How Alone Are We Really?

 

Taking care of Robert involved a huge team. Richard and I were primarily his caregiving team for more than a decade but Robert had other caregivers, doctors, specialists, day program staff, physical therapists and, eventually, skilled nursing facility staff, involved in his care. This doesn’t even take into account the ER doctors and nurses, the pharmacy staff and the companies that provided his medical equipment or the one who supplied his briefs. 

Oh shoot, and I almost forgot about the transportation companies, their drivers and the other riders on the  van through the years! There was also the Regional Center and the many service coordinators Robert had. There was the social worker from IHSS who visited annually (not always the same person but some years we got lucky and had a familiar face). 

Because I shared Robert’s story online and was active in epilepsy awareness and caregiving groups there were many more people who cared for Robert.

Robert’s care and social circle was huge and this does not even include our family! 

Oddly enough, it often felt like Richard and I were on our own caring for Robert. After all, we were the ones changing his soaking wet briefs in the morning and doing several loads of laundry a day. We were the ones logging his seizures, behavior and vital signs to keep an eye on any sort of seizure cluster coming or hint of illness (of which there were many). I was the one to sort his meds for the week and make sure we didn’t run out. 

We had a huge team and took advantage of many resources available to Robert but we still felt alone. 

I suspect this is similar to what other caregivers feel because we are the ones ultimately responsible for our loved one’s care. 

I quite literally felt responsible for keeping Robert alive. 

As parents we feel that way with our babies and toddlers but, if we are lucky, they grow up to be independent, thriving adults. 

As caregivers, there is a reverse trajectory for our loved ones. They decline. Their ability to manage their money, decisions and household declines. Their illness gets worse. Their mobility often worsens and many times they lose the ability to physically take care of themselves. 

And there is no timeline for how long this goes on. Not only that but we don’t always know just how far the decline will go. Sure, we can look up statistics of the disease but that does not give us a definite timeline. Heck, I had a doctor tell me Robert probably had three more years to live – tops. He lived 11 more years and died of something no one saw coming!

We do the best we can to keep our loved ones alive. They depend on us and we don’t just watch for the next pneumonia but we help them thrive. 

We add to our caregiving team. We set up social services. We get to know the doctors and specialists and physical therapists. We add in home services or eventually place our loved one in a facility. 

Robert’s whole team worked to not only keep him alive as long as possible but as happy as possible. We all had the same goal: keeping Robert (as he would say) “super, amazing, excellent and great!” 

Robert wanted to spread epilepsy awareness so we signed him up for various studies (one saved his life years ago when he was testing out new equipment for patients in septic shock). He was very social so we kept him in his day program even when he moved to a skilled nursing facility. 

The staff at the skilled facility recognized Robert’s love of people and games so made sure he participated in group activities instead of keeping him in his room. He depended on people to transfer him from the bed to the wheelchair so this took extra effort which we greatly appreciated. Our beloved special caregiver for Robert, Pattae, made sure Robert was entertained and kept us informed of his health when we couldn’t be at the facility. 

It was so difficult to lose Robert. I still miss bringing him home to get his hair cut or to give him a special treat (usually involving a chocolate Frappuccino or burger and fries). Richard misses playing bingo with him every Friday afternoon. I miss watching Family Feud or Wheel of Fortune with him. I miss watching him toss a toy to Taz down the hallway in our house. 

I also terribly miss Robert’s team we created. I miss talking to his terrific doctors and nurses. I miss Pattae but thankfully we have stayed in touch. I am always on the lookout for caregiving jobs for her and refer her to anyone I know! I miss his day program staff and the friends Robert had there. I keep in touch with his service coordinator from the day program so that definitely helps.  I miss his physical therapy team and will never forget how good they were with Robert. 

It was so difficult to lose Robert but it was also difficult to lose everyone involved in his care over the years. I am grateful we had the awesome team that we did and am positive everyone played a part in keeping Robert around (and happy) much longer than anyone ever thought possible. 

As a caregiver, you may feel alone sometimes (or often) but it helps to create an extended support system and sign up for all the services your loved one qualifies for. Write down all the services and support you currently have and those on your wish list. Add to it as you think of those involved in your loved one’s care or the services you would like to have.  

You may not see it at the time but each of those people involved in the support system and services will contribute in some way to your peace of mind and your loved one’s health and wellbeing. Yes, you are the one doing the laundry and meds and keeping your loved one clean, dry and as healthy as possible but you don’t have to always feel alone. 

