From 1984 until 2011, he ran Apple using the same template.

What is a founder CEO's most crucial skill?

Presentation, communication, and sales

As a Business Angel Investor, I saw many pitch presentations and met with investors one-on-one to promote my companies.

There is always the conception of “Investors have to invest,” so there is no need to care about the presentation.

It's false. Nobody must invest. Many investors believe that entrepreneurs must convince them to invest in their business.

Sometimes — like in 2018–2022 — too much money enters the market, and everyone makes good money.

Do you recall the Buy Now, Pay Later Movement? This amazing narrative had no return potential. Only buyers who couldn't acquire financing elsewhere shopped at these companies.

Klarna's failing business concept led to high valuations.

Investors become more cautious when the economy falters. 2022 sees rising inflation, interest rates, wars, and civil instability. It's like the apocalypse's four horsemen have arrived.

Storytelling is important in rough economies.

When investors draw back, how can entrepreneurs stand out?

In Q2/2022, every study I've read said:

Investors cease investing

Deals are down in almost all IT industries from previous quarters.

What do founders need to do?

Differentiate yourself.

Storytelling talents help.

The Steve Jobs Way

Every time I watch a Steve Jobs presentation, I'm enthralled.

I'm a techie. Everything technical interests me. But, I skim most presentations.

What's Steve Jobs's secret?

Steve Jobs created Apple in 1976 and made it a profitable software and hardware firm in the 1980s. Macintosh goods couldn't beat IBM's. This mistake sacked him in 1985.

Before rejoining Apple in 1997, Steve Jobs founded Next Inc. and Pixar.

From then on, Apple became America's most valuable firm.

Steve Jobs understood people's needs. He said:

“People don’t know what they want until you show it to them. That’s why I never rely on market research. Our task is to read things that are not yet on the page.”

In his opinion, people talk about problems. A lot. Entrepreneurs must learn what the population's pressing problems are and create a solution.

Steve Jobs showed people what they needed before they realized it.

I'll explain:

Present a Big Vision

Steve Jobs starts every presentation by describing his long-term goals for Apple.

1984's Macintosh presentation set up David vs. Goliath. In a George Orwell-style dystopia, IBM computers were bad. It was 1984.

Apple will save the world, like Jedis.

Why do customers and investors like Big Vision?

People want a wider perspective, I think. Humans love improving the planet.

Apple users often cite emotional reasons for buying the brand.

Revolutionizing several industries with breakthrough inventions

Establish Authority

Everyone knows Apple in 2022. It's hard to find folks who confuse Apple with an apple around the world.

Apple wasn't as famous as it is today until Steve Jobs left in 2011.

Most entrepreneurs lack experience. They may market their company or items to folks who haven't heard of it.

Steve Jobs presented the company's historical accomplishments to overcome opposition.

In his presentation of the first iPhone, he talked about the Apple Macintosh, which altered the computing sector, and the iPod, which changed the music industry.

People who have never heard of Apple feel like they're seeing a winner. It raises expectations that the new product will be game-changing and must-have.

The Big Reveal

A pitch or product presentation always has something new.

Steve Jobs doesn't only demonstrate the product. I don't think he'd skip the major point of a company presentation.

He consistently discusses present market solutions, their faults, and a better consumer solution.

No solution exists yet.

It's a multi-faceted play:

• It's comparing the new product to something familiar. This makes novelty and the product more relatable.

• Describe a desirable solution.

• He's funny. He demonstrated an iPod with an 80s phone dial in his iPhone presentation.

Then he reveals the new product. Macintosh presented itself.

Show the benefits

He outlines what Apple is doing differently after demonstrating the product.

How do you distinguish from others? The Big Breakthrough Presentation.

A few hundred slides might list all benefits.

Everyone would fall asleep. Have you ever had similar presentations?

When the brain is overloaded with knowledge, the limbic system changes to other duties, like lunch planning.

What should a speaker do? There's a classic proverb:

“Tell me and I forget, teach me and I may remember, involve me and I learn” (— Not Benjamin Franklin).

Steve Jobs showcased the product live.

Again, using ordinary scenarios to highlight the product's benefits makes it relatable.

The 2010 iPad Presentation uses this technique.

Invite the Team and Let Them Run the Presentation

CEOs spend most time outside the organization. Many companies elect to have only one presenter.

It sends the incorrect message to investors. Product presentations should always include the whole team.

Let me explain why.

Companies needing investment money frequently have shaky business strategies or no product-market fit or robust corporate structure.

