I went in to see Isobel at 5pm. She has had a fair day. She ate all her porridge for breakfast, followed by a pot of balanced supplement. She did not eat lunch but had a pot of balanced supplement early in the afternoon. She had drunk reasonably well, some high energy "shots" are being added to drinks.

Isobel was very soundly asleep when I arrived. I brought the second orchid in with me. Tea was delivered a quarter of an hour later. Isobel was slow to wake but ate her main course easily. There were several incidents of spluttering, these seemed to be related again to a runny nose; they interrupt eating but don't seem to make chewing or swallowing more difficult. She drank half a beaker of tea before the reaction between the thickening agent and the milk fat turned it runny again. Isobel did not have a problem eating her yogurt dessert but was clearly very tired. She fell very soundly asleep immediately she had finished eating.

I let Isobel sleep for an hour while I read the book I had brought with me. Both her left and right hands were tightly curled in a claw like position. For much of the time slight tremors were shaking her left arm. I prepared a beaker of thickened blackcurrant squash but could not wake Isobel to drink it. Her teeth were firmly clenched shut; after forty minutes of intermittent attempts to wake her I gave up. The nurses will make another attempt at 11.30pm when she will have had a long sleep. I left at 8pm.

There is no doubt the maximum depth of sleep is increasing, although the proportion of the day asleep may not be changing much. Failure to wake on at least one occasion is almost a daily occurrence.