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We Grow Accustomed To The Light, Minh Q. Nguyen

HCA Healthcare Journal of Medicine

Drawing inspiration from Emily Dickinson’s exploration of the unknown in "We Grow Accustomed to the Dark," this poem, "We Grow Accustomed to the Light," re-examines the final transition of life through a clinical and humanist lens. While Dickinson focused on the bravery required to navigate the "Dark," this piece explores the courage needed to face the "Light," representing the clarity of terminal illness, the shedding of medical "fetters," and the shared experience of the "final goodbye." It challenges the traditional medical impulse to "push forward" at all costs, instead advocating for a "Wise" acceptance of the natural end of the …

Approaching Well-Being Through The Research Lens: How Hca Healthcare Colleagues Are Building Healthy Work And Learning Environments, Gregory Guldner, Allison Woodall, Deepinder Bal, Jennifer Larkin, Cynthia Borum, Sunny Hull, Annette Edens, Lisa H. Moore, Elaine K. Miller, Harold Gomez Acevedo, Katia M. Lugo Enriquez, Noor Judge, Yanie Oliva, Pablo E. Ramirez Caraballo, Faraz Jaffer, Prerna S. Sharma, Daniel Heller, Siddarth Kathuria, Nathaniel Banet, Orlando Nieves-Lugo, Adrienne Madison, Lily Martin, Oliwier Dziadkowiec

HCA Healthcare Journal of Medicine

At the heart of our commitment to the care and improvement of human life are the physicians who dedicate themselves to delivering exceptional care. To support not only our physicians’ professional excellence but also to foster personal fulfillment, HCA Healthcare partnered with Claremont Graduate University to establish the Physician Wellness Research Lab (PWR Lab). In his new role as the Vice President of Academic Affairs for Graduate Medical Education (GME), Dr Guldner led a nationwide search to establish and implement a new approach to well-being. At HCA Healthcare, we believe that true flourishing requires transforming the work and learning environment …

Beyond Drainage: Can Pleural Effusion Naturally Tamponade Tumor Hemorrhage? Literature Review Of Hypotheses For Possible Mechanisms, Pratyush Kumar, Kumar Abhishek, Pankti Shah, Amelia Goslin, Archana Machavarapu, Catherine Joyce, Michael J. Waxman, Kari Nilsen

HCA Healthcare Journal of Medicine

Background

Malignant pleural effusion (MPE) is a common complication of advanced lung cancer and is typically treated with therapeutic drainage to relieve symptoms. Although this is a well-established palliative approach, removing pleural fluid—especially in cases of necrotic or post-radiation tumors—may disturb the fragile pressure balance within the thoracic cavity. The question of whether pleural effusion can act as a natural tamponade against tumor-related vascular fragility has not been thoroughly investigated.

Case Presentation

We report a case of a 49-year-old man with stage IIIB non–small cell lung cancer (NSCLC) who experienced a catastrophic hemorrhage shortly after pleural fluid removal via a …

Myxedema Coma With Cardiogenic Shock: Diagnostic Challenges And Risks Of Amiodarone In Acute Thyroid Failure, Jean Carlos Ramos Cardona, Gunjan Mundhra, Munachiso Egbo, Veniamin Melnychuk, Suzanne Quinn Martinez

HCA Healthcare Journal of Medicine

Background

Myxedema coma is a rare but life-threatening manifestation of severe hypothyroidism characterized by altered mental status, hypothermia, bradycardia, and multiorgan dysfunction. Delayed diagnosis is common, particularly in elderly patients with multiple comorbidities. Cardiac complications, including malignant arrhythmias, are underrecognized contributors to morbidity and mortality. Profound hypothyroidism compromises cardiac myocyte function through reduced activity of enzymes involved in calcium uptake, leading to impaired myocardial contraction and relaxation. This results in decreased heart rate, reduced cardiac output, and altered left ventricular function, which may be further exacerbated in patients with heart failure with reduced ejection fraction. Prolongation of the ventricular action …

Neuromotor Compromise As A Presenting Symptom In Advanced Lower Extremity Soft Tissue Sarcoma: A Case Series, Adam Maestas, Parsa Charkhchi, Farbod Malek

HCA Healthcare Journal of Medicine

Background

Soft tissue sarcomas (STS) are rare malignant tumors of mesenchymal origin, representing less than 1% of adult cancers. Approximately half arise in the extremities, most often presenting as a painless, enlarging mass. Symptoms are often misattributed to benign neuropathic or musculoskeletal causes, leading to delayed diagnosis and treatment. Neurological deficits such as foot drop or distal weakness are exceptionally uncommon presenting signs and generally indicate advanced local invasion or compression of major peripheral nerves. Recognizing acute neuromotor compromise as a potential manifestation of soft tissue malignancy is crucial for timely oncologic evaluation and limb-sparing management.

