Iona went in to see her mother at half past one. Isobel had eaten and drunk fairly well so far; she was asleep when Iona arrived. Iona woke her and got about halfway through a beaker of blackcurrant squash before she fell asleep again. I arrived at two o'clock. We left Isobel to sleep while we waited for the doctor.

When the doctor arrived Isobel was still asleep and remained asleep during our discussions. Edmund, the senior nurse joined us. We all agreed that at the moment Isobel was feeding well enough although feeding took a considerable effort from everybody involved and filled most of Isobel's waking time. We also agreed that the fairly comfortable situation of the past few days was not likely to last for long and that there would be a return to the difficulties of a week ago when for several days she took limited nutrition. I confirmed that we understood the opinion of the consultant at Darenth Valley Hospital that insertion of the stomach tube would cause more discomfort and risk to Isobel than the benefit to be gained.

Dr Sahota said that he could not say how much longer Isobel will live, the progress of the tumour was inexorable but the effects were unpredictable in detail. He was repeatedly pressed on this point by Iona but reiterated that the would make no prediction. After further discussion of the effects of fluid pressure within the brain (no further increase in steroid dose to reduce this is possible) and the proximity of the tumour regrowth in October to vital areas of the brain concerned with maintaining life, it was agreed that while a sudden crisis might occur at any time, it was more likely that Isobel would slip from the sort of half coma she was in now into a full coma. Iona asked if she was correct in thinking that when in a full coma it would probably be several weeks before her mother died, Doctor Sahota confirmed this would be most likely but every tumour followed its own individual course.

Feeding options were discussed. Iona and I agreed that a nasal tube would not have been tolerated by Isobel if she had been able to make her own decision. The doctor said that intravenous feeding could only be done in a hospital environment as it required a doctor on hand all the time. Supply of fluids into the abdominal cavity or by IV drip could be done at the Centre. We agreed that much would depend on Isobel's condition at the time it became essential to make such choices, what was important was to take the decision which offered most to Isobel.

I stressed that we were not saying that life must be extended as far as possible at all costs, we did not want Isobel to be put through discomfort at this stage. I said that I was confident that Isobel was not in pain at the moment. Edmund and the doctor agreed. I said I expected professional judgment to be used to ensure any pain that developed was relieved, if that required a rapid progression to morphine based painkillers so be it. I had seen how terrible pain could be in the final stages of a brain tumour and did not want Isobel to go through that. We were all in agreement on this point.

We were all agreed that for the moment nothing changed, conventional feeding would continue as long as possible and we would then re-evaluate to situation.I confirmed that I had discussed a "do not resuscitate" notice on Isobel's medical file with some family members and we were all happy that the quality of Isobel's life was so poor that this was an appropriate action. After the doctor had left I signed the paperwork for this note.

Iona and I sat with Iona for a while after the doctor had gone. Iona woke Isobel and gave her the second half of the beaker of blackcurrant squash, Isobel was not really fully awake and fell asleep again when the drink was finished. We left just after 4pm.