Putin's War On Reality
The dictator's playbook.
Stalin's successor, Nikita Khrushchev, delivered a speech titled "On The Cult Of Personality And Its Consequences" in 1956, three years after Stalin’s death.
It was Stalin's grave abuse of power that caused untold harm to our party.
Stalin acted not by persuasion, explanation, or patient cooperation, but by imposing his ideas and demanding absolute obedience. […]
See where Stalin's mania for greatness led? He had lost all sense of reality.
The speech, which was never made public, shook the Soviet Union and the Soviet Bloc. After Stalin's "cult of personality" was exposed as a lie, only reality remained.
As I've watched the nightmare unfold in Ukraine, I'm reminded of that question. Primarily by Putin's repeated denials.
His odd claim that Ukraine is run by drug addicts and Nazis (especially strange given that Volodymyr Zelenskyy, the Ukrainian president, is Jewish). Others attempt to portray Russia as liberators rather than occupiers. For example, he portrays Luhansk and Donetsk as plucky, newly independent states when they have been totalitarian statelets for 8 years.
Putin seemed to have lost all sense of reality.
Maybe that's why his remarks to an oligarchs' gathering stood out:
Everything is a desperate measure. They gave us no choice. We couldn't do anything about their security risks. […] They could have put the country in jeopardy.
This is almost certainly true from Putin's perspective. Even for Putin, a military invasion seems unlikely. So, what exactly is putting Russia's security in jeopardy? How could Ukraine's independence endanger Russia's existence?
The truth is the only thing that truly terrifies leaders like these.
Trump, the president of “alternative facts,” "and “fake news” praised Putin's fabricated justifications for the Ukraine invasion. Russia tightened news censorship as news of their losses came in. It's no accident that modern dictatorships like Russia (and China and North Korea) restrict citizens' access to information.
Controlling what people see, hear, and think is the simplest method. And Ukraine's recent efforts to join the European Union showed a country whose thoughts Putin couldn't control. With the Russian and Ukrainian peoples so close, he could not control their reality.
He appears to think this is a threat worth fighting NATO over.
It's easy to disown history's great dictators. By the magnitude of their harm. But the strategy they used is still in use today, albeit not to the same devastating effect.
The Kim dynasty in North Korea has ruled for 74 years, Putin has ruled Russia for 19 years (using loopholes and even rewriting the constitution).
“Politicians and diapers must be changed frequently,” said Mark Twain. "And for the same reason.”
When their egos are threatened, they sabre-rattle, as in Kim Jong-un and Donald Trump's famous spat about the size of their...ahem, “nuclear buttons”." Or Putin's threats of mutual destruction this weekend.
Most importantly, they have cult-like control over their followers.
When a leader whose power is built on lies feels he is losing control of the narrative, things like Trump's Jan. 6 meltdown and Putin's current actions in Ukraine are unavoidable.
Leaders who try to control their people's reality will have to die to keep the illusion alive.
Long version of this post available here
More on Current Events

Bloomberg
3 years ago
Expulsion of ten million Ukrainians
According to recent data from two UN agencies, ten million Ukrainians have been displaced.
The International Organization for Migration (IOM) estimates nearly 6.5 million Ukrainians have relocated. Most have fled the war zones around Kyiv and eastern Ukraine, including Dnipro, Zhaporizhzhia, and Kharkiv. Most IDPs have fled to western and central Ukraine.
Since Russia invaded on Feb. 24, 3.6 million people have crossed the border to seek refuge in neighboring countries, according to the latest UN data. While most refugees have fled to Poland and Romania, many have entered Russia.
Internally displaced figures are IOM estimates as of March 19, based on 2,000 telephone interviews with Ukrainians aged 18 and older conducted between March 9-16. The UNHCR compiled the figures for refugees to neighboring countries on March 21 based on official border crossing data and its own estimates. The UNHCR's top-line total is lower than the country totals because Romania and Moldova totals include people crossing between the two countries.
