COVID Chronicles: An ICU Nurse with an Underlying Health Condition

Nurse Arista Lee Dupuis is on the front line of coronavirus care at Miriam Hospital in Providence.
Arista

Nurse Arista Lee Dupuis

Arista Lee Dupuis must be one of the best nurses out there. I speak, not from patient experience, but as someone who watched her smile through myriad miseries during our time together as Lincoln High School cheerleaders nearly fifteen years ago. Her buoyancy is an innate and powerful gift — one that’s never been more valuable.

Last week, Arista and I caught up to discuss her work in the intensive care unit at Miriam Hospital in Providence, where she treats Rhode Island’s sickest coronavirus patients. During our conversation, Arista was cleaning her house, which she shares with her husband, Corey, and twin sister Arielle, also a nurse (and an LHS cheerleading alum, too). Both Arista and Arielle have a rare genetic condition that causes dangerous swelling in appendages and airways; flares are triggered in innumerable ways, including viral infections like the coronavirus.

In our conversation below, Arista shares what it’s like working at ground zero in the state’s battle against COVID-19, from the moment she dons her personal protective equipment (PPE) to the time she takes it off — the riskiest point for health care providers. Our conversation has been edited and condensed for clarity.

Rhode Island Monthly: When was the first time you encountered a COVID patient?
Arista Lee Dupuis: About a month ago when it all started, the ICU was taking any COVID patients that were on high-flow oxygen, so anything greater than six liters per minute of oxygen.

RIM: Did anything surprise you about COVID-19?
ALD: The COVID is so different than other viruses because of how contagious it is, so it was interesting to see how different we are treating the patients. We’re double-gloving, donning-off PPE in the room, etc. There is a whole process with PPE and how to place and remove it. The greatest likelihood of getting contaminated is during the PPE donning-off stage, and that’s why it’s so different than other viruses.

RIM: Can you explain how you use PPE to ensure your safety?
ALD: To properly place it, you use Purell or clean your hands, apply a gown, then your N95 [for aerosolizing procedures] or surgical mask, face shield, then two pairs of gloves — you don’t have to put on two pairs but most nurses do — and then go into the room.
After you are done with patient care you have to remove the first pair of gloves, and if you only had on one pair, then you use hand sanitizer and apply a new pair. Then you remove the strings from the gown — best practice is to have a buddy remove the ties, but honestly everyone is so busy it’s hard to have a buddy at the time you need it — so with a new set of gloves or the underlying first pair of gloves you untie the gown. There is a certain way to remove it. You have pull at the chest so it falls off your shoulder and roll it into a ball, and dispose of it in the dirty linen; we ran out of disposable gowns. Then you remove pair one of gloves and hand sanitize before you leave the room.
Then when you are outside the room, you either hand sanitize again, and apply new gloves to remove your face shield, cleanse it with a PDI wipe [a commercial-grade germicidal wipe], and then remove gloves, sanitize and then remove the N95. You have to let your face shield dwell — let the PDI wipe cleaner do its work for at least two minutes. These are the wipes that were in the news that Lifespan is running on short supply.
It’s tasking and long, and it can be really hot in those rooms. All patients ideally should be in a negative-pressure room, but if it isn’t possible then we have HEPA filters in the room that helps clean/filter the air.

RIM: How often are you reusing your N95?
ALD: For forty-eight hours, or two workdays, and then it is sterilized [in an autoclaving machine]. We have to keep our N95 and face shields in a brown bag with our name on it to keep with us. I also use eye shields and a hair covering to cut down the chance of transmission and change before I go home.

RIM: Do you feel confident in this procedure? Are you getting tested at all?
ALD: We have a hotline to call if we have symptoms. I have not had any symptoms or reason to believe I have the virus.

RIM: You have a rare disease, hereditary angioedema [HAE]. Could you tell us about HAE, and if you are considered immunocompromised?
ALD: HAE is a rare swelling disorder that can be deadly secondary to laryngeal edema, where you asphyxiate. I am not considered immunocompromised because I am not on immunosuppressants. But if I did get the virus, I would be sicker and it would trigger my HAE.

