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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.

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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