Sources: IOM, UNHCR
According to IOM estimates based on telephone interviews with a representative sample of internally displaced Ukrainians, over 53% of those displaced are women, and over 60% of displaced households have children.
Gill Pratt
3 years ago
War's Human Cost
War's Human Cost
I didn't start crying until I was outside a McDonald's in an Olempin, Poland rest area on highway S17.
Children pick toys at a refugee center, Olempin, Poland, March 4, 2022.
Refugee children, mostly alone with their mothers, but occasionally with a gray-haired grandfather or non-Ukrainian father, were coaxed into picking a toy from boxes provided by a kind-hearted company and volunteers.
I went to Warsaw to continue my research on my family's history during the Holocaust. In light of the ongoing Ukrainian conflict, I asked former colleagues in the US Department of Defense and Intelligence Community if it was safe to travel there. They said yes, as Poland was a NATO member.
I stayed in a hotel in the Warsaw Ghetto, where 90% of my mother's family was murdered in the Holocaust. Across the street was the first Warsaw Judenrat. It was two blocks away from the apartment building my mother's family had owned and lived in, now dilapidated and empty.
Building of my great-grandfather, December 2021.
A mass grave of thousands of rocks for those killed in the Warsaw Ghetto, I didn't cry when I touched its cold walls.
Warsaw Jewish Cemetery, 200,000–300,000 graves.
Mass grave, Warsaw Jewish Cemetery.
My mother's family had two homes, one in Warszawa and the rural one was a forest and sawmill complex in Western Ukraine. For the past half-year, a local Ukrainian historian had been helping me discover faint traces of her family’s life there — in fact, he had found some people still alive who remembered the sawmill and that it belonged to my mother’s grandfather. The historian was good at his job, and we had become close.
My historian friend, December 2021, talking to a Ukrainian.
With war raging, my second trip to Warsaw took on a different mission. To see his daughter and one-year-old grandson, I drove east instead of to Ukraine. They had crossed the border shortly after the war began, leaving men behind, and were now staying with a friend on Poland's eastern border.
I entered after walking up to the house and settling with the dog. The grandson greeted me with a huge smile and the Ukrainian word for “daddy,” “Tato!” But it was clear he was awaiting his real father's arrival, and any man he met would be so tentatively named.
After a few moments, the boy realized I was only a stranger. He had musical talent, like his mother and grandfather, both piano teachers, as he danced to YouTube videos of American children's songs dubbed in Ukrainian, picking the ones he liked and crying when he didn't.
Songs chosen by my historian friend's grandson, March 4, 2022
He had enough music and began crying regardless of the song. His mother picked him up and started nursing him, saying she was worried about him. She had no idea where she would live or how she would survive outside Ukraine. She showed me her father's family history of losses in the Holocaust, which matched my own research.
After an hour of drinking tea and trying to speak of hope, I left for the 3.5-hour drive west to Warsaw.
It was unlike my drive east. It was reminiscent of the household goods-filled carts pulled by horses and people fleeing war 80 years ago.
Jewish refugees relocating, USHMM Holocaust Encyclopaedia, 1939.
The carefully chosen trinkets by children to distract them from awareness of what is really happening and the anxiety of what lies ahead, made me cry despite all my research on the Holocaust. There is no way for them to communicate with their mothers, who are worried, absent, and without their fathers.
It's easy to see war as a contest of nations' armies, weapons, and land. The most costly aspect of war is its psychological toll. My father screamed in his sleep from nightmares of his own adolescent trauma in Warsaw 80 years ago.
Survivor father studying engineering, 1961.
In the airport, I waited to return home while Ukrainian public address systems announced refugee assistance. Like at McDonald's, many mothers were alone with their children, waiting for a flight to distant relatives.
That's when I had my worst trip experience.
A woman near me, clearly a refugee, answered her phone, cried out, and began wailing.
The human cost of war descended like a hammer, and I realized that while I was going home, she never would

B Kean
2 years ago
To prove his point, Putin is prepared to add 200,000 more dead soldiers.
