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This site is for student nurses or nurses starting out. Letters to a Young Nurse are blog posts written like letters to help you find your way and make your journey as a nurse less difficult. 


A Privilege to Serve

Updated: Jul 19, 2023

A few years ago, in between jobs, I took a job as a private duty nurse in a patient's home while I was pursuing further schooling. The job entailed caring for adults that had the developmental minds of children due to severe and debilitating injuries as infants and children. One of these patients had extensive anoxia at birth and cystic fibrosis. This meant that he was deprived of essential oxygen during his birth and had birth defects because of it. Scotty, age 19, only weighed 60 pounds, was blind and had the worse lung function of any patient I have taken care of in my many years of nursing. Listening to his lungs was like listening to 2 pieces of sandpaper being rubbed together. I don't know how he lived as long as he did with such horrible lung function. He lived with his GREAT-GREAT grandmother (I'll call her GG for short). GG had her own medical problems, but she took phenomenal care of her boy. Scott's lung function was deteriorating quickly which put him in and out of the hospital 15 times in the last 2 years. When I started taking care of him his medical condition was so severe that he had been placed in Hospice to give him comfort and ease his pain in his last few months. His doctors couldn't offer any further treatments apart from giving him a tracheostomy and putting him on a ventilator which GG adamantly refused to have done, EVER! I sat in a chair every evening during the week watching Caillou and the Muppets with him as he hung on to life.

After approximately 6 weeks I went to work and noticed that Scott was not responding as he usually did. He didn't talk but did laugh and move his head to songs on the TV. He wasn't doing that on this particular night and I watched him more than usual. At first, I thought that he was exhausted from his outing to the doctor's office that morning. But something wasn't right related to his vital signs. The level of oxygen in his body began to drop as evidenced by his oxygen saturation monitor kept alarming. It started to drop below 90%, then below 85% and 80%. I tried turning up his oxygen level that he was getting through his nasal cannula, but this was not helping. You cannot turn up the oxygen level higher than 6 liters per minute when a patient has a nasal cannula on. In order to turn it higher and get the oxygen he needed into his blood stream I would need to get a mask. But GG was never told to get one and none of the other nurses had brought one. I called the Hospice nurse for her help. Within 30 minutes more oxygen and an appropriate mask had been delivered to Scotty’s home. The mask and increased oxygen level helped him to be less restless, but I had this undeniable feeling that Scotty was on his way out of this world. and increasing his oxygen didn't make any difference. When I could no longer keep his oxygen saturation above 94% with all of the different interventions (nebulizer treatments, vest percussions, inhalers, etc) I realized that it was time to get the Hospice nurse out to the house. Telling GG that I was going to call Hospice was a painful experience. The look of fear in her eyes brought me to tears and broke my heart. But Scotty was on his way out of this world and I knew she had to get the rest of her family to the house quickly. Before the Hospice nurse arrived, Scotty did stop breathing for a brief second but then came back. GG came very close to calling 911 but deep down she knew that it would do more harm than good to call the ambulance. She had been in the hospital with him enough to know that tubes coming out of every orifice was not going to save Scotty's life. It might buy him a few days but who was she trying to save, him or her? Thank God she listened to reason and was able to hold on until the Hospice RN arrived.

The minute the Hospice nurse walked into Scotty's room she knew he wasn't going to make it through the night. Thank God for her because she helped calm GG down and focus her attention on getting things done. GG wanted a priest to administer last rites and she also needed help calling her extended family to Scotty's bedside. I felt guilty leaving at the end of my shift, but I had to get up very early to attend a morning class. As I left I knew I would never be back in that home again. Scotty died in the early morning hours peacefully and without pain. He was surrounded by friends and family and because of that Hospice nurse Scotty slipped peacefully and painlessly into whatever comes next. GG gave him a beautiful funeral. On previous occasions we had spoken about how he would run and dance and sing in heaven when he died. I think that brought her great peace when she looked at him confined to that bed in the spare room. I have seen families agree to a DNR and Hospice only to change their minds when the patient was declining quickly. I have watched as patients find that last "burst of energy" before death which totally confuses loved ones. Many of these Hospice patients died in the hospital after being "dis-enrolled" from Hospice. I am so grateful that GG listened to her inner voice and allowed her great-great grandson to die peacefully in the only home he ever knew and loved.

Although I only knew Scotty for a very short period of time my heart connected to him in a way that, to this day, I cannot explain. He never spoke to me, never had a conversation, never told me what he loved or wanted out of life. He never ate a piece of chocolate or an ice cream cone. He never threw a baseball or swam in the ocean or rode a bicycle. But he loved listening to Caillou and loved the sound of GG's voice when she talked to him in that sing-song way. Recently I heard a Hospice Chaplain say that her job is to lean in, to listen to people in their weakest moments. And that is what is so special about being a nurse, I get to lean in during their very last moments on the Earth. What a privilege that is even if it brings me to tears and breaks my heart. Learning how to be present in the smallest moments is one of the toughest tasks you will learn as a new nurse. Be patient and know that your heart will guide you there when you realize that is is a privilege to serve others.

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