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Sarah Kate Kendrick with spacer and inhaler, age 7,
Hendersonville, NC
Downstream: Mountaintop Removal and Asthma
Sarah Kate’s hair is damp in the crick of her neck as I tuck
her into bed. Golden curls cup her face, and eyes, deep brown
as the nutrient-rich earth, gaze at me. I search the small
cavity at the base of her neck to see if she’s struggling to
suck in air. There’s a technical term for this, but I’ve
forgotten it. Generally, it’s neither sucking nor wheezing
that alert me to an asthma attack. It’s a chronic cough that
rasps every ten seconds and never resolves. I asked Dr.
Lester why I never hear her wheeze. He said that wheezing
requires a certain amount of air flow. Wheezing would be
preferable, a sign that air was passing through the lungs with
minor obstruction.
Her skin is pale, and though Sarah Kate’s an active child, she
looks sickly. “Please Mama, one more story,” she begs. “Read
this one.”
She hands me a collection of Mother Goose rhymes that runs for
seventy-five pages. I read about Jack Spratt who ate no fat,
Little Boy Blue asleep in the hay, the old woman who lived in
a shoe, and three blind mice. “How about we stop here,” I
say, placing a paper marker on the page.
“No, Mommy, more. Please!”
“We’ll finish the book tomorrow,” I promise, tucking a Little
Mermaid comforter under her chin. She turns onto her side so
I can scratch her back. “Hush little baby, don’t say a word.
. .”
Sarah Kate is two-and-one-half years old. She takes sixteen
doses of medication a day for asthmatic symptoms, some of
which include amphetamines. Dr. Lester will not diagnose her
with asthma until she has several attacks over at least a six
month period. We’ve reached month four and three separate
attacks requiring midnight runs to the local emergency room
where Sarah is hooked up to a breathing machine. I’ve never
loved a medical facility so much. After the panic of a late
night call to the pediatrician and the sight of a twenty-one
pound child with dark circles under her eyes gasping for
breath, the bright lights of Kosair Children’s Hospital beckon
like the star that led the wise men to Bethlehem.
My sleeping daughter is beautiful. Gone is the cranky
disposition caused by medications that rev her up and make it
impossible for her to rest. One morning I counted: every
twenty seconds her mood shifted like a summer squall—from
smiling to crying to screaming to playing to kicking and
pounding her fists on the floor. For now, there is peace.
Sarah Kate clutches her flannel baby doll in her right hand.
Her delicate eyelashes, like crystal filigree, cast the
slimmest shadow against her cheek. I lean down to kiss her
face, savoring the softness of her skin and the scent of
Johnson’s baby shampoo. “I love you, Sweetie.”
At 10:30, I retire knowing my sleep will be disrupted by
Sarah’s cries eight to twelve times during the night. She may
not need anything, in fact, will likely be crying in her
sleep, but I rise to check her anyway.
~~~~~
I
first witnessed strip mining’s destructive power nearly forty
years ago while traveling through eastern Kentucky on
Interstate 75. From the ridgeline between Williamsburg,
Kentucky and Jellico, Tennessee I saw mountains in all
directions whose contours had been ripped away to expose
gouged rock where lush forest had once thrived. Public outcry
in the 60’s and 70’s yielded some gains for ecology so that
strip mining, while not stopped, was at least slowed and moved
further from public view. Hearing nothing more reported by
the media, I naively assumed the matter was settled.
But recently, while reading Erik Reese’s book, Lost
Mountain, I discovered that a more destructive form of
strip mining called mountaintop removal has been leveling the
Appalachians with increased speed and efficiency. This form
of coal mining blasts off entire mountain tops, dumping left
over rock and debris into the valleys below (4). What remains
resembles a moonscape.
Debris from mountaintop removal was originally designated as
“waste” and regulations were developed to guide its disposal.
However, in May 2002, the EPA ruled that debris from
mountaintop removal be reclassified as “fill.” “Fill”,
composed of sulfuric acid and other toxins, can be dumped in
streams (Ray 44).
Estimates of streams buried by mountaintop removal range from
700 to 1,500 miles. These streams serve as the headwaters of
river basins below the mountains such as the Big Sandy that in
turn, feed larger water systems.
