This was a bad day all round, including the lawn mower exploding in the afternoon. I spoke to Rosemary's husband by telephone, she told him that Isobel was sleepy and unresponsive throughout her visit yesterday.

I went in to see Isobel at 5pm. The Speech and Language Therapist, Victoria, was already there. Isobel had eaten little during the day apart from pots of balanced supplement. She had drunk moderately well. I showed Victoria the record of food intake. After a few minutes when tea had not yet appeared, she mentioned that her hired car had to be back at Gravesham Hospital by 6pm! I spoke to Edmond and he got Hayley to produce Isobel's tea within two minutes, Victoria then had five minutes to observe me feeding Isobel before she left - this amounted to two mouthfuls (which was much quicker than yesterday). Victoria expressed the view that her visit had still been useful, apparently she had been working nearby during the afternoon. I said that I felt there were more problems with eating in the last week. I gave her a brief account of the nutritionist's comments last week. It was agreed that she would see Isobel for a full meal next Thursday lunchtime, arriving at 11.50am. This does of course run the risk of not being able to wake Isobel.

After Victoria had left I continued to feed Isobel her main course. She had a number of coughing and spluttering incidents and these seemed to be eased by intercalating mouthfuls of thickened blackcurrant squash between mouthfuls of puréed meat and vegetables. The same procedure was used for dessert of yogurt. I believe part of the problem may be that Isobel has a slight cold again. Eventually the main course, dessert and drink were finished; but Isobel was very tired.

I read a few pages of her book to her but she soon fell fast asleep. I manipulated and massaged her right arm which showed signs of swelling again. For some weeks she has had a slight intermittent tremor of the left arm, this has increased in frequency over the past week and there seems to be a tendency for the left hand to lock into a claw like grip in the same way as the right hand a few months ago. Although Isobel has short sequences of a few bad days followed by a few less bad days, I feel her underlying condition is now significantly worse than a week ago. I sat with Isobel for a short while as she slept, but it seemed unlikely that she would wake again for some time, I left just before half past seven.