Help and Hope

I just love leaving the neurologist’s office with such hope.  Robert’s seizures have remained largely uncontrolled his entire life; his seizures changing over the years but never going away after numerous medications changes, surgeries and the use of various medical devices.

Between seizures - declaring himself excellent

Robert now has seizure clusters just about every two weeks.  These are Complex Partial Seizures and last anywhere from a few seconds to five minutes. They come one right after another with a few minutes in between to just 10 to 20 seconds in between them.  His postictal period is usually very brief and he can answer questions almost immediately.

Questions like: “How are you doing, Robert?”

Always with an answer of: “I’m doing excellent.”

And then another seizure comes.

Just before another seizure

Thursday night this scenario played out during dinner (which, of course, shortened dinner  because we don’t want Robert aspirating on food or drink). I gave him his rescue medication and the seizures slowed. This gave my husband and I time to get Robert ready for bed and in the safety and comfort of his bed.  (My comfort and his – I am comforted knowing he is safe in bed while keeping an eye on him either in person or with the camera.)

He had a couple of more seizures so I gave him the next dose of the rescue medication.  It was late by this time and I watched him on the camera until I was certain the seizures were gone.

Robert woke up the next morning pretty sleepy (seizures and rescue meds will do that to you). I started to get him ready for the day (bathroom, bath, etc.) and the seizures started.

Again, I gave him the first dose of the rescue medication. (We are at 3 mg of Ativan for the first dose and the rule is no more than 6 mg in a day. I was concerned about giving him the meds in the morning since he just had them the prior evening but the neurologist told me every day “restarts” the 6 mg rule.) 

We have to stop the seizures so 3 mg of Ativan it is.

Finally at home after a long day in the ER

Variation of the usual questions were asked during the recovery periods: “Do you know where you are?”

At home.

“Do you know who I am?”

Trish.

“Do you know who he is?”

Richard.

“What is the dog’s name?”

Taz.

“How are you doing?”

Excellent.

The seizures continued.  Step two of the rescue meds (2 mg of Ativan).

And continued. One more mg of Ativan.

The seizures would not stop.  The Ativan did not touch them, slow them or stop them.

I called the neurologist’s office when they opened.  They recommended going to the ER since there could be an underlying infection that wasn’t showing up yet. Plus, you know, the seizures weren’t stopping and there was concern about Robert going into Status Epilepticus.

That would definitely NOT be excellent.

I called the paramedics and they remembered us from the last time.  We also thanked them for participating in the neighborhood Santa visit and told them how much Robert enjoyed that. I was amazed at how they could be so friendly and professional all the while taking vitals and moving Robert from the bathroom to his wheelchair while we waited for an ambulance.

Apparently it was a busy morning for ambulances as they were on their fourth ambulance call of the morning and we had to wait for an ambulance to come from 15 miles away (in traffic, no less).

We waited. We talked. We watched Robert have seizures and tell the paramedics in between that he was excellent.

 

Enjoying Christmas with the Day Program staff

Once he was on his way to the hospital, I followed and thought about how this was the absolute worst seizure cluster Robert has had.  The possibility of him going in to Status Epilepticus seemed very real to me. I teared up and wondered if this was it for Robert.  I didn’t know what the rest of the day would be like. Would he continue to seize? Would I have to make all kinds of life or death decisions for him? Would he be able to tell me he is excellent again? 

The last time his seizures were this awful was when we were in Disneyland for Epilepsy Awareness Day so I could point to over-stimulation as the cause.

This – this was baffling as I had nothing to point to other than he had been super tired all week. I didn’t even have Disneyland as my consolation prize for dealing with such a stressful situation!

Thankfully, the seizures stopped fairly quickly in the ER. The doctors ran tests for an infection and checked his ammonia level because of the report of tiredness. Everything came back fine (even the ammonia level which was surprising because it is always high).

There was nothing we could point to and say that was the cause. The only nagging thought was that he had been very, very tired that whole week.  Even Day Program reported Robert was sleeping more than usual, taking two hours to eat lunch or not finishing his lunch. 

Now that is a definite sign of a problem.  Robert loves his food!

Robert’s case manager at Day Program is a good guy. So sweet and good-natured and very patient with Robert.  He also has epilepsy so I think that gives him a great connection with Robert. The director couldn’t be nicer either. Everyone at Day Program loves Robert.

