A village for Victoria

A WellMed team led by Dr. Lilana Oakes brought better health and peace of mind for an ailing cancer patient

They had each other, but they were alone – and scared.

Victoria and Ilene, both 88, have been best friends for 34 years.

Victoria is frail. Diagnosed with liver cancer, she has been a frequent visitor to the emergency room. Ilene, her caregiver, became exhausted and at a loss for what to do for her friend.

They live together on the northeast side of San Antonio. Victoria, who is originally from Mexico, speaks only Spanish, and Ilene’s Spanish is broken.

Prior to Victoria’s diagnosis, the friends lived simple lives filled with routines and mutual care. Then the bitter sting of cancer shattered their fragile peace.

Accustomed to getting around with her rollator, Victoria became too weak to use it as the illness stole her strength. Then Ilene, the stronger of the two, began showing signs of dementia. The burden of caregiving quickly became overwhelming. With no family nearby and limited support systems, the two women found themselves isolated, frightened and frustrated.

Luckily, the WellMed supportive care team, headed by Medical Director Dr. Liliana Oakes, learned about Victoria, and the work began. The team consists of physicians, advanced practice clinicians, nurses and social workers. Their goal is to support patients who have life-limiting illnesses to help determine care and life goals and help improve the quality of patients’ lives.

Physician Assistant Jason Jackson made the initial visit to the home and admitted Victoria to the program. Then Lori Garcia, RN, visited to begin doing her part.

“My focus was to ensure Victoria had everything she needed, and her caregiver Ilene was supported so she could care for her,” Lori said. She began educating the two about a balanced, healthy diet, fall hazards in the home and medication compliance. It was clear, however, that language was a barrier.

“We used the language line translation services, but the patient and her caregiver often argued in Spanish and confused even the translator,” Lori said.

That’s when Dr. Oakes, whose native language is Spanish, stepped in. Dr. Oakes described Victoria as very sick, infirm and over-medicated. “She was vomiting and hadn’t eaten in days,” she said. A recent trip to the emergency room had failed to help Victoria, and Dr. Oakes discovered that her medications were doing more harm than good.

“She was taking large amounts of ibuprofen, which only served to aggravate her gastritis,” Dr. Oakes said. “I went through her medications one by one, got rid of many and sent new prescriptions to the pharmacy.

Equally concerning to Dr. Oakes was Ilene’s emotional state. It was clear that she had an issue with dementia, so the emotional toll of trying to manage her friend’s care was immense. “Ilene was crying, expressing helplessness. She said she couldn’t do it anymore,” Dr. Oakes said.

Even though social worker Annette Ramos had visited two weeks before, Dr. Oakes asked her to come out again. She knew that the care Victoria and Ilene needed extended beyond physical symptoms; they needed to address their emotional needs.

Annette returned, determined to bridge the gap. “On my first visit, Ilene and Victoria had been in the emergency room the night before, so it was clear they were very tired and had little interest in talking with me,” Annette said.

On the second visit, Ilene seemed suspicious at best but listened as Annette explained the in-home services available to them, as well as hospice. “She informed me that they didn’t need anything and Victoria was going to stay at home. When I told her that hospice was about services coming to them, she looked at me like it wasn’t true,” Annette said. “I didn’t know if I was going to get anywhere, but Victoria told me she was interested.”

Ilene slowly began to understand. Victoria was admitted to hospice care within 72 hours.

The team also worked to set up personal attendant services such as bathing, dressing, cooking and cleaning. Ilene declined Meals on Wheels and insisted she could take care of their food needs, even though she couldn’t remember her phone passwords to set up Uber. Despite these barriers, the house was neat, and the women remained fiercely independent.

Throughout the visits, the care team honored the friends’ autonomy while gently guiding them toward support. They understood that both women had made their own decisions for decades. The challenge was not just medical — it was cultural, emotional and deeply personal.

Through it all, Victoria’s condition improved and the team cultivated trust, educated with empathy and built a bridge between fear and care. “It takes a village,” Dr. Oakes said. “And I’m glad we have the best one around.”