As I was introducing myself to a white haired Korean grandmother in a wheel chair in the corridor of the hospital, she smiled at me, showing her toothless gum. "So, they send you to see me. They finally answered me. It’s good that you came to see me."
She then extended her tiny wrinkled hand and grabbed mine. It seemed like her small body frame would sink in the chair if I didn’t pull her out.
Recently, I visited a skilled nursing facility to meet this Korean American woman who was referred by a social worker of the facility.
The social worker was frank in explaining the situation involving Mrs. Kim.
"Our staff has no idea what to do with her," she said. "She hits staff members and other patients. She pushes paper stacks on the counter, and then, she laughs at the staff. She was doing that intentionally. Really, she has been creating an unsafe, disruptive environment for herself as well as others. We are considering medication as a last resort."
Mrs. Kim is 92 years old although she claims, "I am one hundred plus nine years old". She was born in Kaesung, and lived in Seoul for a long time prior to coming to the United States. But on the day I visited her, she said, "I live in Seoul; this is Seoul, and I am getting ready to go back to my home town, Kaesung." She had no recollection of coming to America.
While we were talking, a lunch tray was brought to her. I tried to cut the deep fried meat patty with thick gravy on her plate. But, she stopped my hands.
"I like to do things by myself," she said. "Don’t help me. I don’t eat this stuff anyway because it gives me diarrhea." She quietly spoke to me, pointing to the meat patty and onion rings. Without hesitation, she shared her reason for not eating much of anything.
Looking at me with a puzzled expression, she moved her index finger, beckoning me to come close to her. Although at times she needed me to speak up a little, Mrs. Kim was able to communicate quite well and have her needs met without any difficulty. She was cute, wise and she surprised me when she said, "When you becomes older than 80 years, you lose hearing and vision. Those problems come with age."
Mrs. Kim brought up the issue of "hitting others" before I even asked her. With that, her delusional story began.
"Look at those people," she said. "Do you see them sleeping? That’s bad, a bad thing to do. This is a temple, and we are inside the temple. Sleeping inside the temple is disrespectful to Buddha. So I hit them to wake them up. So that they would listen instead of sleeping."
Although she is suffering from dementia and delusional thoughts, she gave a clear, understandable reason for hitting others. It was a reasonable thing to do in her little world.
Interestingly, Mrs. Kim did not complain about the noise around her. I wondered why the sleeping peers, the ones with closed eyes, bothered her. Living in a strange place with unfamiliar people, Mrs. Kim may have closed her ears to sounds to and words that were not meaningful to her.
Although she lost all time reference, she was alert enough to carry on a conversation without thought blocking. Like a quietly running stream, she went on and on talking about her children and her native place. "I am getting ready to go back there," she said. "Maybe next year."
One can feel lonely in the presence of others, as one can be happy in solitude. People experience home sickness especially when there is no social integration or meaningful connection with others. Mrs. Kim’s physical needs are being met in that facility, but perhaps not her emotional and psychological needs. Relationships are among the most basic of human needs. When this need is inhibited for any reason, the resulting emotional distress can contribute to an unhappy state and produce negative actions.
Like an old Korean saying says, "a neighbor is a cousin," normally, physical proximity promotes friendship and affinity. This proximity principle, however, includes interaction with one another. If there is no word exchange or overt interaction, a neighbor will be a stranger no matter how physically close he or she is. For Mrs. Kim, everyone around her can be a stranger.
We all need people with whom we can talk to about daily happenings. In addition, much of our self-concepts depend on others’ response to us. Through this kind of process, we build our relationships, which is an important source of stability for individuals. Well-established relationships lend us some order to our lives, and they are essential to our well being.
Away, far away from her native country and family home, Mrs. Kim seems to be in a great need of a sense of connectedness with people in the skilled nursing facility. Yet, Mrs. Kim drives people away from her with her destructive behavior, conveying an opposite message. Indeed, she is destroying relationships instead of developing them.
Hitting others may well be Mrs. Kim’s attempt to be connected with them in some way. She gets attention that contains a sense of excitement, an important element of being alive. She may confer with a sense of power and control over her anxiety, that may stem from her loneliness and home sickness that otherwise she may be unable to express. She wants people around her to be awake and to have spiritual experiences with her. I think awakening others expresses her wish to awaken herself.
I wonder what "sleeping" really means to her. Could it be non-living to Mrs. Kim?

Dr. Beatrice Sool Choi is a registered psychologist at the Richmond Area Multi Services (RAMS) in San Francisco. She can be reached at (415) 668-5955 ex. 39
or RAMS
3626 Balboa Street, San Francisco, CA 94121.