Inside the O'Briens

Eryn Lobo

Client: Joe O’Brien

DOB: 44-45 years old

Date: April 17, 2018

Occupational Profile

	Reason the client is seeking OT services and concerns related to engagement in occupations (may include the client’s general health status)	Joe is seeking OT services because he wants to keep his job as a policeman, manage his chorea, contain his emotional outbursts, manage his depression stemming from his diagnosis with Huntington’s Disease, and because of a general decline in his wellbeing. Joe has a diagnosis of HD and has only told two of his colleagues. He wants to be able to manage his symptoms in order to keep his job. He experiences being in perpetual motion due to chorea, loss of balance, reduced dexterity, and in his late stages slurring his words. Joe is suicidal and upset about his children JJ and Meghan inheriting the gene from him and worried that his other children Katie and Patrick might have it. He wants to be able to manage emotional outbursts, especially around his family and keep his anger in check.
	Occupations in which the client is successful and barriers or potential barriers to his/her success in those occupations (p. S5)	Joe is a successful policeman but his HD is preventing his time management and motor skills at work. He is a great father but he is experiencing extreme mood swings and scaring his family as well as experiencing major depression. He loves to run but has almost fallen down a flight of stairs before and wants help staying safe.
	Personal interests and values (p. S7)	Joe is a true Bostonian and has pride being an Irish ‘townie’ in his neighborhood. He is an avid Red Sox fan and played baseball in his youth. He loves his family and enjoys going to yoga classes that his daughter Katie instructs as well as his daughter Meghan’s dance recitals.
	The client’s occupational history/life experiences	Joe lives in a small neighborhood in Boston called Charleston. He lives in a triple decker with his wife, Rosie, and son Patrick. Patrick usually does not stay in the house and is away most of the time. His daughters Katie and Meghan live above Joe and Rosie’s story of the triple decker. There are stairs that lead up to the second and third floor units. His living room is filled with figurines that could easily be knocked over. He has a dog named Yaz. He has a diagnosis of HD that has debilitated him significantly. His best friends Tommy and Donny have been significant parts of his life and work with him as police officers. His wife Rosie is a homemaker and would likely take care of him when his diagnosis worsens. He had his first child at eighteen and now has four children total. Joe’s duties include walking his dog Yaz and performing his job as a police officer effectively. He struggles doing this due to chorea and forgetfulness and worries about providing for his family. He also has to attend a family supper every Sunday. He wants to contain his emotional outbursts, especially while there. He was forced to ‘divorce’ his wife so that she would not lose all of his money due to his diagnosis and early retirement.
	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)	Joe has had the role of father, husband, and police officer. He walks his dog every day. He wakes up and takes a shower and gets dressed each morning. He leaves for work around 7:05 a.m. everyday. He has many duties associated with being  a police officer such as documentation, cross walk guard, and active participation in arrests. He then goes home and spends time with his wife Rosie. After his diagnosis of HD, he had to quit his job and rely on his wife Rosie. He now struggles running and performing motor movements. He used to thoroughly enjoy is family Sunday dinners but because of his emotional outbursts they have become strained.
	Aspects of the client’s environments or contexts, as viewed by the client (p. S28)	Supports to Occupational Engagement:	Barriers to Occupational Engagement:
	Physical	Joe’s house is close to the Fourty Flights stairway that he exercises on everyday.	Joe has a three story house and in his late stages may not be able to climb his stairs.
	Social	Joe has an attentive wife and loving children. His wife would take care of him in his late stages. His two best friends are supportive and look out for him. His daughter in law is a PT and knows about the disease.	Some friends accuse Joe of being drunk because of his chorea. His mother died of complications due to HD so this upsets him. His son Patrick is suspected of being an alcoholic.
	Cultural	Joe is a townie in his Boston neighborhood. He values being Irish and coming from a Catholic family.	Joe’s town is divided between the ‘townies’ and ‘toonies’ and they usually do not intermingle.
	Personal	Joe is a 44-45 year old man who tries to stay active.	Joe turns to drinking because of his depression.
	Temporal	Joe wants to spend his remaining time teaching his family members to live and die with Huntington’s in a graceful way.	Joe is worried about the time left he has with his family.
	Virtual	Joe tried to educate his town on HD by presumably using a computer to create shirts about it.	Joe is slow on the computer he uses to file his police reports.
	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)	Joe hopes to improve his gross motor functioning and lessen some of his chorea as a result of OT. He wants to prevent worsening of his condition and wants to work on balance and preventing word slurring. He wants help managing his depression and coping with his diagnosis. He also wants to keep his emotional outbursts in check.

I really enjoyed Inside the O'Briens. Although the story is heart wrenching, it had a good plot that kept me entertained. The story starts out as a 'flashback', with Joe O'Brien filled with rage at his family and a look in his eyes that reminded him of his mother. Later in the story we find out that his mother died of HD before it was a commonly known diagnosis. Emotional outbursts can be the first sign of HD so it was not surprising that Joe experienced this before any other symptom. I was intrigued by Joe's relationship with his daughter Katie. Katie is a free spirited yoga instructor who is afraid that her parents will not approve of her black, non-Irish and Catholic boyfriend Felix. She experiences feelings that no one could ever love her because of Huntington's in her gene pool and is afraid to move to Portland with Felix because she does not want to put her possible diagnosis on him as well. It takes her a long time to tell him about HD in her family and he is very supportive of her, yet she is still hesitant. She reaches a breaking point when two of her siblings are diagnosed, Patrick and then her sister Meghan. She writes the gene sequence CAG on her walls and comes home to find that her family painted over them. This gives her courage and she eventually returns to get her genetic testing results from her doctor. She had previously gone to her mandatory appointments to get the testing done but was hesitant to get her results. The story ends with her in the waiting room and does not disclose if she was gene positive or negative. One of my favorite parts in the story was when Katie gave Joe yoga lessons. It was a positive bonding experience for both of them and I think it helped both of them come to terms with how they could still do activities they enjoy with their diagnosis. I felt especially bad for Rosie during the story knowing that her husband had HD and she was watching his decline knowing that would happen to at least two of her children. The relationship the family had with Patrick was interesting because he was an alcoholic and not at home a lot of the time. It seemed like he might have the beginning stages of juvenile Huntington's and was acting out in his emotional stages. When Joe was at PT with his therapist, I was interested in the book's depiction of his therapy for slurring of words. She had him stick his tongue out and in and move it to the right and left. She then gave him a lollipop to hold in his mouth and pulled it towards her while she gave him instructions not to let her pull it out. This sounds like an intervention that an OT could perform as well. I enjoyed learning about the O'Brien family and getting an in depth picture into their life living with Huntington's Disease.