Love and Grief in the Time of Coronavirus

Marcia Dupree never imagined the two greatest crises of her life would occur simultaneously.

For two months starting in late February 2020, her husband, David, was at a local hospital being treated for multiple complications arising from gastrointestinal bleeding from diverticulitis. Every other day, Dupree, 75, would drive an hour to the hospital to help fill an external infusion pump with treprostinil, better known as Remodulin, to increase blood flow through her husband’s lungs, which were damaged from the pulmonary arterial hypertension he’d developed six years before. “Administering his medication was very complex,” says Dupree of the multistep procedure.

But just when her husband was ready to be discharged, he tested positive for COVID-19. The nurses put Dupree in personal protective equipment before allowing her to see her husband and tell him the bad news.

“As soon as he heard, David said, ‘This is it,’” recalls Dupree. “He felt that COVID-19 was an automatic death sentence, especially after the medical ordeal he’d just been through. Nurses whisked him to an isolation ward so fast that all I could do was shout ‘I love you’ as the elevator doors closed.”

Two days later, Dupree’s husband of nearly 53 years was dead. In less than a week, Dupree would also test positive for COVID-19.

“My mom wasn’t eating or drinking and she slept a lot, but she was also mourning the death of her husband,” recalls DJ, Dupree’s son, with whom she now lives near Smith Mountain Lake, Virginia. But when she became too weak to stand, DJ called an ambulance to take Dupree to Carilion Roanoke Memorial Hospital. In the Emergency Department, Dupree, whose oxygen saturation level was normal, received a COVID-19 test, was treated for dehydration and exhaustion, and was released.

The next day Dupree learned she’d tested positive for COVID-19 and on May 4, five days later, she was admitted to a COVID-19 unit at Roanoke Memorial with a high fever, profound weakness, and difficulty breathing. Thus began Dupree’s three-week hospitalization for COVID-19, including 14 days in the intensive care unit.

“I was totally numb; I thought, I can’t lose her, too,” recalls DJ when his mother was admitted to the hospital. DJ also worried that his own symptoms of exhaustion and feeling winded were harbingers of COVID-19, but his test results were negative. And with international flights severely restricted, Dupree’s daughter, Diane, who lives in Ireland, had to remain thousands of miles away from her critically ill mother.

When infectious diseases specialist Ekta Bansal, M.D., saw Dupree on May 7, she privately worried that Dupree, who had severe respiratory failure and pneumonia in both lungs, might not survive.

“She looked so sick and she required a considerable amount of high-flow oxygen—up to 80 percent—in order to breathe,” says Dr. Bansal. Dupree’s age, coupled with her diabetes and hypertension, made her particularly vulnerable to severe illness.

“In early May, we didn’t have any specific therapies for COVID-19,” says Dr. Bansal. “We were still learning about the virus and could primarily offer only supportive care to treat symptoms.”

A day later, Dupree was transferred to the ICU. “Patients on high-flow oxygen can deteriorate quickly and require mechanical ventilation,” says Dr. Bansal. “Marcia was nearly at the threshold for intubation.”

Dupree was too weak to talk with her son over FaceTime, but physicians called DJ daily with updates about his mother. “I was pretty oblivious to what was going on around me initially,” says Dupree, “because I was so sick.”

Dupree received a transfusion of convalescent plasma. At the time, Roanoke Memorial was participating in the National Expanded Access Program for Convalescent Plasma, which was sponsored by the U.S. Food and Drug Administration and led by Mayo Clinic. Across the country, more than 35,000 hospitalized patients critically ill with COVID-19 were given plasma rich with antibodies from people who had already recovered from the virus.

Convalescent plasma has been used to treat infectious diseases for more than a century; many hoped that a treatment of antibodies from recovered patients might prevent progression of COVID-19 in those struggling to fight the virus on their own.

In May, Dupree became Roanoke Memorial’s first patient to receive the then investigational therapy for COVID-19. She felt results within 24 hours of receiving the infusion.

“My breathing became easier and I felt much better,” she says. “On day two I felt better still. That’s when I thought I would survive this.”

DJ also heard the difference in his mother’s voice. “She sounded stronger and had more pep during our conversation,” he says. “I was happy her physicians were trying experimental treatments like convalescent plasma.”

Dupree received one unit of convalescent plasma per the study’s protocol. Although the Mayo study was not a randomized, placebo-controlled trial,Dr. Bansal thought it was worth a try based on early, preliminary data.

“She required less oxygen after the infusion and her inflammatory markers showed improvement,” Dr. Bansal says. “While more recent trials have shown that convalescent plasma doesn’t benefit all patients, and other treatments such as monoclonal antibodies have since become available, we were very pleased with the progress she made after the infusion and other treatments we used.”

Dupree also received systemic corticosteroids for three days based on early observational studies that suggested improvement from short courses of steroids, as they temper the host immune response and decrease lung inflammation.

In addition, Dupree received therapeutic anticoagulation therapy, since she had elevated levels of D-dimer, a marker for blood clots, which are a risk for people with COVID-19. Elevated D-dimer levels have been found to correlate with severe disease and worse outcomes. Dupree also practiced self-proning—a method of lying on one side alternating with lying face down—in an effort to improve her oxygenation.

It wasn’t until Dupree left the ICU on May 19 and was back on a COVID-19 floor that she realized how sick she’d been.

“My vision was blurry,” she says. “I couldn’t write or feed myself well because my hand would shake, and I was so weak I couldn’t stand or get out of bed.”

But Dupree, a Michigan native, has retained her Midwestern grit and fortitude in the face of adversity. “There’s no sense in being miserable,” says Dupree, who spent 34 years as an elementary school art teacher in Michigan and Delaware, instructing as many as 1,100 students each week. “There are so many things in life to be happy about, or at least you can be content.”

Despite grieving her husband’s death and coping with the challenging effects of COVID-19, Dupree found comfort in a cardinal that repeatedly flew to her hospital window.

“I’ve long heard stories that cardinals are messengers sent from above to remind you of a loved one who has died,” she says. “I’ve no idea if that’s true, but looking for that cardinal every day gave me strength, and I felt my husband’s presence when I saw it.”

Her doctor won’t soon forget Dupree’s positive spirit and determination.

“From day one, she was a warrior and never gave up,” Dr. Bansal says. “She knew her situation was critical, but she said she would deal with whatever came her way. She had faith that she would make it, and she did.”

After leaving the hospital in late May, Dupree has been recovering at her apartment within DJ’s Virginia home. The fatigue she felt when she first returned home is easing, and her strength is slowly returning, though she finds her short-term memory is still impaired.

“I forget the simplest things, and I can’t add numbers in my head the way I used to,” she says. “My son has to remind me to do things.”

Over the summer, mother and son drove from Virginia to Michigan and back multiple times, hauling a trailer filled with three generations of antiques and family heirlooms as Dupree prepared to put her Michigan home of 16 years on the market.

“It’s in an isolated wooded area, and I wouldn’t be able to enjoy the house without David in it,” says Dupree. In time, she says, she will return to painting, sculpting, and designing clothes for herself. Dupree and DJ also plan to adopt two rescue greyhounds.

When Dupree reflects on her ordeal with COVID-19, it’s not without humor. She laughs when she relates how a physical therapist and an occupational therapist—both men—improvised a hair band from a surgical glove and worked together to tame her unruly hair before helping her walk.

“Everyone I met at the hospital was not only caring, but also kind,” says Dupree. “My doctors were so knowledgeable and I felt like I was treated as a family member.”

Story by Anita Slomski