Investors solely bet on a team's ability to implement ideas and make a profit.

Early team involvement helps investors understand the company's drivers. Travel costs are worthwhile.

But why for product presentations?

Presenters of varied ages, genders, social backgrounds, and skillsets are relatable. CEOs want relatable products.

Some customers may not believe a white man's message. A black woman's message may be more accepted.

Make the story relatable when you have the best product that solves people's concerns.

Best example: 1984 Macintosh presentation with development team panel.

What is the largest error people make when companies fail?

Saving money on the corporate and product presentation.

Invite your team to five partner meetings when five investors are shortlisted.

Rehearse the presentation till it's natural. Let the team speak.

Successful presentations require structure, rehearsal, and a team. Steve Jobs nailed it.

This is how to build a car while driving.

Building a high-growth startup is compared to building a car while it's speeding down the highway.

How to plan without going crazy? Or, without losing team, board, and investor buy-in?

I just delivered our company's product roadmap for the rest of the year. Complete. Thorough. Page-long. I'm optimistic about its chances of surviving as everything around us changes, from internal priorities to the global economy.

It's tricky. This isn't the first time I've created a startup roadmap. I didn't invent a document. It took time to deliver a document that will be relevant for months.

Goals matter.

Although they never change, goals are rarely understood.

This is the third in a series about a startup's unique roadmapping needs. Velocity is the intensity at which a startup must produce to survive.

A high-growth startup moves at breakneck speed, which I alluded to when I said priorities and economic factors can change daily or weekly.

At that speed, a startup's roadmap must be flexible, bend but not break, and be brief and to the point. I can't tell you how many startups and large companies develop a product roadmap every quarter and then tuck it away.

Big, wealthy companies can do this. It's suicide for a startup.

The drawer thing happens because startup product roadmaps are often valid for a short time. The roadmap is a random list of features prioritized by different company factions and unrelated to company goals.

It's not because the goals changed that a roadmap is shelved or ignored. Because the company's goals were never communicated or documented in the context of its product.

In the previous post, I discussed how to turn company goals into a product roadmap. In this post, I'll show you how to make a one-page startup roadmap.

In a future post, I'll show you how to follow this roadmap. This roadmap helps you track company goals, something a roadmap must do.

Be vague for growth, but direct for execution.

Here's my plan. The real one has more entries and more content in each.

Let's discuss smaller boxes.

Product developers and engineers know that the further out they predict, the more wrong they'll be. When developing the product roadmap, this rule is ignored. Then it bites us three, six, or nine months later when we haven't even started.

Why do we put everything in a product roadmap like a project plan?

Yes, I know. We use it when the product roadmap isn't goal-based.

A goal-based roadmap begins with a document that outlines each goal's idea, execution, growth, and refinement.

Once the goals are broken down into epics, initiatives, projects, and programs, only the idea and execution phases should be modeled. Any goal growth or refinement items should be vague and loosely mapped.

Why? First, any idea or execution-phase goal will result in growth initiatives that are unimaginable today. Second, internal priorities and external factors will change, but the goals won't. Locking items into calendar slots reduces flexibility and forces deviation from the single source of truth.

No soothsayers. Predicting the future is pointless; just prepare.

A map is useless if you don't know where you're going.

As we speed down the road, the car and the road will change. Goals define the destination.

This quarter and next quarter's roadmap should be set. After that, you should track destination milestones, not how to get there.

When you do that, even the most critical investors will understand the roadmap and buy in. When you track progress at the end of the quarter and revise your roadmap, the destination won't change.

Elon's rides start rough, but then...

Elon Musk has never been so hated.

They don’t get Elon.

• He began using PayPal in this manner.

• He began with SpaceX in a similar manner.

• He began with Tesla in this manner.

Disruptive.

Elon had rocky starts. His creativity requires it. Just like writing a first draft.

His fastest way to find the way is to avoid it.

PayPal's pricey launch

PayPal was a 1999 business flop.

They were considered insane.

Elon and his co-founders had big plans for PayPal. They adopted the popular philosophy of the time, exchanging short-term profit for growth, and pulled off a miracle just before the bubble burst.

PayPal was created as a dollar alternative. Original PayPal software allowed PalmPilot money transfers. Unfortunately, there weren't enough PalmPilot users.

Since everyone had email, the company emailed payments. Costs rose faster than sales.

The startup wanted to get a million subscribers by paying $10 to sign up and $10 for each referral. Elon thought the price was fair because PayPal made money by charging transaction fees. They needed to make money quickly.