“It’s a terrible thing when they destroy where you’ve lived
all your life,” laments Eugene Mullins in an editorial to the
Courier-Journal. He continues: “Puncheon Creek is part
of the headwaters of the Big Sandy River. This is where the
river starts. That means the river is going to be polluted
all the way down.”
~~~~~
Sarah Kate’s breathing machine plugs into a socket in the wall
next to the bunk bed where she and her sister sleep. The
nebulizer is an off-white metal box one foot square with an
enclosed motor that pumps air and produces a steady mist when
combined with her medicines. Four feet of clear plastic
tubing fits onto a nodule on the side of the machine and
connects to a small plastic canister about 1 ½ inches in
diameter. I snap one tube of Albuterol, a form of Prednisone,
and pour it into the canister. Next, I draw up Pulmicort in a
dropper and release it into the vial. A blue plastic top
screws tightly and connects to a mask I place against Sarah
Kate’s face. A green piece of elastic secures the apparatus
to her head, leaving her hands free to color in her Beauty and
the Beast coloring book. I flip the black switch and the
nebulizer drones like a small engine. As Sarah breathes, she
absorbs medicine through the mist.
Two weeks ago, Dr. Lester officially diagnosed Sarah Kate with
asthma. A respiratory therapist came to our home and showed
us how to operate the nebulizer. Since then, we’ve been able
to treat Sarah Kate at home instead of rushing to the
emergency room. Every four hours, we hook her up to the
machine. Afterward, her coughing stops. Like the waters of
baptism, relief pours over me and I’m reborn.
~~~~~
More than fifty percent of American homes depend upon
electricity generated by coal-fired power plants (Reese 3).
When you flip a light switch, put a load in the wash, run your
dishwasher, or cook with an electric stove, you utilize power
generated by coal.
“100 tons of coal are extracted every two seconds in Kentucky,
West Virginia, Wyoming, Pennsylvania, and a handful of other
states,” writes Erik Reese. “Nearly 70 percent of that coal
comes from surface mines” (3).
Big coal is big money. “Kentucky ranks third in national
production of coal,” writes Stephen George, “But 80% of the
region’s coal leaves the state. . . It is a
multibillion-dollar international industry. . . . But
suggesting that money is fed back into the economies of the
counties where coal is mined reveals . . . dyspeptic logic”
(26).
Best-selling Appalachian author Silas House comes from a coal
mining family. He claims, “I’m proud of every single person
in my family who has worked like a dog trying to make a living
in the coal mines. But I can’t tolerate the industry titans
that so blatantly abuse the land and the people who have made
them rich” (43).
~~~~~
My parents, brother, and I, first drove through the mountains
of Eastern Kentucky to vacation in the Blue Ridge Mountains of
North Carolina when I was eleven years old. But it wasn’t
until the next year, when I turned twelve that I fell in love
with the sandy creek bottoms and towering pines of the
Appalachian range. Lured by the scent of Sassafras, I roamed
wooded trails and stomped through creeks draped in purple
Rhododendron. Beneath a canopy of white oak and hickory, I
followed the flight of a Pilleated woodpecker as it swooped
through the forest and came to rest against the trunk of a
hollow tree.
That same year, I conducted research as part of an assignment
for my biology class. I compared wild flowers growing on
north and south facing slopes in the woods behind my house in
Louisville, Kentucky. As early as mid-March, hepaticas,
trillium, and wild ginger began poking through dead leaves.
Then came red columbine with yellow stamens perching at the
edge of cliffs. Next, larkspur, wild phlox, and purple
delphinium flanked the hillside down to Goose Creek. By early
summer, shooting star, blood root, trout lilies, and
jack-in-the pulpits bloomed.
In later years, hiking the hills of eastern Kentucky near
Berea, Cumberland Falls, and Pine Mountain, I discovered these
same wildflowers, as well as others like pink lady’s slipper
and dwarf iris. By then, these mountains of redbud and
dogwood, southern pine and hemlock, felt like kin to me.
