Inside the O'Briens Reflection

Client OP Report - Joe O'Brien 4/20/2018

Client Report	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 recently diagnosed with Huntington’s Disease (HD). Symptoms are affecting his daily occupations. 2 of his 4 children are HD positive. The other 2 have yet to be tested. Grandson may be affected as well.
	Occupations in which the client is successful and barriers or potential barriers to his/her success in those occupations (p. S5)	Successful in: dressing, personal hygiene, self-feeding (with adaptations) Barriers: chorea, decreased coordination, irritability, difficulty thinking, depression
	Personal interests and values (p. S7)	Interests: Red Sox (baseball), spending time with family and friends Values: weekly family dinners, providing for his family
	The client’s occupational history/life experiences	Former Boston Police officer. Lives on first story of three story house shared with wife, two daughters, two sons, one daughter in law, and grandson. Mother died of HD when he was young. Work/home duties: none due to HD symptoms. Would like to remodel home to make more room for family activities.
	Performance patterns (routines, habits, & rituals) – what are the client’s patterns of engagement in occupations and how have they changed over time? What are the client’s daily life roles? Note patterns that support and hinder occupational performance. (p. S8)	Roles: husband, father, police officer (former), Red Sox fan, member of Boston’s Irish community Routines: Wakes up, watches sports TV, drinks beer, eats dinner with family Habits: Walks dog Yaz daily
Context	Aspects of the client’s environments or contexts, as viewed by the client (p. S28)	Supports to Occupational Engagement:	Barriers to Occupational Engagement:
	Physical	First floor bedroom eliminates barrier of stairs	Uneven cobblestones and stairs for walking around town
	Social	Two best friends from the police force	N/A
	Cultural	Sees children often (live on upper stories of home)	Spending time in a bar often encourages over-indulging
	Personal	Middle-age man. Used to physical activity from police force.	Shame, depression, and stress from recent diagnosis and the effects on his children.
	Temporal	N/A	Schedule is now non-consistent since retirement. Increased time required to complete tasks.
	Virtual	Cell phone allows easy communication with family when they are not around.	N/A
Client Goals Context	Client’s priorities and desired target outcomes (consider occupational performance – improvement and enhancement, prevention, participation, role competence, health & wellness, quality of life, well-being, and/or occupational justice) (p. S34)	Be able to walk up/down stairs in neighborhood without falling. Assist wife with household duties without destroying objects/hurting himself. Hold grandson without fear of dropping/hurting him.

As expected, the book Inside the O’Briens is very sad. To read a first-hand account of how a condition such as Huntington’s Disease (HD) can affect not only the individual diagnosed, but the family unit, is horrible. I enjoyed Lisa Genova’s writing very much! I thought she did a great job expressing both Joe and Katie’s perspective and made it a very enjoyable read. I am also glad she wrote this book because hopefully it will help spread awareness about HD and how it develops and manifests itself.

The one thing I did not like about the story is that we do not find out whether or not Katie has the genetic marker for HD. I am glad she has decided to move to Portland and not let HD hold her hostage within her own mind, but I do wish we could have found out what her results said. I also am left wondering if JJ’s son, Patrick, and Patrick’s (unborn) child will develop HD. Although I appreciate some things being left to the reader’s imagination, for my own personal curiosity, I wish there had been some sort of epilogue to answer those questions.

I believe the underlying purpose of the book (besides providing awareness of HD) is to get the reader to ponder whether he/she would get the genetic test in order to find out if he/she is HD positive or negative. While I understand both sides, as conveyed through the children and their differing opinions, I personally think I would have the genetic test done. While I would be slightly concerned that, should I be HD positive, I would “see” signs in myself very early, I think I would want to plan my life accordingly. I would want to know if having a child would be affected by HD, much like JJ and Patrick are wondering. Unlike JJ and Colleen, if I found out that I was HD positive after my child was conceived or born, I would want to get them tested as well. That way, the child can become aware and, when at later age, he/she can plan his/her future accordingly as well.

I would strongly recommend this book to anyone interested in health care, neuroscience, and/or psychology. After reading this book, I plan to explore others written by Lisa Genova.