Inside the O'Briens -- Occupational Profile and Reflection

        I genuinely enjoyed "Inside the O'Briens." I am not someone who reads in her leisure time, but this book may have changed that for me. I began this book thinking that I would be dragging myself along to read it, but it was just the opposite. As this book followed Joe O'Brien and his family, I felt like I was in this journey alongside them.

        As Joe displayed various signs and symptoms (falling, losing balance, anger outbursts) and blamed his knee problems, you could feel the denial. He was a father, a police officer, a husband. He couldn't be sick. He had a full life ahead with a loving family. It is a father's true reaction to those situations. He played off the symptoms until a true friend was concerned enough that he had his wife contact Rosie. Rosie, being a concerned and loving wife, confronts Joe about these situations. As he realizes that he actually sounds as if he has been drinking, he finally agrees to see a doctor (even though he doesn't like doctors) to please his wife. Although, his gene-positive results for HD took a horrible turn.

        This book does an amazing job of making you feel what the family is feeling. My heart broke for Joe at the doctor's office, my heart broke for Colleen after being told about Joe's HD, my heart broke for JJ and Meghan when they tested gene-positive. However, my heart grew tremendously when JJ and Joe shared cigars after the birth of JJ's son and Joe thinks about the amazing amount of love he has for this grandchild. Not only that, but the amount of love that JJ will experience when he has this moment with his grandchild. (Ugh... my heart strings!)

        I felt a strange sense of paranoia as the story shifted it's focus to Katie as she decides whether or not she wants to be tested. I was so set in my train of thought telling myself, "Why in the world won't she just get tested?!" However, as Katie talks more about her struggle I slowly changed my point of view. This book somewhat put me in Katie's shoes. It showed me the paranoia of movements that could be harmless, thoughts that could be completely normal, but when you think about your chance of developing a cruel, fatal disease, that all changes.

        Not only is Katie facing the decision of finding out, she is facing the decision of telling Felix that she has it. Would he want to leave her? Would he still want to move away with her? What if she wants children, would he understand? So many thoughts raced through my mind as the book followed Katie.

        In short, I have never been so bothered by the ending of a book—or lack thereof. The book follows Katie as she worries about her possible diagnosis, especially after JJ and Meghan tested gene-positive for HD, and finally goes to get her results and then… we never know! She almost acts as if she wants to be diagnosed with it to confirm all of her assumptions, like having it because she looks like her grandmother or her being “unlovable.” My heart wants to believe that she is negative because her doctor before seeing Eric assured her that her movements were normal. I need confirmation! However, I see both sides of her decision. She would have to tell Felix about her diagnosis, possibly causing him to leave her, as well as dealing with the fact that she will suffer from this cruel, unforgiving disease. However, she went through all of the testing, worries herself sick, even watches the doctor fill out a full pedigree, and then nothing! I also feel like the doctor emphasized the outcomes of being gene-positive immensely compared to the one statement about how she would be relieved if she tested negative. That is understandable because I know the point of the evaluation is to ensure that the person can handle knowing how and approximately when they could die. As much as I hope the future film of this movie will alter the ending and provide an answer, I have a gut feeling that it won’t. Something inside me says that Lisa Genova left the last words in the book, "I am," as a hint.

Therapist: Alli Hayes, MOT/S                                             Date of Evaluation: April 18, 2018

Client: Joe O’Brien

Age: 44 y/o

	Reason the client is seeking OT services and concerns related to engagement in occupations (may include the client’s general health status)	Client has been diagnosed with Huntingdon’s Disease. Client aspires to manage his coordination difficulties due to the interference with work. He displays decreased spatial awareness, causing him to fall while walking up/down stairs. He struggles walking his dog in the morning due to fatigue and previously mentioned incoordination. His wife reports that he has impaired executive function, impaired attention, and irritability/anger outbursts. She describes him having decreased manual dexterity, causing him to often drop/break cups and other dinnerware as well as making him struggle to button his shirts. Chorea, dystonia interferes with his ability to participate and successfully complete drills at work.
	Occupations in which the client is successful and barriers or potential barriers to his/her success in those occupations (p. S5)	Dressing (without buttons) Sleeping Self-care tasks Talking to family and friends Barriers: chorea causes him to drop things throughout things throughout the day, memory problems interfere with communication
	Personal interests and values (p. S7)	Time with family, RedSox baseball, walking his wife’s dog, values hard work and his career, being independent
	The client’s occupational history/life experiences	Boston police officer, lives in a three story home on the first floor with his wife and his children live upstairs. He has lived locally in Boston for most of his life. He recently found out his diagnosis of HD, but wasn’t aware that he was at risk for it because he was told his mother passed from a drinking problem.
	Performance patterns	ROLES: Father of 4 children, husband, son, landlord, police officer of 25 years, RedSox baseball fan, hard worker DAILY ROUTINE: Morning/Midday – early morning walks with his wife’s dog, gets ready for work, interacts with family at breakfast, drives to work, patrols town/works 8-10 hours/day Evening – files necessary reports towards end of shift, driven home, finds parking spot, “unwinds” by watching TV or reading the newspaper, eats dinner with family. *eats dinner with entire family every Sunday CHANGES: Doesn’t fill family’s drinking glasses at dinner due to decreased manual dexterity
		Supports to Occupational Engagement:	Barriers to Occupational Engagement:
	Physical	- sits inside patrol car for most of his day - lives on the first floor of his home - takes walks to clear his head - is seeing PT for balance and coordination	- Must travel upstairs occasionally - Parking is inconvenient, making him have to park far from his home and travel up a hill - balance and coordination interferes with his walks - is not fond of doctors
	Social	- Occasionally goes to a bar to socialize with friends after work and relax - Has a loving and supporting family; family is a positive distraction from stress	- Very conscious of his drinking because his mother was known for being a drunk - He doesn’t want to burden family with his complications or concerns; feels guilt because his son, JJ, tested positive for HD
	Cultural	- Identifies prayers as support for coping with HD	- son is blaming God for giving his father HD
	Personal	- 44 y/o male - enjoys his set daily routine - his daughter in law is a PT and can discuss HD concerns with him	- Has had to alter his daily routine due to HD symptoms
	Temporal	- His wife reports more successful completion of tasks in the morning	- Increased pain/fatigue can impact his routine when he gets home.
	Virtual	- Researches HD to inform himself of his condition	- Sometimes gets discouraged when reading research or stories about HD
	Client’s priorities and desired target outcomes	Client wants to be able to take walks with his wife’s dog without falling or losing his balance, document at work without attention straying, and have dinner with his family without any accidents.