On a recent trip to Pine Mountain Settlement School in Letcher
County Kentucky, I discovered Lilley Cornett Woods which
serves as the Appalachian Ecological Research Station of
Eastern Kentucky University. Scanning a brochure, I read that
that the “rich mixture of plant life in the cool, moist
environments of these mountains led [Dr. E. Lucy Braun of the
University of Cincinnati] to designate this part of Kentucky
as the center of ‘The Mixed Mesophytic Forest Region,’ a
forest ecosystem that covered the Appalachian Plateau from
Alabama to Pennsylvania (‘Mixed” refers to the mixture of
several species of canopy trees; ‘Mesophytic’ refers to plants
that favor moist habitats).”
Braun considered this kind of forest to be of great
antiquity. Although the trees live for only a few hundred
years, she argued that this type of temperate deciduous forest
had been here for millions of years because of the species
diversity and environmental stability. Further, Braun claimed
this part of Kentucky was the center of development for the
rest of the deciduous forests of the eastern United States
(Lilley).
This disappearing forest is home to nearly eighty different
species of trees, 530 species of flowering plants, and 700
breeding pairs of birds (Lilley).
~~~~~
Sarah Kate is six-years-old, and her asthma is worsening.
I’ve been giving her breathing treatments so many nights I’ve
lost count. For three days, my heart has raced and I’ve had
trouble catching my breath. I don’t understand: I breastfed
my babies. Breastfeeding was supposed to protect my children
from allergies. Allergies, I’m told, trigger asthma.
“Asthma,” I read, “is a chronic (long-lasting) inflammatory
disease of the airways in the human body. The inflammation
causes the airways to narrow from time to time. This
narrowing can produce wheezing and breathlessness. In extreme
cases, the asthma patient may need to gasp to get enough air
to breathe. Occasionally, a severe attack can be fatal (www.faqs.org).’’
Asthma affects the bronchi and bronchioles in the lungs. “The
bronchi and bronchioles are tiny tubes through which air
passes in and out of the body. In people with asthma, certain
materials, such as dust and pollen, can irritate these tubes”
(www.faqs.org).
I once heard asthma described as trying to suck air through a
soda straw.
Dr. Lester has instructed me in charting Sarah’s peak flows.
Sarah Kate takes a deep breath and blows as hard as she can
into a clear plastic tube about eight inches tall. Her breath
causes a blue bead to rise, halting at a number between 50 and
350. Higher numbers are good, but Sarah Kate seldom reaches
them. She hovers between 100 and 160. When her peak flows
dip below 100, it’s time to call the doctor.
Dr. Lester helps me develop an asthma care plan with a green
zone (Sarah’s best numbers when not suffering an asthma
attack), a yellow zone (80% of her personal best), and a red
zone (medical alert or 50% or less of her personal best). I
learn to chart Sarah Kate’s peak flows three times a day on
graph paper. In this manner, I can predict when she’s heading
into an asthma crisis. In the last two weeks, I’ve charted
fourteen pages of peak flows, administered 56 breathing
treatments, and carted Sarah to the pediatrician for four
allergy shots and two office visits. Her peak flows have been
falling for the last three days.
Today is Sunday, Sabbath rest, and I’m ready to snap. The
skillet sizzles with grilled cheese sandwiches. As I’m
pouring iced tea, Sarah Kate stomps into the kitchen wearing
snow boots, a tiara, pink tutu, and superman cape. “Can I go
down to Alice’s after lunch?” she asks.
“No.”
“Why not? she demands. “I won’t touch the cat.”
“You’re not allowed to go anywhere until your asthma is
better,” I snarl.
Pumped on steroids, she glares at me with her chin thrust out
and hands on her hips. “That’s not fair,” she yells. “I’m
going anyway. I don’t care what you say.”
“You’re not going anywhere,” I scream, blocking her as she
maneuvers toward the front door.
“I am too!”
“No, you’re not!”
Later, I find Sarah sobbing, huddled on a pillow on the floor
of her room with her cloth baby and blanket clutched in one
arm. We cuddle and cry and laugh and dance. Chelsea joins us
while the dog runs in circles at our feet—all of us held
hostage by childhood asthma.