A Wall Street Journal article valuing PayPal at $500 million attracted investors. The dot-com bubble burst soon after they rushed to get financing.

Musk and his partners sold PayPal to eBay for $1.5 billion in 2002. Musk's most successful company was PayPal.

SpaceX's start-up error

Elon and his friends bought a reconditioned ICBM in Russia in 2002.

He planned to invest much of his wealth in a stunt to promote NASA and space travel.

Many called Elon crazy.

The goal was to buy a cheap Russian rocket to launch mice or plants to Mars and return them. He thought SpaceX would revive global space interest. After a bad meeting in Moscow, Elon decided to build his own rockets to undercut launch contracts.

Then SpaceX was founded.

Elon’s plan was harder than expected.

Explosions followed explosions.

• Millions lost on cargo.

• Millions lost on the rockets.

Investors thought Elon was crazy, but he wasn't.

NASA's biggest competitor became SpaceX. NASA hired SpaceX to handle many of its missions.

Tesla's shaky beginning

Tesla began shakily.

• Clients detested their roadster.

• They continued to miss deadlines.

Lotus would handle the car while Tesla focused on the EV component, easing Tesla's entry. The business experienced elegance creep. Modifying specific parts kept the car from getting worse.

Cost overruns, delays, and other factors changed the Elise-like car's appearance. Only 7% of the Tesla Roadster's parts matched its Lotus twin.

Tesla was about to die.

Elon saved the mess as CEO.

He fired 25% of the workforce to reduce costs.

Elon Musk transformed Tesla into the world's most valuable automaker by running it like a startup.

Tesla hasn't spent a dime on advertising. They let the media do the talking by investing in innovation.

Elon sheds. Elon tries. Elon learns. Elon refines.

Twitter doesn't worry me.

The media is shocked. I’m not.

This is just Elon being Elon.

• Elon makes lean.

• Elon tries new things.

• Elon listens to feedback.

• Elon refines.

Besides Twitter will always be Twitter.

A few days ago, I was discussing dall-e with two art and tech pals. One artist acquaintance said she knew a frightened illustrator. Would the ability to create anything with a click derail her career? The artist feared this. My curator friend smiled and said this has always been a dread among artists. When the camera was invented, didn't painters say this? Even in the Instagram era, painting exists.

When art and technology collide, there's room for innovation, experimentation, and fear — especially if the technology replicates or replaces art making. What is art's future with dall-e? How does technology affect music, beyond visual art? Recently, I saw "ABBA Voyage," a holographic ABBA concert in London.

"Abba voyage?" my phone asked in early March. A Gen X friend I met through a fashion blogging ring texted me.

"What's abba Voyage?" I asked while opening my front door with keys and coffee.

We're going! Marti, visiting London, took me to a show.

"Absolutely no ABBA songs here." I responded.

My parents didn't play ABBA much, so I don't know much about them. Dad liked Jimi Hendrix, Cream, Deep Purple, and New Orleans jazz. Marti told me ABBA Voyage was a holographic ABBA show with a live band.

The show was fun, extraordinary fun. Nearly everyone on the dance floor wore wigs, ankle-breaking platforms, sequins, and bellbottoms. I saw some millennials and Zoomers among the boomers.

I was intoxicated by the experience.

Automatons date back to the 18th-century mechanical turk. The mechanical turk was a chess automaton operated by a person. The mechanical turk seemed to perform like a human without human intervention, but it required a human in the loop to work properly.

Humans have used non-humans in entertainment for centuries, such as puppets, shadow play, and smoke and mirrors. A show can have animatronic, technological, and non-technological elements, and a live show can blur real and illusion. From medieval puppet shows to mechanical turks to AI filters, bots, and holograms, entertainment has evolved over time.

I'm not a hologram skeptic, but I'm skeptical of technology, especially since I work with it. I love live performances, I love hearing singers breathe, forget lines, and make jokes. Live shows are my favorite because I love watching performers make mistakes or interact with the audience. ABBA Voyage was different.

Marti and I traveled to Manchester after ABBA Voyage to see Liam Gallagher. Similar but different vibe. Similar in that thousands dressed up for the show. ABBA's energy was dizzying. 90s chic replaced sequins in the crowd. Doc Martens, nylon jackets, bucket hats, shaggy hair. The Charlatans and Liam Gallagher opened and closed, respectively. Fireworks. Incredible. People went crazy. Yelling exhausted my voice.

