Rachel Litchman

Step Therapy

-in honor of Carrie Ann Lucas and Dr. Bill Peace

The way you play this game is simple: there is a boy 
on a skateboard and the boy has four lives. The goal of 

            the game is to get the boy on the skateboard to the end
            of the racecourse. The racecourse is not an oval 

                           or a circle; it’s a city. Miles translate into a pixels. The
                           pixels may be counted. The counting, of course, is not 

                                         a requirement, but a strategy: 

                                                                                  the math works like this: a clinitron bed,
could relieve the pressure on bedsores,
upwards of 40,000 dollars. Less than one
of infected blood may lead to sepsis. If
                                                                                     septic I
would be hospitalized and placed in a
                                                                                     clinitron bed.
Once sepsis is cleared I would be sent
                                                                                     home and to
the same bed that caused my wounds.
                                                                                     An obvious
pattern would emerge.[1]

The city is blocked off by buildings. The stairs 
supplemented by railings. The ramps are 

            fashioned into figure eights. To take the stairs would crack
            the skull. To ride the railings would break a leg. To risk

                           the ramps would lie to gravity. The skateboard boy
                           has four lives and with each death he can experience

                                        partial revival. The funding for complete revival floats at the end
                                        of the racecourse in a pot of stars. The pot of stars is surrounded by

                                                       a pit of fire and evil wizards. The evil wizards hold
                                                       both the wand of Sudden Death and the Key to Level Up

                                                                                      The concept of step therapy is simple: just
                                                                                      because something is expensive doesn’t mean it’s
                                                                                      the best option. A medication made out of dirt is the
                                                                                      same as a medication made out of chemicals. Both
                                                                                      drugs have capsules. Both drugs are dissolvable.
                                                                                      The idea is not to dwell on differences but to be
                                                                                      grateful for your temporary survival.

In a simulated attempt to Level-Up, the skateboard boy calculates
the inertia needed to conquer the ramps. The skateboard boy

            succeeds the figure eight but on the way down gets shocked
            by the wizard’s wand of death. The boy loses one life, revives

                           inside the pit of fire and loses a second life. The skateboard
                           boy bleeds from his neck and stomach. He can see

                                        the pot of stars, but, oh, are the wizards laughing.

                                                                                 The concept of step therapy in practice: Because
                                                                                    Carrie Ann worked for the state, she had to use
                                                                                    state insurance…. In January of 2018 she got a cold
                                                                                    which turned into a trach and lung infection. Her
                                                                                    insurance company UnitedHealthcare, refused to
                                                                                    pay for the one specific inhaled antibiotic that she
                                                                                    really needed. She had to take a less effective drug
                                                                                    and had a bad reaction to that drug.[2]

To revive from the second death is to not to be confused
with the revival of Jesus. The body quivers with

            electricity. Nerves tingle. Burn marks fester
            and bleed. Bacteria crawls into open sores

                           and tissue necrotizes. Stars blur into the retina, 
                           begins visual snow. Lack of blood flow to the brain…

                                                                                    Bouts of sepsis, an increasing number of wounds     
                                                                                    and hospitalizations. Over the period of time my
                                                                                    body will weaken, sepsis will become increasingly
                                                                                    difficult to treat and recover from.[1] In this state,
                                                                                 the wizard shocks the boy again. 

Of course, there are strategies: trick the wizard,
take out the middleman, start a go-fund me, grow 

            a rich uncle, a relationship with the president, unblock
            the buildings, throw the wizard into the fire,

                           fix the ramps, find the bug, rewrite the program.

                                                                                      My name is Carrie Ann Lucas. I am here today on
                                                                                      behalf of Not Dead Yet … If I were to become
                                                                                      depressed… and this bill passes, I could go to my
                                                                                      doctor and ask for a lethal prescription. Because I
                                                                                      have a disability, and because physicians are
                                                                                      terrible at evaluating quality of life of people with
                                                                                      disabilities, I would likely be given that lethal

                           The doctor comes into your room in the hospital at night
                           and shares the math with you: 

                           this medication, bed, treatment, pill, stars, Level-Up 
                           will costs 2,000 dollars. Not to mention the cost
                           of wound care is astronomical.

                           It’s your choice how you would like to proceed,
                           he says gently. He tells you he can make you very comfortable. 

[1] Peace, Bill “Worse Wound Care Woes” Bad Cripple. 24, April, 2019,

[2]Lucas, Carrie Ann. Carrie Ann Lucas Death. Facebook. 24 Feb. 2019
        Accessed 26, Oct. 2019

[3] Lucas, Carrie Ann. “Carrie Ann Lucas Testimony in Opposition of Colorado SB 16-025.”
        Not Dead Yet, 3 Feb. 2016, notdeadyet.org/carrie-ann-lucas-testimony-in-opposition-of-
        sb-16-025. Accessed 27 Oct. 2019.


Rachel Litchman (Rachel DL) is a queer, disabled artist, writer, and member of the Dane County Youth Action Board. Her work centers themes of survivorship, trauma, chronic illness, disability rights and justice. She has been published in Colorado Review, Rooted in Rights, Redivider, and Black Warrior Review, among other places. She is at work on a graphic novel about being hospitalized during the COVID-19 pandemic. You can find her on twitter @wordcalculator or on her website racheldl.com.