~~~~~
Consider these facts and figures. After a site is cleared of
trees and plants, explosives which are up to 10 times as
strong as those that tore open the Oklahoma City Federal
building are used to blow the top off the mountain (Buchannan
and Popham 35).
An editorial in the New York Times on Nov.7, 2005 said,
“Estimates are that by the end of the decade, an area larger
than the state of Delaware will have been laid waste by
dynamite and bulldozer”(Ray 44).
Proponents of mountaintop removal such as Bill Caylor,
President of the Kentucky Coal Association, argue that this
method of mining boosts the economy and provides jobs.
However, blasting mountains requires only a handful of men and
equipment to “accomplish in a matter of months what an
underground mine would take years with a lot of men to do” (www.ilovemountains.org).
Furthermore, as Erik Reese indicates, Appalachia’s poverty
rate has changed little, if any, over the past forty years.
It continues to hover around 31 percent (52).
Toxic coal slurry is held in hundreds of impoundments
throughout Appalachia. In 2000, one of the impoundments
broke. 300 million gallons of toxic sludge, thirty times
larger than the Exxon-Valdez tanker disaster, spilled into the
Big Sandy River in Kentucky. The Environmental Protection
Agency called it the worst environmental disaster ever east of
the Mississippi. “Few people heard of it,” (www.ilovemountains.org).
~~~~~
Mrs. King, Sarah Kate’s first grade teacher, suffers from
asthma. How grateful I am to have someone who understands and
advocates for my child—someone not cowed by the apparatus of
the nebulizer; who encourages Sarah to research asthma for her
first independent project; who doesn’t penalize her for school
absences. It will become Sarah Kate’s dream to achieve
perfect attendance. Years from now, she will achieve it, and
will await her award with excitement other children cannot
understand. Nonetheless, she’ll be bypassed, as she arrived
late for school one day which counted as an absence. At age
12, she’ll leave the ceremony in tears.
Here we are six years prior. For more than three weeks, I’ve
struggled to keep Sarah in the yellow zone of her asthma care
plan. This afternoon, I take her to the pediatrician’s
office. Dr. Lester listens to her chest. It is clear. He
recommends I treat her cough with Robitussin.
Cough medicine is a tricky thing. Dr. Lester has warned me in
the past that cough medicine can thicken the secretions
produced by asthma, thus worsening the condition. Therefore,
it’s critically important to distinguish the difference
between a normal cough, as one gets with a cold, and asthma.
Some nights I can tell the difference between an asthma and
normal cough. Others, it’s a matter of trial and error. This
afternoon in Dr. Lester’s office, I think to myself that he’s
wrong. The cough I’ve been hearing in the middle of the night
is not a cold.
I
give Dr. Lester the benefit of the doubt and administer one
dose of Robitussin. Sarah Kate’s cough becomes worse, so I
abandon the cough medicine and increase her breathing
treatments. “Sarah honey, sit up,” I whisper to my sleeping
child at 3:00 AM. “I’m going to give you a breathing
treatment.”
She doesn’t resist. She props herself against the study
pillow and strokes my face, then twirls her hair as she
relaxes to the hum of the nebulizer.
~~~~~
In April of 2005, a group of Kentucky writers traveled to
Appalachia to witness the devastation of mountaintop removal
as part of a tour organized by Kentuckians for the
Commonwealth. They heard testimonies from mothers, fathers,
sisters, and sons who daily suffer the effects of mountaintop
removal. A man told of drilling five wells in one year
because mining blasts caused each one of them to go dry.
Others talked about well water turned foul due to cracks
enabling acid rain and toxic chemicals to seep through. One
woman’s water turned black so she couldn’t bathe her child or
run her washing machine. The foundation of houses cracked
from mining blasts. Overloaded coal trucks, screaming down
mountainsides killed four people on a one-mile stretch of
road. Blasting rocked houses like earthquakes in the middle
of the night. A three year old boy was killed when a boulder
dislodged and smashed into his bedroom (Missing).
“Billions of dollars in taxpayer money have been spent to try
cleaning up the messes that mountaintop removal and surface
mining have caused,” writes Brenda Mutter Urias, whose family
has lived in Pike County Kentucky since the 1800’s. “The coal
companies call it ‘an act of God’ when in truth it’s an act of
the devil (46).”