This week in music featured AI-enabled holograms and a decades-old rocker. Both are warm and gooey in our memories.

After seeing both, I'm wondering if we need AI hologram shows. Why? Is it good?

Like everything tech-related, my answer is "maybe." Because context and performance matter. Liam Gallagher and ABBA both had great, different shows.

For a hologram to work, it must be impossible and big. It must be big, showy, and improbable to justify a hologram. It must feel...expensive, like a stadium pop show. According to a quick search, ABBA broke up on bad terms. Reuniting is unlikely. This is also why Prince or Tupac hologram shows work. We can only engage with their legacy through covers or...holograms.

I drove around listening to the radio a few weeks ago. "Dreaming of You" by Selena played. Selena's music defined my childhood. I sang along and turned up the volume (or as loud as my husband would allow me while driving on the highway).

I discovered Selena's music six months after her death, so I never saw her perform live. My babysitter Melissa played me her album after I moved to Houston. Melissa took me to see the Selena movie five times when it came out. I quickly wore out my VHS copy. I constantly sang "Bibi Bibi Bom Bom" and "Como la Flor." I love Selena. A Selena hologram? Yes, probably.

Instagram advertised a cellist's Arthur Russell tribute show. Russell is another deceased artist I love. I almost walked down the aisle to "This is How We Walk on the Moon," but our cellist couldn't find it. Instead, I walked to Magnetic Fields' "The Book of Love." I "discovered" Russell after a friend introduced me to his music a few years ago.

I use these as analogies for the Liam Gallagher and ABBA concerts.

You have no idea how much I'd pay to see a hologram of Selena's 1995 Houston Livestock Show and Rodeo concert. Arthur Russell's hologram is unnecessary. Russell's work was intimate and performance-based. We can't separate his life from his legacy; popular audiences overlooked his genius. He died of AIDS broke. Like Selena, he died prematurely. Given his music and history, another performer would be a better choice than a hologram. He's no Selena. Selena could have rivaled Beyonce.

Pop shows' size works for holograms. Along with ABBA holograms, there was an anime movie and a light show that would put Tron to shame. ABBA created a tourable stadium show. The event was lavish, expensive, and well-planned. Pop, unlike rock, isn't gritty. Liam Gallagher hologram? No longer impossible, it wouldn't work. He's touring. I'm not sure if a rockstar alone should be rendered as a hologram; it was the show that made ABBA a hologram.

Holograms, like AI, are part of the future of entertainment, but not all of it. Because only modern interpretations of Arthur Russell's work reveal his legacy. That's his legacy.

Large-scale arena performers may use holograms in the future, but the experience must be impossible. A teacher once said that the only way to convey emotion in opera is through song, and I feel the same way about holograms, AR, VR, and mixed reality. A story's impossibility must make sense, like in opera. Impossibility and bombastic performance must be present for an immersive element to "work." ABBA was an impossible and improbable experience, which made it magical. It helped the holographic show work.

Marti told me about ABBA Voyage. She said it was a great concert. Marti has worked in music since the 1990s. She's a music expert; she's seen many shows.

Ai isn't a god or sentient, and the ABBA holograms aren't real. The renderings were glassy-eyed, flat, and robotic, like the Polar Express or the Jaws shark. Even today, the uncanny valley is insurmountable. We know it's not real because it's not about reality. It was about a suspended moment and performance feelings.

I knew this was impossible, an 'unreal' experience, but the emotions I felt were real, like watching a movie or tv show. Perhaps this is one of the better uses of AI, like CGI and special effects, like the beauty of entertainment- we were enraptured and entertained for hours. I've been playing ABBA since then.

or, how I spread monkeypox and got it myself.

This story contains nsfw (not safe for wife) stuff and shouldn't be read if you're under 18 or think I'm a newborn angel. After the opening, it's broken into three sections: a chronological explanation of my disease course, my ideas, and what I plan to do next.

Your journey awaits.

As early as mid-may, I was waltzing around the lab talking about monkeypox, a rare tropical disease with an inaccurate name. Monkeys are not its primary animal reservoir. It caused an outbreak among men who have sex with men across Europe, with unprecedented levels of person-to-person transmission. European health authorities speculated that the virus spread at raves and parties and was easily transferred through intimate, mainly sexual, contact. I had already read the nejm article about the first confirmed monkeypox patient in the u.s. and shared the photos on social media so people knew what to look for. The cdc information page only included 4 photographs of monkeypox lesions that looked like they were captured on a motorola razr.