We talked about Robert’s seizure cluster when I picked him up for his neurology appointment.  They both suggested that maybe he isn’t sleeping well and that perhaps he has sleep apnea. 

That could explain his tiredness so I mentioned it to his neurologist (actually, the Nurse Practitioner who then discusses things with the neurologist – I am perfectly happy with that arrangement as I love his NP.)

She thinks that could be causing his tiredness and his seizure clusters.  The neurologist doesn’t want to change the medication regimen until we get the results of the sleep study. (They’re testing his thyroid levels too since that can cause tiredness.)

I love the simplicity of that possible solution. What if he has sleep apnea? We can manage that and maybe, just maybe, his seizure clusters will be reduced or go away all together!

I just love leaving the neurologist’s office with such hope!

 

With the great help and support of the paramedics, Richard, the Day Program staff, the Nurse Practitioner, the neurologist (not to mention all the love and support from people that care about Robert), Robert just might get some relief from these seizure clusters.

Now that would be excellent!

New Day Program: A Warm Welcome

Once we determined Robert needed more care at his Day Program, including having the option of using his wheelchair when his mobility was questionable, the transfer happened fairly quickly.

Robert's first day of new program (2014)

Fortunately, we had the option of going to another program run by Easter Seals.  I have been very happy with Robert’s other Easter Seals Day Program and had no doubt the new one would be just as terrific. 

We toured the facility, completed paperwork, got the transfer arranged through Robert’s Regional Center and had the intake meeting all within a few weeks of the decision to move him.

As with any change, I was a little concerned if this was the best choice for Robert.  After all, the staff at the other program knew his quirks, Robert had friends at his other program and most of all, he had his routines.

Routine is huge in Robert’s life.  We have realized that change is actually a seizure trigger for him so I do not take lightly making any changes to his routine. 

The new program had numerous benefits though: Robert could use the wheelchair whenever we thought it was necessary (and, actually, it’s become a daily necessity). There were more staff per clients and since Robert’s needs were increasing, this was a huge bonus.

Selfishly, I was looking forward to it being in a more convenient location. Since Robert returned home from the Skilled Nursing Facility, we had decided to make the morning routine less rushed.  Robert sleeps in later than he did before being hospitalized and we no longer take advantage of the morning transportation to program.  Richard or I take him to program once he is ready and we are not rushing him or stressing him (and us) out in the morning. The problem with this plan is that the previous program is 20 minutes from our home and that much further from my office. 

As a working caregiver, this was a price I decided was necessary to pay.  Even though I arrived at the office later than I would have liked, I checked emails and voicemails in the morning (don’t worry – not while driving!).  I also spent a lot more at Starbucks because by the time I was done with the caregiving part of my morning, I was ready for another dose of caffeine!

The new program is mid-way between our house and the office and five minutes from Robert’s physical therapy. (That is a whole other routine of drop off and pick up on physical therapy days.)

So, yes, selfishly, I was looking forward to this more convenient location. I was also relieved that I didn’t have to worry about sending Robert to program with a walker when he would be safer in the wheelchair.  I was looking forward to more staff helping Robert in the bathroom and helping him make safe decisions (sometimes Robert misjudges distance or his ability to pick up something from the floor which causes him to topple over).

I’d rather not get calls that Robert has fallen onto another client or over-corrected his walker and fallen sideways onto the floor. (Both have happened.)

During the transition period, Richard and I spoke enthusiastically of the new program and Robert was excited about the change.  He did have an uptick in his seizures which I believe was due to the anticipated change.  However, I knew he would establish new routines quickly and was happy with the speed of the transfer so was confident this disruption would pass.

The intake process was extremely helpful as it gave me an opportunity to tell them about Robert’s likes, quirks and things that irritated him. I asked if it would be helpful to send a list of upcoming appointments instead of calling in the morning of each appointment and they appreciated that idea.  The intake meeting was a great chance to offer suggestions on how best to communicate with Robert, especially during his stubborn moments.

I was very impressed with the staff on Robert’s first day.  They were very conscientious about the medication I was dropping off, counting it, completing paperwork and even training other staff members on how medication intake was done. 

It seemed as if the staff had read all about Robert before he even arrived that first day.