What does Ukraine's murderous craziness mean?
Vladimir Putin expressed his patience to Israeli Prime Minister Naftali Bennet. Thousands, even hundreds of thousands of young and middle-aged males in his country have no meaning to him.
During a meeting in March with Prime Minister Naftali Bennett of Israel, Mr. Putin admitted that the Ukrainians were tougher “than I was told,” according to two people familiar with the exchange. “This will probably be much more difficult than we thought. But the war is on their territory, not ours. We are a big country and we have patience (The Inside Story of a Catastrophe).”
Putin should explain to Russian mothers how patient he is with his invasion of Ukraine.
Putin is rich. Even while sanctions have certainly limited Putin's access to his fortune, he has access to everything in Russia. Unlimited wealth.
The Russian leader's infrastructure was designed with his whims in mind. Vladimir Putin is one of the wealthiest and most catered-to people alive. He's also all-powerful, as his lack of opposition shows. His incredible wealth and power have isolated him from average people so much that he doesn't mind turning lives upside down to prove a point.
For many, losing a Russian spouse or son is painful. Whether the soldier was a big breadwinner or unemployed, the loss of a male figure leaves many families bewildered and anxious. Putin, Russia's revered president, seems unfazed.
People who know Mr. Putin say he is ready to sacrifice untold lives and treasure for as long as it takes, and in a rare face-to-face meeting with the Americans last month the Russians wanted to deliver a stark message to President Biden: No matter how many Russian soldiers are killed or wounded on the battlefield, Russia will not give up (The Inside Story of a Catastrophe).
Imagine a country's leader publicly admitting a mistake he's made. Imagine getting Putin's undivided attention.
So, I underestimated Ukrainians. I can't allow them make me appear terrible, so I'll utilize as many drunken dopes as possible to cover up my error. They'll die fulfilled and heroic.
Russia's human resources are limited, but its willingness to cause suffering is not. How many Russian families must die before the curse is broken? If mass protests started tomorrow, Russia's authorities couldn't stop them.
When Moscovites faced down tanks in August 1991, the Gorbachev coup ended in three days. Even though few city residents showed up, everything collapsed. This wicked disaster won't require many Russians.
One NATO member is warning allies that Mr. Putin is ready to accept the deaths or injuries of as many as 300,000 Russian troops — roughly three times his estimated losses so far.
If 100,000 Russians have died in Ukraine and Putin doesn't mind another 200,000 dying, why don't these 200,000 ghosts stand up and save themselves? Putin plays the role of concerned and benevolent leader effectively, but things aren't going well for Russia.
What would 300,000 or more missing men signify for Russia's future? How many kids will have broken homes? How many families won't form, and what will the economy do?
Putin reportedly cared about his legacy. His place in Russian history Putin's invasion of Ukraine settled his legacy. He has single-handedly weakened and despaired Russia since the 1980s.
Putin will be viewed by sensible people as one of Russia's worst adversaries, but Russians will think he was fantastic despite Ukraine.
The more setbacks Mr. Putin endures on the battlefield, the more fears grow over how far he is willing to go. He has killed tens of thousands in Ukraine, leveled cities, and targeted civilians for maximum pain — obliterating hospitals, schools, and apartment buildings while cutting off power and water to millions before winter. Each time Ukrainian forces score a major blow against Russia, the bombing of their country intensifies. And Mr. Putin has repeatedly reminded the world that he can use anything at his disposal, including nuclear arms, to pursue his notion of victory.
How much death and damage will there be in Ukraine if Putin sends 200,000 more Russians to the front? It's scary, sad, and sick.
Monster.
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Katrina Paulson
3 years ago
Dehumanization Against Anthropomorphization
We've fought for humanity's sake. We need equilibrium.
We live in a world of opposites (black/white, up/down, love/hate), thus life is a game of achieving equilibrium. We have a universe of paradoxes within ourselves, not just in physics.