Case Presentation

This series …

Avoiding Unnecessary Surgery In Acute Longus Colli Calcific Tendinitis: A Clinical Image Of A Retropharyngeal Abscess Mimicker, Brandon M. Nielsen, Oluyemi O. Omotoso

HCA Healthcare Journal of Medicine

Acute calcific tendinitis of the longus colli (LCT) is a rare, benign condition that frequently mimics retropharyngeal abscesses (RPA), a true surgical emergency. We present a 34-year-old woman presenting with 4 days of severe posterior neck pain, stiffness, and odynophagia. Initial evaluation revealed significantly elevated inflammatory markers (erythrocyte sedimentation rate [ESR] 113 mm/hr, C-reactive protein [CRP] 128 mg/L) and leukocytosis, raising immediate concern for deep neck infection. Contrast-enhanced computed tomography (CT) demonstrated a retropharyngeal fluid collection; however, the absence of peripheral ring enhancement and the presence of a pathognomonic calcification anterior to the C1 arch pointed toward LCT. This distinction …

Gallbladder Ascariasis Presenting As Acalculous Biliary Colic, Carmen A. Urbina, Luigi G. Cubeddu, Luigi X. Cubeddu

HCA Healthcare Journal of Medicine

We detail a case of gallbladder ascariasis, presenting as an acute episode of acalculous biliary colic, nausea, bloating, an unremarkable abdominal ultrasound, and negative helminth and protozoa stool smears. A follow-up ultrasound provided unexpected images consistent with gallbladder infection by Ascaris lumbricoides. Repeat ultrasonography performed 10 days after anthelmintic therapy showed no live worms and 2 newly appearing echogenic areas suggestive of gallbladder calculi that were confirmed following elective cholecystectomy. The case course highlights key clinical, diagnostic, and management considerations in gallbladder ascariasis and underscores the value of repeated ultrasonographic evaluation in affected patients.

Blaschko-Linear Lupus Erythematosus In A Pediatric Patient, Marshall Hall, Olivia Mayer, Henry Lim, Dustin V. Wilkes, Michael Carletti, Stephen E. Weis

HCA Healthcare Journal of Medicine

The lines of Blaschko represent epithelial cell migration during embryonic development. Rare forms of cutaneous lupus erythematosus may manifest along these lines, and lesions are termed Blaschko-linear lupus erythematosus (BLE). The purpose of this case study is to present a rare manifestation of linear cutaneous lupus erythematosus following the lines of Blaschko in a pediatric patient. To date, there are very few reports of BLE. We present a 17-year-old female with a 2-month history of a mildly tender growing lesion along the right nasofacial sulcus. The patient denied lesions elsewhere and any systemic, joint, or mucosal symptoms. A biopsy of …

Presentations Of Cutaneous Disease In Various Skin Pigmentations: Hidradenitis Suppurativa, Jamie Y. Choe, Henry Lim, Marshall Hall, Christian Scheufele, Dustin V. Wilkes, Michael Carletti, Stephen E. Weis

HCA Healthcare Journal of Medicine

Hidradenitis suppurativa (HS) is a chronic inflammatory skin disorder characterized by recurrent deep-seated nodules and painful abscesses with scars, fistulae, and sinus tracts that predominately affect the intertriginous sites. Onset typically occurs soon after puberty. Depending on disease severity, HS can lead to varying levels of pain, disability, and disfiguration with significant impacts on quality of life. Hidradenitis suppurativa is diagnosed clinically, and no diagnostic tests are specific to the disease. Therefore, clinicians must have the knowledge and competence to identify the clinical features of HS accurately. The purpose of this report is to provide descriptions of characteristic clinical presentations …

Sebaceous Gland Heterotopia Of The Esophagus: A Rare Incidental Finding During Upper Endoscopy, Samuel Ramos, Margaret-Anne Huntley, Eric Vargas, Jignesh Parikh, Vania Zayat

HCA Healthcare Journal of Medicine

Esophageal heterotopic sebaceous glands (EHSG) are an extremely rare finding within the esophageal epithelium. These glands are typically benign, presenting as small, yellow-white plaques or lesions observed on endoscopy, often in the middle third of the esophagus. Esophageal heterotopic sebaceous glands are generally asymptomatic, and surveillance is not required. While their origin is unclear, proposed mechanisms include metaplastic transformation and congenital development. Recognition and histologic confirmation are essential to distinguish EHSG from other esophageal lesions and to avoid unnecessary interventions. We report the case of a 55-year-old man in whom multiple diminutive plaques were identified in the mid-esophagus during esophagogastroduodenoscopy …