RIM: What’s it like going into work knowing your health is at a greater risk? Is it something you worry about?
ALD: I think it’s safe to say almost all hospital staff are scared and worried. It’s an overwhelming anxiety knowing that any wrong move can get you or your loved ones sick.
I am most worried for my sister and my family. My HAE is mild, so I rarely have throat swelling. But [twin sister] Arielle is severe and if she had the virus it could kill her with a lethal laryngeal edema.
Most of my coworkers are so scared to bring it home to their families, I know some people who are giving up their children so they are safe. That’s heart-wrenching.

RIM: How is your sister and your family holding up?
ALD: Arielle lives with me and my husband in our in-law so we see each other a lot. But she is working from home primarily as a nurse doing triage at Rhode Island Hospital cancer center. I have only seen my family through the glass storm door, and if they have anything for me like food, they leave it outside. I don’t go over anymore unfortunately.
My family is doing well. My grandmother from New York City is staying here to be safe since she’s eighty-one and only has one lung due to cancer.

RIM: What’s your family doing to stay safe?
ALD: They don’t go out of the house except for a walk and only food shopping once a week as needed. My father wears a mask and sanitizes everything.

RIM: That must be comforting. Unfortunately, not everyone is taking the same precautions. What would you say to people who aren’t practicing safe social distancing, wearing a cloth mask in public, etc.?
ALD: That it’s really only prolonging the virus. If everyone did it right then it would be over a lot sooner. Unfortunately, their actions are taking other people’s lives. It’s irresponsible.
Just a case and point: These “healthy individuals” who maybe have mild symptoms or are asymptomatic go into a nursing home or the store or basically anywhere and give it to five people who give it to their elderly grandmother — the ignorance is astounding! I have watched people die from this, and they wouldn’t have died if some healthy individual didn’t give it to them. The nursing home deaths are horrible. Sorry, that’s my rant.

RIM: Excellent rant, if I say so myself. Could you tell us what your patients are going through?
ALD: We have seen a common theme that they are very hard to sedate, therefore they are on a lot of medication to help make them comfortable but are still waking up coughing and uncomfortable. Also, when they aren’t well sedated they are not allowing the ventilator to do its work. They often become hypoxic (an absence of oxygen at the tissue level) or their oxygen saturation goes down with any repositioning or care.

RIM: In their condition, do they grasp what’s happening to them?
ALD: Some do and some don’t. My patient yesterday was nodding yes and no and could understand what was going on. I called his sister so she could talk to him. I feel like it helps soothe them and helps with their fears. But also some do not because they are on so many medications, and maybe have ICU delirium.

RIM: ICU delirium — could you explain what that is?
ALD: So ICU delirium is when someone who is receiving lots of medications, not sleeping adequately, sensory overload, too many lines and tubes…. basically the patient may be confused, agitated, hypoactive.

RIM: What’s it like working with patients when you’re in full PPE?
ALD: It’s very hard to connect and spend the time you’d like to with your patients. You mainly have to do your tasks and leave because the more time you are in the room the higher you are at risk for being infected. We try to cluster our care and only go in when needed, so it’s been hard for me because I like to spend time with my patients. It’s just sad that in PPE patients can’t see your smile.
My patients have mainly been intubated and sedated so I usually talk to them when I do my care. I call their family and ask them what music they like so I can play it for them, or what TV shows they like. I memorized their family members’ names so when I go in the room I can tell them that so-and-so loves them and is praying for them. It’s the little things like that that gives these patients and families hope to get strong and hopefully get better. I’ve also FaceTimed with a few families so they can see them.

RIM: The families must appreciate that. It has to be so hard for them to stay away.
ALD: It’s been so difficult for these families to sit at home, so giving them those few moments of hope is really special.

RIM: Is there anything we didn’t cover that you think people should know about your work and about your patients?
ALD: Just to stress that the virus doesn’t discriminate, that you may be healthy and young but that does not mean your actions don’t affect others. Be kind, this is hard for everyone, so the least you can do is be nice to others.

 

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