Individually, you balance your intellect and heart, but as a species, we're full of polarities. They might be gentle and compassionate, then ruthless and unsympathetic.
We desire for connection so much that we personify non-human beings and objects while turning to violence and hatred toward others. These contrasts baffle me. Will we find balance?
Anthropomorphization
Assigning human-like features or bonding with objects is common throughout childhood. Cartoons often give non-humans human traits. Adults still anthropomorphize this trait. Researchers agree we start doing it as infants and continue throughout life.
Humans of all ages are good at humanizing stuff. We build emotional attachments to weather events, inanimate objects, animals, plants, and locales. Gods, goddesses, and fictitious figures are anthropomorphized.
Cast Away, starring Tom Hanks, features anthropization. Hanks is left on an island, where he builds an emotional bond with a volleyball he calls Wilson.
We became emotionally invested in Wilson, including myself.
Why do we do it, though?
Our instincts and traits helped us survive and thrive. Our brain is alert to other people's thoughts, feelings, and intentions to assist us to determine who is safe or hazardous. We can think about others and our own mental states, or about thinking. This is the Theory of Mind.
Neurologically, specialists believe the Theory of Mind has to do with our mirror neurons, which exhibit the same activity while executing or witnessing an action.
Mirror neurons may contribute to anthropization, but they're not the only ones. In 2021, Harvard Medical School researchers at MGH and MIT colleagues published a study on the brain's notion of mind.
“Our study provides evidence to support theory of mind by individual neurons. Until now, it wasn’t clear whether or how neurons were able to perform these social cognitive computations.”
Neurons have particular functions, researchers found. Others encode information that differentiates one person's beliefs from another's. Some neurons reflect tale pieces, whereas others aren't directly involved in social reasoning but may multitask contributing factors.
Combining neuronal data gives a precise portrait of another's beliefs and comprehension. The theory of mind describes how we judge and understand each other in our species, and it likely led to anthropomorphism. Neuroscience indicates identical brain regions react to human or non-human behavior, like mirror neurons.
Some academics believe we're wired for connection, which explains why we anthropomorphize. When we're alone, we may anthropomorphize non-humans.
Humanizing non-human entities may make them deserving of moral care, according to another theory. Animamorphizing something makes it responsible for its actions and deserves punishments or rewards. This mental shift is typically apparent in our connections with pets and leads to deanthropomorphization.
Dehumanization
Dehumanizing involves denying someone or anything ethical regard, the opposite of anthropomorphizing.
Dehumanization occurs throughout history. We do it to everything in nature, including ourselves. We experiment on and torture animals. We enslave, hate, and harm other groups of people.
Race, immigrant status, dress choices, sexual orientation, social class, religion, gender, politics, need I go on? Our degrading behavior is promoting fascism and division everywhere.
Dehumanizing someone or anything reduces their agency and value. Many assume they're immune to this feature, but tests disagree.
It's inevitable. Humans are wired to have knee-jerk reactions to differences. We are programmed to dehumanize others, and it's easier than we'd like to admit.
Why do we do it, though?
Dehumanizing others is simpler than humanizing things for several reasons. First, we consider everything unusual as harmful, which has helped our species survive for hundreds of millions of years. Our propensity to be distrustful of others, like our fear of the unknown, promotes an us-vs.-them mentality.
Since WWII, various studies have been done to explain how or why the holocaust happened. How did so many individuals become radicalized to commit such awful actions and feel morally justified? Researchers quickly showed how easily the mind can turn gloomy.
Stanley Milgram's 1960s electroshock experiment highlighted how quickly people bow to authority to injure others. Philip Zimbardo's 1971 Stanford Prison Experiment revealed how power may be abused.
The us-versus-them attitude is natural and even young toddlers act on it. Without a relationship, empathy is more difficult.
It's terrifying how quickly dehumanizing behavior becomes commonplace. The current pandemic is an example. Most countries no longer count deaths. Long Covid is a major issue, with predictions of a handicapped tsunami in the future years. Mostly, we shrug.