Mountaintop mining has forced out all but four families in
Urias’ community of Island Creek in Phyllis, Kentucky. She
concludes: “But we will stand our ground because these are our
homes. We will not surrender our property, our way of life,
our heritage, our dreams for our young. This place is
precious to us. It holds our memories and history. We won’t
give up. We will stay. Please remember us” (47).
~~~~~
“Blow,” I instruct Sarah Kate, after handing her the peak flow
meter.
A
whisper of air escapes her lips.
“Blow again,” I command, thinking the reading can’t possibly
be right.
She blows again. The place at the base of her neck sucks in
and a puff of air releases.
“One more time, as hard as you can.” She pulls a breath and
starts coughing. “That’s okay; skip it.” Sarah Kate’s peak
flow, below fifty, doesn’t even register on the meter. “I’m
going to call the doctor,” I tell Sarah, my heart racing.
Twenty minutes later, we arrive at Kosair Children’s emergency
room.
The diagnosis is flu, which has precipitated an asthma
attack. A nurse hooks up Sarah Kate to a heart monitor and
oxygen. She tapes an oxygen probe on Sarah’s finger to
measure oxygen saturations in her blood. Another nurse places
an IV to administer steroids. Sarah Kate is too weak to
complain. She doesn’t even try to pull the oxygen canula from
her nose. How tiny she looks, swathed in starched white
hospital sheets in a bed that swallows her amid machines twice
her size.
Later in the day, my judgment clouded, I keep an appointment
with an accountant about my business taxes. He turns to me in
his high-powered, glass-walled office and asks me why I came
to see him. “I need an accountant for my counseling records,”
I explain.
He regards me for a moment through wire-rimmed reading glasses
and counters, “We represent companies like Ford and LG&E. You
don’t need someone of our skills and caliber for a small
business such as yours.”
The lump in my throat bursts. He turns and reaches for a cup
of gourmet coffee. Tears stream down my face, and I berate
myself for not canceling the appointment.
~~~~~
While reading Erik Reese’s book about radical strip mining in
Appalachia, I stop short at the following sentence: “The
sulfur dioxide that escapes coal-burning plants is responsible
for acid rain, smog, respiratory infections, asthma, and lung
disease” (24). My breath stalls in my throat as I absorb this
information. Continuing with the text, I read, “In Kentucky,
the number of children treated for asthma has risen almost 50
percent since 2000” (25). So this is the connection, —between
mountaintop removal and Sarah Kate’s struggle to breathe. I
re-read the paragraph and discover a sentence I’ve missed: “In
2000, the Clean Air Task force, commissioned by the EPA,
determined that coal-fired plants account for 30,000 deaths
per year” (24-25).
I
set the book aside, boot my computer, and google “coal-burning
plants,” which leads to a host of websites. From a 1996
report, I learn that stationary polluters in Kentucky release
approximately 601,000 tons of sulfur dioxide each year making
Kentucky 11th in the nation for sulfur dioxide
emissions (Smoke 4).
Curious what this means for the part of the state in which I
live, I search further. Louisville Gas & Electric (LG&E)
operates two coal-burning plants in the Louisville area.
According to a 2007 study, LG&E emits more than 3 million
pounds of sulfuric acid, a type of fine particle pollution
linked to premature death from lung and heart disease (Bruggers).
Feeling like Erin Brockovich, I google “asthma” and uncover a
study by Patricia McLendon and Sara Robeson in 2002 in which
Louisville is ranked the fifth worst city in America for
asthma (2). Southeastern Kentucky, where coal is mined, ranks
higher for adult asthma than any other region of the state
(2).
~~~~~
While I lie in bed nursing a cold, Sarah Kate slips a note
under my bedroom door.
Sarah Kate Kendrick, age 6, following hospitalization
My heart swells with tenderness and tears with the poignancy
of Sarah’s misplaced guilt. What strikes me about this note
is that she misspells words such as “sorry,” “hope,” “wish,”
and “hate,” but spells “asthma” correctly all three times.