I warned my ex-boyfriend about monkeypox. Monkeypox? responded.

Mom, I'm afraid about monkeypox. What's monkeypox?

My therapist is scared about monkeypox. What's monkeypox?

Was I alone? A few science gays on Twitter didn't make me feel overreacting.

This information got my gay head turning. The incubation period for the sickness is weeks. Many of my social media contacts are traveling to Europe this summer. What is pride? Travel, parties, and sex. Many people may become infected before attending these activities. Monkeypox will affect the lgbtq+ community.

Being right always stinks. My young scientist brain was right, though. Someone who saw this coming is one of the early victims. I'll talk about my feelings publicly, and trust me, I have many concerning what's occurring.

Part 1 is the specifics.

Wednesday nights are never smart but always entertaining. I didn't wake up until noon on june 23 and saw gay twitter blazing. Without warning, the nyc department of health announced a pop-up monkeypox immunization station in chelsea. Some days would be 11am-7pm. Walk-ins were welcome, however appointments were preferred. I tried to arrange an appointment after rubbing my eyes, but they were all taken. I got out of bed, washed my face, brushed my teeth, and put on short shorts because I wanted to get a walk-in dose and show off my legs. I got a 20-oz. cold brew on the way to the train and texted a chelsea-based acquaintance for help.

Clinic closed at 2pm. No more doses. Hundreds queued up. The government initially gave them only 1,000 dosages. For a city with 500,000 LGBT people, c'mon. What more could I do? I was upset by how things were handled. The evidence speaks for itself.

I decided to seek an appointment when additional doses were available and continued my weekend. I was celebrating nyc pride with pals. Fun! sex! * ‍

On tuesday after that, I felt a little burn. This wasn't surprising because I'd been sexually active throughout the weekend, so I got a sti panel the next day. I expected to get results in a few days, take antibiotics, and move on.

Emerging germs had other intentions. Wednesday night, I felt sore, and thursday morning, I had a blazing temperature and had sweat through my bedding. I had fever, chills, and body-wide aches and pains for three days. I reached 102 degrees. I believed I had covid over pride weekend, but I tested negative for three days straight.

STDs don't induce fevers or other systemic symptoms. If lymphogranuloma venereum advances, it can cause flu-like symptoms and swollen lymph nodes. I was suspicious and desperate for answers, so I researched monkeypox on the cdc website (for healthcare professionals). Much of what I saw on screen about monkeypox prodrome matched my symptoms. Multiple-day fever, headache, muscle aches, chills, tiredness, enlarged lymph nodes. Pox were lacking.

I told my doctor my concerns pre-medically. I'm occasionally annoying.

On saturday night, my fever broke and I felt better. Still burning, I was optimistic till sunday, when I woke up with five red splotches on my arms and fingertips.

As spots formed, burning became pain. I observed as spots developed on my body throughout the day. I had more than a dozen by the end of the day, and the early spots were pustular. I had monkeypox, as feared.

Fourth of July weekend limited my options. I'm well-connected in my school's infectious disease academic community, so I texted a coworker for advice. He agreed it was likely monkeypox and scheduled me for testing on tuesday.

nyc health could only perform 10 monkeypox tests every day. Before doctors could take swabs and send them in, each test had to be approved by the department. Some commercial labs can now perform monkeypox testing, but the backlog is huge. I still don't have a positive orthopoxvirus test five days after my test. *My 12-day-old case may not be included in the official monkeypox tally. This outbreak is far wider than we first thought, therefore I'm attempting to spread the information and help contain it.

*Update, 7/11: I have orthopoxvirus.

I spent all day in the bathtub because of the agony. Warm lavender epsom salts helped me feel better. I can't stand lavender anymore. I brought my laptop into the bathroom and viewed everything everywhere at once (2022). If my ex and I hadn't recently broken up, I wouldn't have monkeypox. All of these things made me cry, and I sat in the bathtub on the 4th of July sobbing. I thought, Is this it? I felt like Bridesmaids' Kristen Wiig (2011). I'm a flop. From here, things can only improve.

Later that night, I wore a mask and went to my roof to see the fireworks. Even though I don't like fireworks, there was something wonderful about them this year: the colors, how they illuminated the black surfaces around me, and their transient beauty. Joyful moments rarely linger long in our life. We must enjoy them now.

Several roofs away, my neighbors gathered. Happy 4th! I heard a woman yell. Why is this godforsaken country so happy? Instead of being rude, I replied. I didn't tell them I had monkeypox. I thought that would kill the mood.