In 2020, we panicked. Remember everyone's caution? Now Long Covid is ruining more lives, threatening to disable an insane amount of our population for months or their entire lives.
There's little research. Experts can't even classify or cure it. The people should be outraged, but most have ceased caring. They're over covid.
We're encouraged to find a method to live with a terrible pandemic that will cause years of damage. People aren't worried about infection anymore. They shrug and say, "We'll all get it eventually," then hope they're not one of the 30% who develops Long Covid.
We can correct course before further damage. Because we can recognize our urges and biases, we're not captives to them. We can think critically about our thoughts and behaviors, then attempt to improve. We can recognize our deficiencies and work to attain balance.
Changing perspectives
We're currently attempting to find equilibrium between opposites. It's superficial to defend extremes by stating we're only human or wired this way because both imply we have no control.
Being human involves having self-awareness, and by being careful of our thoughts and acts, we can find balance and recognize opposites' purpose.
Extreme anthropomorphizing and dehumanizing isolate and imperil us. We anthropomorphize because we desire connection and dehumanize because we're terrified, frequently of the connection we crave. Will we find balance?
Katrina Paulson ponders humanity, unanswered questions, and discoveries. Please check out her newsletters, Curious Adventure and Curious Life.

Katrine Tjoelsen
3 years ago
8 Communication Hacks I Use as a Young Employee
Learn these subtle cues to gain influence.
Hate being ignored?
As a 24-year-old, I struggled at work. Attention-getting tips How to avoid being judged by my size, gender, and lack of wrinkles or gray hair?
I've learned seniority hacks. Influence. Within two years as a product manager, I led a team. I'm a Stanford MBA student.
These communication hacks can make you look senior and influential.
1. Slowly speak
We speak quickly because we're afraid of being interrupted.
When I doubt my ideas, I speak quickly. How can we slow down? Jamie Chapman says speaking slowly saps our energy.
Chapman suggests emphasizing certain words and pausing.
2. Interrupted? Stop the stopper
Someone interrupt your speech?
Don't wait. "May I finish?" No pause needed. Stop interrupting. I first tried this in Leadership Laboratory at Stanford. How quickly I gained influence amazed me.
Next time, try “May I finish?” If that’s not enough, try these other tips from Wendy R.S. O’Connor.
3. Context
Others don't always see what's obvious to you.
Through explanation, you help others see the big picture. If a senior knows it, you help them see where your work fits.
4. Don't ask questions in statements
“Your statement lost its effect when you ended it on a high pitch,” a group member told me. Upspeak, it’s called. I do it when I feel uncertain.
Upspeak loses influence and credibility. Unneeded. When unsure, we can say "I think." We can even ask a proper question.
Someone else's boasting is no reason to be dismissive. As leaders and colleagues, we should listen to our colleagues even if they use this speech pattern.
Give your words impact.
5. Signpost structure
Signposts improve clarity by providing structure and transitions.
Communication coach Alexander Lyon explains how to use "first," "second," and "third" He explains classic and summary transitions to help the listener switch topics.
Signs clarify. Clarity matters.
6. Eliminate email fluff
“Fine. When will the report be ready? — Jeff.”
Notice how senior leaders write short, direct emails? I often use formalities like "dear," "hope you're well," and "kind regards"
Formality is (usually) unnecessary.
7. Replace exclamation marks with periods
See how junior an exclamation-filled email looks:
Hi, all!
Hope you’re as excited as I am for tomorrow! We’re celebrating our accomplishments with cake! Join us tomorrow at 2 pm!
See you soon!
Why the exclamation points? Why not just one?
Hi, all.
Hope you’re as excited as I am for tomorrow. We’re celebrating our accomplishments with cake. Join us tomorrow at 2 pm!
See you soon.
8. Take space
"Playing high" means having an open, relaxed body, says Stanford professor and author Deborah Gruenfield.
Crossed legs or looking small? Relax. Get bigger.

Kyle Planck
3 years ago
The chronicles of monkeypox.
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