~~~~~
A
few years ago while hiking in Red River Gorge, I rounded a
bend in the trail, crossed over a stream, and heard splashing
like the sound of campers washing cookware in the creek. I
stepped out on a rocky promontory and peered over the edge.
Ten feet below me, two river otters played in the creek. One
at a time, they slipped off a rock ledge into the water and
paddled across the creek, their whiskered noses jutting above
the stream’s dark surface. How long till the otters are gone?
I wonder.
Erik Reese once raised the subject of his being an outsider
with Teri Blanton, who grew up in Appalachia. “You’re not an
outsider,” she replied. “We all live downstream” (61).
Suddenly, I see Sarah Kate, her sister, and myself, ankle deep
in Beargrass Creek, warning signs about mercury and other
contaminants dotting the shore. I envision women—entire
families—standing hand in hand from creek to creek to river to
dried up streambed to vanished headwaters, all lamenting, our
wails winding toward heaven, demanding justice.
~~~~~
Sarah Kate is now 18 years old and goes to college in Ohio.
This week, she’s home on spring break. A couple hours after
I’ve fallen asleep for the night, she pounds on my door.
“What’s the matter?” I ask.
“I’m having an asthma attack.”
“Did you use your inhaler?”
“Yes, but I can’t stop coughing, and I can’t get back to
sleep.”
Suddenly, my pulse quickens and a familiar tightness seizes my
chest. I tell myself that she’s okay, that the rescue inhaler
will kick in if we wait a few minutes.
“Will you lie down with me?” she asks.
“Sure,” I say, climbing under the comforter with her. As she
clutches her flannel baby, ragged with age, I scratch her back
till she stops coughing and falls asleep. “Hush little
baby, don’t say a word. . .”
Works Cited
Bruggers, James. “Emissions Rise after Attempt to Reduce
Smog.” Courier-Journal
24 March 2007: A1.
Buchannan, Bobbi and Mary Popham. “Coal Mountain: Communities
and Coal Industry
War over Mountaintop Mining.” New Southerner
2005-2006 Anniversary
Edition. 34-35.
George, Stephen. “Bringing Down a Mountain.”
MissingMountains: We Went to the
Mountaintop But It Wasn’t There. Eds. Johannsen,
Kristen, Bobbie Ann Mason, and Mary Ann Taylor-Hall.
Nicholasville, KY: Wind, 2005. 25-31.
House, Silas. “Mountaintop Removal Mining Causes Cultural,
Environmental Suffering.”
New Southerner 2005-2006 Anniversary
Edition. 42-43.
Johannsen, Kristin, Bobbie Ann Mason, and Mary Ann
Taylor-Hall, eds. Missing
Mountains: We Went to the Mountaintop but It
Wasn’t There. Nicholasville,
KY: Wind, 2005.
Lilley Cornett Woods. Brochure. Appalachian Ecological
Research Station of Eastern
Kentucky University, 2006.
McLendon, Patricia and Sara Robeson. “Asthma in Kentucky:
Hitting the Airways.”
Kentucky Epidemiologic Notes & Reports.
July 2004. Cabinet for Health and
Family Services. 10 April 2007
http://chfs.Ky.gov/.
Mullins, Eugene. “Dispatch from Puncheon Creek.” Editorial.
Courier Journal. 5 March
2007.
Ray, Janisse. “Coal-Blooded Removal: Went to the Mountaintop
but It Was Gone.” New
Southerner 2005-2006 Anniversary Edition.
44-45.
Reese, Erik. Lost Mountain: A Year in the Vanishing
Wilderness. New York: Riverhead,
2006.
“Smokestacks and Smoke Screens: Big Polluters, Big Profits,
and the Fight for Cleaner
Air in Kentucky.” Environmental Working Group.
1997. EWP Report. 10 April
2007 <http://www.ewg.org/reports/smoke/ toppolluters.html>.
Urias, Brenda Mutter. “The House My Dad Built Is Being
Destroyed.” New Southerner
2005-2006 Anniversary Edition. 46-47.
http://www.faqs.org/health/Sick-V1/Asthma.html
10 April 2007.
http://www.ilovemountains.org/multimedia
Introductory Video 10 April 2007. |