By the time I went to the hospital the next day to get my lesions swabbed, wearing long sleeves, pants, and a mask, they looked like this:

I had 30 lesions on my arms, hands, stomach, back, legs, buttcheeks, face, scalp, and right eyebrow. I had some in my mouth, gums, and throat. Current medical thought is that lesions on mucous membranes cause discomfort in sensitive places. Internal lesions are a new feature of this outbreak of monkeypox. Despite being unattractive, the other sores weren't unpleasant or bothersome.

I had a bacterial sti with the pox. Who knows if that would've created symptoms (often it doesn't), but different infections can happen at once. My care team remembered that having a sti doesn't exclude out monkeypox. doxycycline rocks!

The coworker who introduced me to testing also offered me his home. We share a restroom, and monkeypox can be spread through surfaces. (Being a dna virus gives it environmental hardiness that rna viruses like sars-cov-2 lack.) I disinfected our bathroom after every usage, but I was apprehensive. My friend's place has a guest room and second bathroom, so no cross-contamination. It was the ideal monkeypox isolation environment, so I accepted his offer and am writing this piece there. I don't know what I would have done without his hospitality and attention.

The next day, I started tecovirimat, or tpoxx, for 14 days. Smallpox has been eradicated worldwide since the 1980s but remains a bioterrorism concern. Tecovirimat has a unique, orthopoxvirus-specific method of action, which reduces side effects to headache and nausea. It hasn't been used in many people, therefore the cdc is encouraging patients who take it for monkeypox to track their disease and symptoms.

Tpoxx's oral absorption requires a fatty meal. The hospital ordered me to take the medication after a 600-calorie, 25-gram-fat meal every 12 hours. The coordinator joked, "Don't diet for the next two weeks." I wanted to get peanut butter delivered, but jif is recalling their supply due to salmonella. Please give pathogens a break. I got almond butter.

Tpoxx study enrollment was documented. After signing consent documents, my lesions were photographed and measured during a complete physical exam. I got bloodwork to assess my health. My medication delivery was precise; every step must be accounted for. I got a two-week supply and started taking it that night. I rewarded myself with McDonald's. I'd been hungry for a week. I was also prescribed ketorolac (aka toradol), a stronger ibuprofen, for my discomfort.

I thought tpoxx was a wonder medicine by day two of treatment. Early lesions looked like this.

however, They vanished. The three largest lesions on my back flattened and practically disappeared into my skin. Some pustular lesions were diminishing. Tpoxx+toradol has helped me sleep, focus, and feel human again. I'm down to twice-daily baths and feeling hungrier than ever in this illness. On day five of tpoxx, some of the lesions look like this:

I have a ways to go. We must believe I'll be contagious until the last of my patches scabs over, falls off, and sprouts new skin. There's no way to tell. After a week and a half of tremendous pain and psychological stress, any news is good news. I'm grateful for my slow but steady development.

Part 2 of the rant.

Being close to yet not in the medical world is interesting. It lets me know a lot about it without being persuaded by my involvement. Doctors identify and treat patients using a tool called differential diagnosis.

A doctor interviews a patient to learn about them and their symptoms. More is better. Doctors may ask, "Have you traveled recently?" sex life? Have pets? preferred streaming service? (No, really. (Hbomax is right.) After the inquisition, the doctor will complete a body exam ranging from looking in your eyes, ears, and throat to a thorough physical.

After collecting data, the doctor makes a mental (or physical) inventory of all the conceivable illnesses that could cause or explain the patient's symptoms. Differential diagnosis list. After establishing the differential, the clinician can eliminate options. The doctor will usually conduct nucleic acid tests on swab samples or bloodwork to learn more. This helps eliminate conditions from the differential or boosts a condition's likelihood. In an ideal circumstance, the doctor can eliminate all but one reason of your symptoms, leaving your formal diagnosis. Once diagnosed, treatment can begin. yay! Love medicine.

My symptoms two weeks ago did not suggest monkeypox. Fever, pains, weariness, and swollen lymph nodes are caused by several things. My scandalous symptoms weren't linked to common ones. My instance shows the importance of diversity and representation in healthcare. My doctor isn't gay, but he provides culturally sensitive care. I'd heard about monkeypox as a gay man in New York. I was hyper-aware of it and had heard of friends of friends who had contracted it the week before, even though the official case count in the US was 40. My physicians weren't concerned, but I was. How would it appear on his mental differential if it wasn't on his radar? Mental differential rhymes! I'll trademark it to prevent theft. differential!

