I went in to the Centre at 11am and met the speech and language therapist Claire and her student Amy. I outlined the events of the past week and mentioned that although Isobel was continuing to swallow that the act of swallowing had become less easy to observe and seemed to be weaker. I described the difficulties at the end of last week and the improvement over the weekend. Isobel was awake and a nurse was part way through giving her the main batch of daily medicines. We moved into Isobel's room and observed the problems the nurse was having. This process took the best part of half and hour and Isobel seemed, not surprisingly rather tired afterwards. After I had cleaned her up, Isobel dozed lightly while I arranged for her lunch to be accelerated so that we could use it to check her swallowing.

Isobel was more or less awake when the food arrived at ten to twelve. I fed her the main course while Claire felt her throat and listened with a stethoscope. Isobel ate the main course with few problems, although she was clearly rather tired. Although the eating went fairly smoothly, the first course took half an hour to consume. Claire confirmed that the act of swallowing was significantly weaker. She was satisfied that Isobel retained an awareness of what was going on in her mouth, she could feel when she had food in her mouth and was sensitive to food tickling the back of her throat and would respond with a cough. Today Isobel showed an ability to continue eating and swallowing when her her head fell somewhat to the left, usually this requires the head to be manually realigned to avoid either food falling out of the left hand side of the mouth or teeth clenching preventing food being taken into the mouth - I pointed out this was unusual. For the moment Claire is happy with the established regime, although this could deteriorate at any time, in which case she cvan be contacted by phone. It was agreed that it was not very good for Isobel to spend most of her waking time being fed. Neither of us have heard any more about the stomach tube.

After Claire and Amy had left just before one o'clock, Isobel needed a rest of over half an hour, during which she slept, before she could tackle the yogurt dessert. At first she was very slow eating this but then speeded up and finished it without major problems. She needed a further short sleep before she drank the beaker of juice that had accompanied lunch. I manipulated and massaged her right arm which continues to cause less problems and is not significantly swollen.

Isobel was still awake so I read the end of her book to her again, as she had fallen asleep on the previous occasion. Once again she fell asleep, just as I reached the end. I sat with her for a few minutes, checking that returning the bed to a nearly flat position had caused no problems, then left at about twenty to three. Once again Isobel did not say a single word.