Iona and I went in to see Isobel at 2pm. Isobel had eaten most of her breakfast and a pot of balanced supplement after, but was then slightly sick. The air mattress had developed a fault and the transfer to a conventional mattress triggered the vomiting. She did not eat dinner but ate a pot of balanced supplement early in the afternoon. She had drunk fairly well during the day. She drank a glass of blackcurrant squash without any problems soon after we arrived but was very sleepy. She is now on a regime of regular three hourly turning as a result of the mattress change and the nurses turned her and changed her pad at 3pm; the doctor arrived shortly after.

The doctor listened to Isobel's chest with his stethoscope and confirmed that her lungs were clear, there was no sign of a chest infection but she had a slight cold. Phlegm from the cold may have made a mechanical contribution to the vomiting yesterday. Her overall condition was what was to be expected from her illness although the rate of decline was apparently slow. He could not speculate on the time she would survive, it could be days or weeks, or longer. She did not seem to be in any discomfort from the infection being treated with antibiotics. She continues on the reduced level of steroids.

Isobel was very soundly asleep after the doctor left. Iona and I sat with her until tea arrived a couple of minutes before 5pm. At the same time Isobel's dietitian, Patricia, arrived. While I fed Isobel, we discussed her nutrition. She has lost 9kg since she arrived in the Centre. She understands that Isobel frequently misses one meal a day (usually lunch) and has on average between two and three pots of balanced supplement. We agreed that wasting of muscle mass was occurring, but this did not unduly affect Isobel's sedentary lifestyle. The rate of weight loss was not alarming, but some changes could be made to increase the average calorie content of her food by adding fat in the form of butter and cream. This would compensate for any tendency for feeding difficulties to reduce the mass of food taken in. Additionally, small pots of high calorie supplement could be added to her food. These were only 30ml each but would significantly increase the energy value of each meal. She was happy with the way Isobel was eating.

After Patricia had left, Isobel finished her tea and then ate a pot of balanced supplement. She was very tired and fell soundly asleep as soon as she had finished eating. I washed her face and settled her down. Iona and I left at 6pm, stopping for sausage and mash in the Chequers on the way home.