates and biscuits she was working her way through steadily until very recently.