While I was discussing medications and the bathroom help that is needed, Robert made himself comfortable at a nearby table and was soon surrounded by clients befriending the “new guy.”

It didn’t hurt that most of them were women since Robert fancies himself a ladies man!

Unfortunately, Robert had an incident after the first few days (Argh! It’s only been three days!). Apparently, he refused bathroom help and got angry with the staff person trying to help him. He was eventually changed but refused help later in the day and ended up at home soaking wet.

The site manager has been terrific with communication, though. By the time I got home from work, Richard told me how Robert came home on the van soaking wet.  I had an email from the site manager explaining what happened as well as a note in Robert’s bag from the staff member who was involved in the incident. 

I talked with Robert and explained the staff were there to help and that it wasn’t okay to not be nice to them.  Robert listened intently, as he always does, and said, “I understand.”

I explained to Robert that he would have to apologize to the staff member the next day.  He agreed and I told him the name of the person he needed to apologize to.  The whole next morning while getting ready, Robert asked me who he was supposed to apologize to.  I told him he had to talk to Noah.

“Noah?”

Yes, Noah.

“Thank you for telling me that.”

Fifteen minutes would pass and Robert asked, “Is the lady’s name Christine?”

No, you have to talk to Noah. It’s a guy.

“Noah?”

Yes, Noah.

“Thank you for telling me that.”

We repeated this routine until we arrived at Day Program. As I pushed the wheelchair into the building, I asked a staff member where we could find Noah. She didn’t hear me at first so Robert repeated the question. She pointed us in the right direction and Robert looked at Noah and said, “I’m sorry I wasn’t nice to you, Noah” and extended his hand.

Noah shook Robert’s hand and told him it was okay.

I talked with the site manager and told her I was sure there would be more instances like this but hopefully, they would be few and far between.  I asked her to continue to keep me informed about behavior issues and we would work on them at home. She was grateful for our communication.

I too am grateful for the communication, as well as the care they are giving Robert, even on his difficult days.

Aside from the “off” day, Robert is coming home excited about his day and the various activities they have him doing.  So far, he has tried arts & crafts, a visit to the local park and a day of volunteer work.  All things he said he wanted to do. 

He is coming home telling Richard the names of the new people he met and as far as I can tell, he already has several friends. One morning when I dropped him off he greeted one of the clients by extending his hand to hers. More of a “holding hands” gesture than a handshake so I think he’s getting along with his new friends just fine.

There were bumps in the first week but overall, I think Robert is going to be just fine – if not downright excellent.

Changing Day Programs

Robert has gone to the same Easter Seals Day Program for the past three years and really enjoyed his time there. Not surprisingly, he made friends with other clients and found his way into the hearts of the staff. 

Robert walking into Easter Seals (2012)

Usually the transport van dropped Robert off at program but I would do so after any doctors’ appointments. When we arrived, I thought I had walked into a slightly different version of a Cheers episode.  Robert would walk in and everyone yelled, “Robert!”

Robert loved it there. 

During much of this time Robert lived at the care facility but the Day Program staff was terrific at keeping me informed of any changes in his health or problems they noticed. They followed protocol and kept the care facility apprised as well but knew that I was an involved caregiver so took the extra time to also communicate with me.

I loved having Robert there.

During the three years at the program, Robert’s health declined and living situation changed. They kept up with all of it.  They called to check on him whenever he was in the hospital. When he was at program, they kept him involved in activities, took him out in the community, treated him with respect and were amused by his jokes. The staff was caring and full of heart. 

A staff member even enlarged copies of word search puzzles to give to Robert – and created a binder we could keep them all in!

That’s how much Robert was loved there. 

This past year has been challenging. Robert’s needs increased to the point of needing a wheelchair.  Putting him into a wheelchair is something I have resisted for years but his case manager at program suggested in June that he use a wheelchair while at program and I agreed with her assessment. He needed it to keep him safe.

Unfortunately, Robert’s mood was also changing rapidly so the terrific staff at Day Program had to deal with Robert’s outbursts and demands. They had to deal with him refusing their help when he needed a change of clothes. They watched him go from a happy, engaged, “excellent” kind of guy to one who could fall asleep while eating lunch, not wanting to participate in activities and, when awake, arguing about sitting in a certain recliner.

Robert would have been happy to have every day be “recliner day” but the staff wanted him to continue to participate in activities and to share the one recliner that seemed to be everyone’s favorite.

