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Sandra’s Story: I was nervous

Sandra Schemske and her husband arrived at Moffitt Cancer Center's, Richard M. Shulze Family Foundation Outpatient Center at McKinley Campus on March 13. Feeling nervous, she already had a lot on her mind. She was diagnosed with adenocarcinoma and was beginning her infusion treatment. 

Fifteen minutes into treatment, Schemske started experiencing abnormal symptoms with chest pain. Her nurse practitioner, Linda Marie De Zago, was called over to assess the situation and the infusion was stopped. Schemske had a previous diagnosis of bradycardia, a slower than normal heart rate, as well as a type 1 atrioventricular (AV) block, which is a normally benign condition. 

But after consulting with the cardiologist, De Zago informed Schemske that her heart block had progressed. Schemske felt blindsided by what was occurring. As she became overwhelmed by what was happening, she self-admittedly became “dismissive and belligerent.” She just wanted to finish her treatment and go home. 

Patient Sandra Schemske keeps a positive outlook as she continues her treatment at Moffitt with full faith in her care team.

Patient Sandra Schemske keeps a positive outlook as she continues her treatment at Moffitt with full faith in her care team.

But neither was an option as De Zago had advised the care team to call the ambulance immediately and have Schemske admitted to another hospital for emergency cardiac care.

Linda’s Story: Listen to your intuition

“It’s not uncommon for patients to have a reaction to their first dose of Paclitaxel. It happens all the time,” says De Zago. “But in Sandra’s case, there was something bigger going on.”

After checking Schemske’s vital signs, De Zago noticed that her heartbeat was ranging from the upper 30s to the lower 40s. She knew she had to restart Schemske’s treatment, but she wasn’t comfortable with her low heart rate. 

Schemske tried to reassure De Zago that she was aware of her heart condition. In fact, she had just seen her doctor and was told everything was fine. As the situation unfolded, Schemske became agitated, yet De Zago still wasn’t comfortable with the vitals. She knew more needed to be done. 

“I did a stat 12 lead EKG because my intuition was telling me something wasn’t right,” said De Zago. “I looked at the EKG and noticed it wasn’t the heart block that she thinks she has. This was something more advanced.” 

Thinking fast, she reached out to cardiology. Her suspicion was correct. Schemske had a much more dangerous heart rhythm. She had a third-degree heart block. Schemske was not happy with the news and De Zago’s words weren’t getting through to her. 

“I called Sandra’s care team and informed them of the situation. They stated that they weren’t going to restart her treatment until her heart had been evaluated,” said De Zago. This led De Zago back to Schemske’s room where the patient was anxiously waiting for her treatment to restart. 

“I knew I was upsetting her and her husband, but eventually, I sat down and was very blunt with her,” said De Zago. “I told them that this is a rhythm that could kill her and that she most likely needed a pacemaker.” 

De Zago informed Schemske and her husband that she needed to go to a cardiac facility immediately, but the couple didn’t want to go.

“I finally got Sandra to agree to go to the ER, but she wanted her husband to take her to the hospital in Sarasota,” De Zago added. “I had to firmly tell her no and that she needed to go by ambulance because she needed to be monitored.” Schemske finally listened and went. A pacemaker was installed the next day. 

Ultimately, De Zago saved Schemske’s life. 

Methods of De-escalation

As a nurse practitioner, De Zago understands that every patient encounter is different and that some days it may call for de-escalation. Although no one desires to confront a challenging situation, she addressed it with composure.

“One of the methods that I always use is I get down at the patient’s eye level,” said De Zago. “I sit with them and I have a dialogue. I explain the facts, but I don’t get emotional about it. I am in the moment with them. I am showing that I care because I do. People don’t care what you know until they know you care.” 

To De Zago, attentive listening and genuine presence hold significance. She emphasizes that in every scenario, comprehending the patient’s priorities and determining how one can be of assistance are crucial. Her advice to other nurses is to always listen to your intuition. 

Forever Linked 

Before her experience with De Zago, Schemske considered receiving cancer treatment closer to her home in Sarasota. But after this encounter, she knew staying at Moffitt was the right decision, as she is forever grateful for the care she received.

“It was Linda’s calm and compassionate nature in convincing me to go to the ER that shifted my attitude,” said Schemske. “Her skills, professionalism, care and compassion are a tribute to her and the entire Moffitt community. My life will be forever linked to her actions that day.”