Comparing The Expression Of Estrogen Receptors, Progesterone Receptors, And Human Epidermal Growth Factor Receptor 2 Between Initial Biopsy And Excision Specimens In Invasive Breast Carcinoma Cases. Is There A Need For Universal Repeat Testing? Experience From A Community Hospital, Astrid M. Sacasa, Gul Emek Wymer, Susana Ferra

HCA Healthcare Journal of Medicine

Background

The current national recommendation is that breast biomarkers estrogen receptors (ER), progesterone receptors (PR), and human epidermal growth factor receptor 2 (HER2) testing should be done on all primary invasive breast carcinomas and on recurrent or metastatic tumors. Repeat testing on a subsequent excision specimen is not indicated unless results appear discordant with the histopathologic findings. The objective of the current study was to evaluate the need for adopting universal reflex re-testing of breast biomarkers in excision specimens in our institution.

Methods

The study population included 70 sequential invasive breast cancer patients where the results of ER, PR, and …

Opioid Free Anesthesia In Arthroscopic Knee Surgery: A Feasible Approach To Patient Care, Carson Gifford, Denise Vidal, Dail Kim, Austin Goff, Paul Reynolds

HCA Healthcare Journal of Medicine

Background

The opioid epidemic has prompted exploration of opioid-free anesthesia (OFA) techniques, but the optimal approach is still debated. While some OFA protocols substitute opioids with other agents, these alternatives can introduce their own risks. The objective of this study was to investigate whether eliminating intraoperative opioids without analgesic substitution in arthroscopic knee procedures affects postoperative pain control and opioid requirements.

Methods

We conducted a retrospective analysis of 205 patients who underwent arthroscopic knee procedures between August and November 2023. Patients were divided into 2 groups: those who received intraoperative fentanyl (25-200 mcg, n = 144) and those who received …

Psychological Adaptation In Colorectal Cancer Survivors: Pilot Study Findings, Anuja L. Sarode, Emily M. Su, Amber Kerstetter-Fogle, Steve Paciorek, Erica L. Laipply

HCA Healthcare Journal of Medicine

Background

In this pilot study, we examined psychological impacts of colorectal cancer (CRC), focusing on cancer-related posttraumatic stress disorder (CR-PTSD) symptoms, posttraumatic growth (PTG), and their relationship with coping strategies in surgically treated CRC patients.

Methods

This prospective pre- and postoperative pilot study assessed CRC patients at 2 time points, pre- and postoperative. Psychological symptoms were evaluated using the PTSD Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (PCL-5) and the PTG Inventory Short Form (PTGI-SF). Coping strategies were assessed using the Brief Coping Orientation to Problems Experienced (COPE) instrument. Changes in CR-PTSD, PTG, and coping …

Coping Beyond Cancer: Exploring Fear Of Recurrence In Colorectal Cancer Survivors—A Pilot Investigation, Emily M. Su, Steve Paciorek, Erica L. Laipply, Anuja L. Sarode

HCA Healthcare Journal of Medicine

Background

Evidence is limited on the fear of cancer recurrence (FCR) among colorectal cancer (CRC) survivors in the US, especially regarding patterns and trends of post-recovery coping mechanisms. This pilot mixed-methods study quantified FCR, examined its associations with Brief COPE domains, and contextualized coping through qualitative analysis.

Methods

Twenty-three patients who successfully underwent CRC surgery were included in this pilot study. Fear of cancer recurrence was measured using the FCR Inventory (FCRI) Short Form, and coping strategies were assessed with the Brief Coping Orientation to Problems Experienced (COPE) survey. Descriptive statistics summarized participant characteristics, FCR, and COPE scores. Spearman correlation …

An Acknowledgement To The Hca Healthcare Journal Of Medicine's Reviewers And Editors For The First Half Of 2026, Graig Donini

HCA Healthcare Journal of Medicine

The HCA Healthcare Journal of Medicine would like to thank those behind the scenes who make this publication possible. Our journal would not be possible without the assistance of our peer reviewers, authors, and board members.

Erratum: Presentation Of Cutaneous Large B-Cell Lymphoma, Leg Type

HCA Healthcare Journal of Medicine

This corrects the article “Presentation of Cutaneous Large B-Cell Lymphoma, Leg Type” in volume 6, issue 6 on page 527.

Note On Judge Corbans Parents, Myrtis S. Wineman

A.G. Wineman & Sons Records, and Wineman, Williams, Guice, and Stockwell et al Family Papers

This note names of Judge Corban's parents and where they lived.