During Robert’s most recent hospitalization, his case manager called me to check on him. She hoped he could somehow get back to usual, jovial self.  I kept her up to date on Robert’s condition and new diagnoses even when he was transferred to the Skilled Nursing Facility. 

After several weeks of therapy, Robert was ready to return home! I was anxious to see how he would do at home and slowly transitioned him to his regular routine.  He was discharged mid-week before Labor Day and I thought that gave him plenty of time to get used to being home. I planned to take him to Day Program on the following Tuesday.

After a change in medications as well as intensive physical therapy, Robert was able to use a walker. I thought it best if he used the walker during the short distances he walked around our house but wanted him to stay in the wheelchair during his time at Day Program – just in case. I notified Day Program that Robert would return but it was probably best for him to stay in his wheelchair.

Robert was excited about returning to program to see his friends again.

The Friday before Robert was to return program, I received a message telling me that since Robert would be using a wheelchair he couldn’t come to that Day Program any longer. Apparently, they were already full for non-ambulatory clients and Robert would have to be re-classified if he returned there.

NO! I was frustrated I wasn’t told this was even a possibility and was also panic-stricken: what was I to do with Robert during the day?  I needed to go to work!  

The case manager didn’t have any authority to change the decision so I immediately called the program director. The order had come from her so I knew the only way to resolve this was to talk with her directly.

I explained that Robert was doing so well that he could use his walker. I was just concerned about tripping and whether or not he could use it all day. She told me about their other program that has a lower staff to client ratio. She was going to check to see if they had availability for a non-ambulatory client.

In the meantime, she worked with me. 

We sent Robert back to program using a walker. He stood tall and walked in and was greeted with love and shouts of “Robert!”

He did great for three weeks.  Then he caught a cold and his brain couldn’t deal with both the cold and being able to walk.  His ability to walk fell off a cliff.  Again. 

Back in the wheelchair – there was no other option. Another call to the director is all it took to work out a transfer plan. He could be in the wheelchair at program until the transfer to the new program could take effect.

The transfer process started.  I contacted his Regional Center case worker and we made an appointment to tour the new facility.

Robert, Richard and I met with staff at the new program and were enthusiastically greeted by both staff and clients.  One even came up to Robert, put his hand on his shoulder and said, “You’re my buddy.” 

It was a relief to see staff members that Robert knew.  One woman worked at Robert’s former care facility and remembered him. Another spent time at his other Day Program so knew Robert. A client at the program is also a resident of the facility Robert goes to for respite.

It’s a small world and all of the familiarity and warm welcomes pushed away any doubts I had about the change. 

The transfer came through very quickly and within weeks Robert was having a goodbye party at his “old” Day Program. Robert will miss everyone but it is reassuring to know many of them will see Robert again and he will get to see his friends when the two programs have their combined parties.

I am grateful for the staff at the old Day Program for their love and heart in caring for Robert the past three years. I couldn’t have asked for better care and know that because Robert is going to a different Easter Seals program, he will be in good hands there as well. 

The next post will be about Robert’s first week at the new program!

I feel very fortunate that we found not only one but two wonderful programs but I wonder what others have experienced. Please share your experience with day programs in the comment section.  

Dreaming Big, Just for Fun . . .

What would you do with $640 million?

At 1 in 175.7 million, the odds of winning the lottery are ridiculously astronomical. (By comparison, the Institute of Medicine of the National Academies released their long-awaited “Epilepsy Across the Spectrum” report to the nation and estimates “approximately 1 in 26 people will develop epilepsy at some point in their lives”).

Ahh, but someone has to win the jackpot and because I lean toward optimistic with a healthy dose of delusional, I bought a lottery ticket (or 20).

Because I also like to be prepared, I’m planning what to do with that astounding amount of money.

After the initial “everyone gets a new car/house/boat” euphoria wears off, bills have been paid and college tuition has been set aside for future generations, it would be time to set up a non-profit or two.

I would love to open a facility (eventually going national) for the disabled where they could live and receive individualized levels of care. We would not try to fit everyone into the same plan – individuals need actual individualized plans. Everyone is unique and we will celebrate that!

There would be a bustling activities center onsite with a variety of activities to please anyone (run by my favorite Day Program director, of course).  I would definitely put Robert in charge of teaching the residents how to win at card games!

