I went in to see Isobel just before 5pm. She had eaten her breakfast and a pot of balanced supplement during the morning. She had no lunch as she could not be woken. When I arrived her eyes were open but staring vacantly at the wall on the other side of her room. The television was on but she was paying no attention to it. When I sat down beside her in her line of vision and spoke to her I got her attention. She confirmed she would like some of her book read to her before tea. I started reading but had only read two pages when tea arrived.

I will not give a blow by blow account of the next two hours, but for the whole of this time Isobel was either eating, drinking, resting or having brief spluttering episodes. At the end she had finished all her first course and dessert and a larger than usual (300ml) beaker of juice. It was clear that her swallowing was much weaker than any time in the past. It was taking her many swallows to clear a mouthful of food. She was unable to support her head at all in a position for eating. Long recovery intervals were needed after about four or five mouthfuls. It may be that tomorrow she will be back to previous performance, but I think today was a preview of what will be the situation regularly in the near future. The spluttering is caused by small amounts of food and drink entering the windpipe. I am supposed to find her ability to splutter reassuring, as it indicates she can still sense what is going on and probably will not fill her lungs up with food or drink and end up with pneumonia.

After Isobel had finished eating and drinking I washed her face and cleaned up some minor food spillages. During resting periods I had massaged and manipulated both her arms. The right arm seems stable, although Isobel has not been able to use it at all for two months. I have been watching the left arm carefully for a few days. There is now no doubt that muscle wasting is taking place, although Isobel is still able to control its movement to some extent.

Isobel was very tired and seemed close to sleep, but her eyes remained open. She was sensitive to light as she found it uncomfortable when the sun suddenly shone in her face through the door and corridor opposite her room while she was eating. She was still just about awake when I left at twenty past seven.