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The Permanente Press, in conjunction with The Permanente Journal presents this medical literary and arts e-journal, leaflet -- to open greater opportunity to share the creative visual and written works of physicians and nurses.


Health care professionals and employees are encouraged to submit original poetry, prose, and artwork for future issues.

On The Cover

15 025A lunar love09

Lunar Love
by Kamran Nikravan, MD

Lunar Love was painted in 2009, with mixed media on a 20” x 20” wood panel. It is a depiction of moonlight’s grace and beauty. Dr Nikravan has enjoyed and practiced meditation for many years, and this has influenced his practice of medicine and life in general in a very substantial way. His art, whether landscape or abstract, is a byproduct of this influence.

New Online

E-pub: 07-25-2016
Recurrence of Epithelioid Hemangioendothelioma during Pregnancy: Case Report and Systematic Review


E-pub: 07-22-2016
Hyperparathyroidism of Renal Disease


E-pub: 07-15-2016
Future Challenges of Robotics and Artificial Intelligence in Nursing: What Can We Learn from Monsters in Popular Culture?


E-pub: 07-15-2016
Lifestyle and Self-Management by Those Who Live It: Patients Engaging Patients in a Chronic Disease Model


E-pub: 07-15-2016
Monoarticular Poncet Disease after Pulmonary Tuberculosis: A Rare Case Report and Review of Literature


E-pub: 07-15-2016
Voices of the "99 Percent": The Role of Online Narrative to Improve Health Care


E-pub: 07-08-2016
Image Diagnosis: Encephalopathy Resulting from Dural Arteriovenous Fistula


E-pub: 07-06-2016
Plant-Based Diets: A Physician’s Guide


E-pub: 07-05-2016
Exploring the Reality of Using Patient Experience Data to Provide Resident Feedback: A Qualitative Study of Attending Physician Perspectives


E-pub: 07-01-2016
A Pharmacist-Staffed, Virtual Gout Management Clinic for Achieving Target Serum Uric Acid Levels: A Randomized Clinical Trial


E-pub: 06/29/2016
Difference in Effectiveness of Medication Adherence Intervention by Health Literacy Level


E-pub: 06/29/2016
Improving Care in Older Patients with Diabetes: A Focus on Glycemic Control


E-pub: 06/27/2016
Metastatic Renal Cell Carcinoma Presenting as Painful Chewing Successfully Treated with Combined Nivolumab and Sunitinib


E-pub: 06/27/2016
The Handshake Layer Cake: Meeting and Regreeting Difficulties for a Non-French Surgeon in France


E-pub: 06/24/2016
Image Diagnosis: Pott Puffy Tumor


E-pub: 06/24/2016
Image Diagnosis: Gastric Migration of Hookworms in a Patient with Anemia


E-pub: 06/24/2016
Image Diagnosis: Tubo-ovarian Abscess with Hydrosalpinx


E-pub: 06/22/2016
Treatment of Tracheoinnominate Fistula with Ligation of the Innominate Artery: A Case Report


E-pub: 06/22/2016
The Truth about Truth-Telling in American Medicine: A Brief History


E-pub: 06/20/2016
You Are Not Alone: Ten Strategies for Surviving a Malpractice Lawsuit


E-pub: 06/17/2016


E-pub: 06/17/2016
Quality Over Quantity: Integrating Mental Health Assessment Tools into Primary Care Practice


E-pub: 06/16/2016 
Ethical Analysis for Physicians Considering the Provision of Life-Ending Medication in Compliance with the California End of Life Option Act


E-pub: 05/20/2016
Refining Reporting Mechanisms in Oregon’s Patient-Centered Primary Care Home Program to Improve Performance


E-pub: 03/17/2016
The Use of Narrative as a Treatment Approach for Obesity: A Storied Educational Program Description


E-pub: 02/01/2016
Weight Loss and the Prevention of Weight Regain: Evaluation of a Treatment Model of Exercise Self-Regulation Generalizing to Controlled Eating

Biliary Obstruction

Image Diagnosis: Worm-Induced Biliary Obstruction
Andrew W Phillips, MD, MEd; Joanna Ready, MD;
Gus M Garmel, MD, FACEP, FAAEM

A 57-year-old woman, who was born in the Philippines, presented to the Emergency Department with 6 hours of epigastric and right upper quadrant abdominal pain radiating to her back. She denied fever, nausea, and vomiting. An endoscopic retrograde cholangiopancreatography showed the presence of a worm, extending from the ampulla into the bowel lumen.


Capitellar Fracture

Image Diagnosis: Capitellar Fracture
Ganesh Nagaraj, MD; Justin P Mitchelson, MD;
Cameron M McFarland, MD; Matthew A Silver, MD

A healthy 35-year-old man presented with left elbow pain and swelling after a ground-level fall onto his outstretched left hand. Greatest pain and swelling was over the distal humerus. On x-ray, disruption of the radiocapitellar joint was noted along with presence of a raised anterior fat pad and the resulting sail sign.



Bronchioloalveolar Carcinoma

Image Diagnosis: Bronchioloalveolar Carcinoma Presenting as Unilateral “Crazy-Paving” Pattern on High-Resolution Computed Tomography
Vikas Pilaniya, MD; Shekhar Kunal, MBBS;
Sudhir Jain, MD; Ashok Shah, MD

A 70-year-old man presented to our hospital with 18 months of cough and breathlessness. He was tachypneic and had decreased breath sounds and coarse crackles over his left chest. He was human immunodeficiency virus-negative and had never smoked. The 6-minute walk test revealed blood oxygen desaturation from 94% to 86%. The patient was admitted to the hospital for further tests and monitoring to establish a diagnosis.




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