The Day Program would also be available for people to come just for the day, giving caregivers a break. Heck, we’ll even provide the transportation (it’s a dream so let’s dream big!).

We would provide the opportunity for respite visits for longer periods of time because caregivers need a chance to recharge in order to continue to stay healthy themselves and take care of their loved one.

The facility would err on the side of being overstaffed if needed so there would be enough staff to give full attention and exceptional care to the residents and guests. We would create a positive work environment in order to keep caregiver/employee burn-out at bay. (We would expect exceptional employees in return).

The facility would be both a compassionate employer and a top-ranked, sought after provider of care for the disabled.

Because friends and family have such a love of animals (which have been shown to provide positive emotional benefits to just about everyone whether disabled, elderly or not), the facility would be animal friendly!

The last piece of this dream is that since the state would get a windfall in tax revenue, I would make a request the tax money be used to help replenish the recent cuts made to social service programs.

Let's have some fun and fantasize about winning this huge jackpot.  What will you do with your winnings? We’re dreaming big – please share what you would do with your winnings!

Finding Comfort Even on the Bad Days

I don’t like hearing that Robert got in trouble (or is causing trouble) at his New Home or at Day Program. My first thought is “oh, crap, he’s going to get kicked out” which is a leftover reaction from when his previous care facility used an incident to try to evict him. (Never mind that Robert’s longtime girlfriend had just broken up with him and I had warned the facility he was going to act out. Which he did.)

The call this morning was from Day Program. The director calmly told me that Robert was having a rough day. She explained there is a client at the program who talks loud and incessantly, repeating the same thing over and over. She said it can be annoying to people. It was early in the day and clients were being rewarded with a breakfast (this would be Robert’s second breakfast of the day). Robert became agitated with the constant talking and yelled at the other client. He even used a few curse words while doing so. He wouldn’t stop doing it so the director took away Robert’s breakfast (it was a treat, after all, and he wasn’t behaving).

Taking food from Robert is never a good idea but I understand why it had to be done. There are consequences for bad behavior. (At least he wasn’t in the middle of eating Rocky Road ice cream – I cringe at the thought of what would have happened if he had that taken from him).

Taking breakfast away from Robert further upset him and he took a swing at the director (thankfully, missing).

Robert was having a very, very bad day.

The director calmly explained the story to me and said that he was now in a different room, participating in a different activity with a different group of people. She told me she wants me to know when these things happen and for me not to worry (obviously, she’s met me before and knows worry and I are best buds).

I told her I thought there might be a few things going on that contributed to him getting upset. For one, it’s raining. Robert does not like the rain. If one drop of water gets on him or his walker, it stops him in his tracks and he wants it dried off immediately. For some reason, water really causes him stress. I’ve provided him a rain coat with a hood but he still wants to use an umbrella (although I’m not sure how he manages to push his walker and carry his umbrella). I think one reason why Robert is hesitant to wash him hands is he doesn’t like them to be wet. Luckily, he doesn’t refuse to bathe so this is a manageable problem.

Another possibility for Robert’s crankiness is I told him earlier in the week that I would be out of town this weekend and he wouldn’t be able to come over to visit. I know he looks forward to his visits with us but this is an overdue Valentine’s Day trip with Hubby. This combined with the rain and the other client yelling (and whatever else may have happened at New Home this morning) was just too much for Robert. He acted out and got in trouble.

The director agreed that any of these possible reasons for the acting out (or combination of them) could cause Robert to have a bad day. She assured me this happens and they deal with this all the time. She told me not to worry and that Robert would be fine.

When the director and I finished talking, I spoke with Robert.

“How is your day, Rob?” (Other Brother and I are the only ones who get away with calling him Rob).

“They took my food.” (I saw that coming).

I put on my “mom” hat and explained to him that he can’t get extra treats when his behavior is not good. After I was certain he understood that he needed to behave, we started joking around and he was laughing and cracking a few jokes of his own. I told Robert to apologize to the director and give her a hug. He agreed he would be good and would tell her he was sorry.

After saying our goodbyes, I hung up then called to talk to the director again. She said Robert had a huge grin on his face and “was back.” She said she and Robert agreed to talk nice to one another and then she held out her hand to shake on it. He held out both hands to her and they clasped hands, agreeing to a better day.

Because of this kind of communication, because I know this incident will not get him kicked out of the program, I know I don’t have to worry.

Robert is definitely in good hands, even on his bad days.