I was in a rare position to recognize my condition and advocate for myself. I study infections. I'd spent months researching monkeypox. I work at a university where I rub shoulders with some of the country's greatest doctors. I'm a gay dude who follows nyc queer social networks online. All of these variables positioned me to think, "Maybe this is monkeypox," and to explain why.

This outbreak is another example of privilege at work. The brokenness of our healthcare system is once again exposed by the inequities produced by the vaccination rollout and the existence of people like myself who can pull strings owing to their line of work. I can't cure this situation on my own, but I can be a strong voice demanding the government do a better job addressing the outbreak and giving resources and advice to everyone I can.

lgbtqia+ community members' support has always impressed me in new york. The queer community has watched out for me and supported me in ways I never dreamed were possible.

Queer individuals are there for each other when societal structures fail. People went to the internet on the first day of the vaccine rollout to share appointment information and the vaccine clinic's message. Twitter timelines were more effective than marketing campaigns. Contrary to widespread anti-vaccine sentiment, the LGBT community was eager to protect themselves. Smallpox vaccination? sure. gimme. whether I'm safe. I credit the community's sex positivity. Many people are used to talking about STDs, so there's a reduced barrier to saying, "I think I have something, you should be on the watch too," and taking steps to protect our health.

Once I got monkeypox, I posted on Twitter and Instagram. Besides fueling my main character syndrome, I felt like I wasn't alone. My dc-based friend had monkeypox within hours. He told me about his experience and gave me ideas for managing the discomfort. I can't imagine life without him.

My buddy and colleague organized my medical care and let me remain in his home. His and his husband's friendliness and attention made a world of difference in my recovery. All of my friends and family who helped me, whether by venmo, doordash, or moral support, made me feel cared about. I don't deserve the amazing people in my life.

Finally, I think of everyone who commented on my social media posts regarding my trip. Friends from all sectors of my life and all sexualities have written me well wishes and complimented me for my vulnerability, but I feel the most gravitas from fellow lgbtq+ persons. They're learning to spot. They're learning where to go ill. They're learning self-advocacy. I'm another link in our network of caretaking. I've been cared for, therefore I want to do the same. Community and knowledge are powerful.

You're probably wondering where the diatribe is. You may believe he's gushing about his loved ones, and you'd be right. I say that just because the queer community can take care of itself doesn't mean we should.

Even when caused by the same pathogen, comparing health crises is risky. Aids is unlike covid-19 or monkeypox, yet all were caused by poorly understood viruses. The lgbtq+ community has a history of self-medicating. Queer people (and their supporters) have led the charge to protect themselves throughout history when the government refused. Surreal to experience this in real time.

First, vaccination access is a government failure. The strategic national stockpile contains tens of thousands of doses of jynneos, the newest fda-approved smallpox vaccine, and millions of doses of acam2000, an older vaccine for immunocompetent populations. Despite being a monkeypox hotspot and international crossroads, new york has only received 7,000 doses of the jynneos vaccine. Vaccine appointments are booked within minutes. It's showing Hunger Games, which bothers me.

Second, I think the government failed to recognize the severity of the european monkeypox outbreak. We saw abroad reports in may, but the first vaccines weren't available until june. Why was I a 26-year-old pharmacology grad student, able to see a monkeypox problem in europe but not the u.s. public health agency? Or was there too much bureaucracy and politicking, delaying action?

Lack of testing infrastructure for a known virus with vaccinations and therapies is appalling. More testing would have helped understand the problem's breadth. Many homosexual guys, including myself, didn't behave like monkeypox was a significant threat because there were only a dozen instances across the country. Our underestimating of the issue, spurred by a story of few infections, was huge.

Public health officials' response to infectious diseases frustrates me. A wait-and-see approach to infectious diseases is unsatisfactory. Before a sick person is recognized, they've exposed and maybe contaminated numerous others. Vaccinating susceptible populations before a disease becomes entrenched prevents disease. CDC might operate this way. When it was easier, they didn't control or prevent monkeypox. We'll learn when. Sometimes I fear never. Emerging viral infections are a menace in the era of climate change and globalization, and I fear our government will repeat the same mistakes. I don't work at the cdc, thus I have no idea what they do. As a scientist, a homosexual guy, and a citizen of this country, I feel confident declaring that the cdc has not done enough about monkeypox. Will they do enough about monkeypox? The strategic national stockpile can respond to a bioterrorism disaster in 12 hours. I'm skeptical following this outbreak.

