I went in to see Isobel at a quarter past five. She was awake and a nurse was feeding her, she was just finishing the first course and had not had any problems eating although she seemed to be showing the first signs of tiredness in swallowing. She had eaten breakfast but had missed lunch as she was soundly asleep. I took over feeding and Isobel ate her afters of strawberry mousse fairly quickly without and great problems. The same could not be said of her grapefruit drink which posed problems from the start and required two long recovery breaks during which Isobel fell asleep. When she had finished the grapefruit drink she fell asleep for almost an hour. While she was asleep I manipulated and massaged her right arm, this did not cause her to wake.

It had been planned to feed her one of the pots of balanced supplement as well as part of her tea, but this was clearly impossible. The fluid intake record showed that Isobel had not drunk much during the day as she had been sleeping most of the time. As soon as Isobel showed signs of sleeping more lightly I woke her and helped her to start drinking a beaker of tea.

Like all Isobel's drinks now, this is thickened to the consistency of custard and fed to her on a spoon. Isobel had difficulty coping with the tea, tending to either close her mouth and clench her teeth on the spoon or keep her teeth clenched all the time. These problems occurred before the steroid dose was increased and it will be depressing if we have come back to the same point so soon. After about ten minutes I switched to the pot of balanced supplement, this has just the right consistency to hang on the spoon and Isobel ate half of it in about ten minutes. We then went back to the tea and continued making very slow progress, by the time Isobel had drunk three quarters of the beaker (150ml) the tea was cold. She then finished the second half of the pot of supplement rather slowly.

As soon as Isobel had finished the supplement, her evening medication arrived. All her medicine is now in liquid form apart from paracetemol. She drank the tiny beaker without problem. The paracetemol is dissolved in a beaker of water and thickened. It took over half an hour for her to drink the whole beaker. She fell asleep several times during this process. When she finished, she fell very deeply asleep.

During my visit, all of the time Isobel was awake was spent trying to get her to take food or drink. I don't think this can be much fun for her. She did not speak at all to me today, a nurse said she spoke "yes" and "no" a couple of times this morning. I did not manage to contact Claire, the speech and language therapist, by 'phone today, I will try again tomorrow. I went home at 9pm.