Memo, Deed From William Fitzhugh To William Williams, Myrtis S. Wineman

A.G. Wineman & Sons Records, and Wineman, Williams, Guice, and Stockwell et al Family Papers

This memo documents an order for a deed from William Fitzhugh to William Williams dated May 18, 1767 from Fairfax county at a cost of three dollars and fifty cents.

Reminder Note, Myrtis S. Wineman

A.G. Wineman & Sons Records, and Wineman, Williams, Guice, and Stockwell et al Family Papers

This note reminds Myrtis Wineman to contact Harvey Flemming, her cousin's grandson, as he is interested in genealogy.

Notes On Farr, Kinnison, And Brown Genealogy, Myrtis S. Wineman

A.G. Wineman & Sons Records, and Wineman, Williams, Guice, and Stockwell et al Family Papers

These notes contain information on Robert Farr, Elijah Woodworth Brown, and their ties to the Guice and Kinnison families.

Notes On Norwood Family, Myrtis S. Wineman

A.G. Wineman & Sons Records, and Wineman, Williams, Guice, and Stockwell et al Family Papers

This note contains a list of research topics concerning the Norwood family with reminders of what Wineman wants to look further into on the subject.

Letter, Perle Pearman To Myrtis S. Wineman, Perle Pearman

A.G. Wineman & Sons Records, and Wineman, Williams, Guice, and Stockwell et al Family Papers

In this undated letter, Perle Pearman writes to Myrtis S. Wineman to explain her delay in responding to Wineman's letter and to share the little she knows about the Rawls/Rawles family line. She goes on to provide a contact for Wineman to reach out to for more help. The typed letter was transcribed to include the handwritten inserts and additions as well as Wineman's handwritten notes.

Letter, Eloise Freeman To Mrs. Lyon, Eloise Freeman

A.G. Wineman & Sons Records, and Wineman, Williams, Guice, and Stockwell et al Family Papers

In this undated letter, Eloise Freeman writes to Mrs. Lyon to provide her with Mrs. Kemp (Mildred) White's address and apologizes for taking so long in getting it to her.

Natchez Memos, Myrtis S. Wineman

A.G. Wineman & Sons Records, and Wineman, Williams, Guice, and Stockwell et al Family Papers

This memo documents Myrtis Wineman's note to herself to ask Margaret Lee Guice Head about a potential photograph of Delilah Williams Guice.

Postcard, Joseph C. Wolf, Joseph C. Wolf

A.G. Wineman & Sons Records, and Wineman, Williams, Guice, and Stockwell et al Family Papers

Joseph C. Wolf, head of the Newberry Library in Chicago, Illinois, responds to an inquiry for a consolidated list of marriage records and passes on the business card, on which the response is typed, of a professional genealogy researcher, Emma Lee Walton.

Notes On Goose Creek Deed, Hugh Caldwell To William Williams

A.G. Wineman & Sons Records, and Wineman, Williams, Guice, and Stockwell et al Family Papers

These typed notes cover information on the Williams family's ties to land at Goose Creek on "Secolin's Branch" and the Ravensworth tract as well as attempts to connect the families who leased or owned nearby to the Williams family. the notes also provide a brief description of Goose Creek and it's location.

Draft Of Letter, Myrtis S. Wineman To Lurline Sullivan, Myrtis S. Wineman

A.G. Wineman & Sons Records, and Wineman, Williams, Guice, and Stockwell et al Family Papers

In this undated draft of a letter, Myrtis S. Wineman writes to Lurline Sullivan to ask for exact copies of the Rawls records that were accepted by the DAR in hopes of using them to link her line to it.

Partial Letter, Myrtis S. Wineman To Unknown, Myrtis S. Wineman

A.G. Wineman & Sons Records, and Wineman, Williams, Guice, and Stockwell et al Family Papers

In this partial letter, Myrtis S. Wineman writes to an unidentified person, possibly Mrs. Osie Hope, to update on her genealogy research. She goes on to discuss personal matters.

Envelope With Notes About Contents, 1959, Myrtis S. Wineman

A.G. Wineman & Sons Records, and Wineman, Williams, Guice, and Stockwell et al Family Papers

Notes about its contents are written on this brown envelope, the contents being letters by Charlie Electious Williams to various people. The notes also include what Wineman did with some of the letters and who she intended to show other letters to.

Letter, M. H. Rodgers To Charlie Electious Williams, M. H. Rodgers

A.G. Wineman & Sons Records, and Wineman, Williams, Guice, and Stockwell et al Family Papers

In this letter, M. H. Rodgers writes to Electious Williams to tell him about his Uncle Billie as well as what he's been told about his Grandfather Williams.