It's simple to criticize the cdc, but they're not to blame. Underfunding public health services, especially the cdc, is another way our government fails to safeguard its citizens. I may gripe about the vaccination rollout all I want, but local health departments are doing their best with limited resources. They may not have enough workers to keep up with demand and run a contact-tracing program. Since my orthopoxvirus test is still negative, the doh hasn't asked about my close contacts. By then, my illness will be two weeks old, too long to do anything productive. Not their fault. They're functioning in a broken system that's underfunded for the work it does.

*Update, 7/11: I have orthopoxvirus.

Monkeypox is slow, so i've had time to contemplate. Now that I'm better, I'm angry. furious and sad I want to help. I wish to spare others my pain. This was preventable and solvable, I hope. HOW?

Third, the duty.

Family, especially selected family, helps each other. So many people have helped me throughout this difficult time. How can I give back? I have ideas.

1. Education. I've already started doing this by writing incredibly detailed posts on Instagram about my physical sickness and my thoughts on the entire scandal. via tweets. by producing this essay. I'll keep doing it even if people start to resent me! It's crucial! On my Instagram profile (@kyleplanckton), you may discover a story highlight with links to all of my bizarre yet educational posts.

2. Resources. I've forwarded the contact information for my institution's infectious diseases clinic to several folks who will hopefully be able to get tpoxx under the expanded use policy. Through my social networks, I've learned of similar institutions. I've also shared crowdsourced resources about symptom relief and vaccine appointment availability on social media. DM me or see my Instagram highlight for more.

3. Community action. During my illness, my friends' willingness to aid me has meant the most. It was nice to know I had folks on my side. One of my pals (thanks, kenny) snagged me a mcgriddle this morning when seamless canceled my order. This scenario has me thinking about methods to help people with monkeypox isolation. A two-week isolation period is financially damaging for many hourly workers. Certain governments required paid sick leave for covid-19 to allow employees to recover and prevent spread. No comparable program exists for monkeypox, and none seems to be planned shortly.

I want to aid monkeypox patients in severe financial conditions. I'm willing to pick up and bring groceries or fund meals/expenses for sick neighbors. I've seen several GoFundMe accounts, but I wish there was a centralized mechanism to link those in need with those who can help. Please contact me if you have expertise with mutual aid organizations. I hope we can start this shortly.

4. lobbying. Personal narratives are powerful. My narrative is only one, but I think it's compelling. Over the next day or so, i'll write to local, state, and federal officials about monkeypox. I wanted a vaccine but couldn't acquire one, and I feel tpoxx helped my disease. As a pharmacologist-in-training, I believe collecting data on a novel medicine is important, and there are ethical problems when making a drug with limited patient data broadly available. Many folks I know can't receive tpoxx due of red tape and a lack of contacts. People shouldn't have to go to an ivy league hospital to obtain the greatest care. Based on my experience and other people's tales, I believe tpoxx can drastically lessen monkeypox patients' pain and potentially curb transmission chains if administered early enough. This outbreak is manageable. It's not too late if we use all the instruments we have (diagnostic, vaccine, treatment).

*UPDATE 7/15: I submitted the following letter to Chuck Schumer and Kirsten Gillibrand. I've addressed identical letters to local, state, and federal officials, including the CDC and HHS.

I hope to join RESPND-MI, an LGBTQ+ community-led assessment of monkeypox symptoms and networks in NYC. Visit their website to learn more and give to this community-based charity.

How I got monkeypox is a mystery. I received it through a pride physical interaction, but i'm not sure which one. This outbreak will expand unless leaders act quickly. Until then, I'll keep educating and connecting people to care in my neighborhood.

Despite my misgivings, I see some optimism. Health department social media efforts are underway. During the outbreak, the CDC provided nonjudgmental suggestions for safer social and sexual activity. There's additional information regarding the disease course online, including how to request tpoxx for sufferers. These materials can help people advocate for themselves if they're sick. Importantly, homosexual guys are listening when they discuss about monkeypox online and irl. Learners They're serious.

The government has a terrible track record with lgtbq+ health issues, and they're not off to a good start this time. I hope this time will be better. If I can aid even one individual, I'll do so.

Thanks for reading, supporting me, and spreading awareness about the 2022 monkeypox outbreak. My dms are accessible if you want info, resources, queries, or to chat.

y'all well

kyle