The danger zone
In Louisville, the fifth-worst American city for asthma, a mother ponders the connection between coal-burning plants and her daughter’s illnessBY LESLIE SMITH TOWNSENDSarah 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 10 seconds and never resolves. I asked Dr. Lester why I never hear her wheeze. He said 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 is 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 75 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. “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 16 doses of medication a day for asthmatic symptoms, some of which include amphetamines. Dr. Lester won’t diagnose her with asthma until she has several attacks over at least a six-month period. We’ve reached month four, with three separate attacks requiring midnight runs to the local emergency room where Sarah is hooked 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 21-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 wise men to Bethlehem.At home in her own bed, my sleeping daughter is beautiful. Gone is the cranky disposition caused by medications that rev her up and make it impossible to rest. One morning I counted: every 20 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 12 times during the night. She may not need anything; in fact, she will likely be crying in her sleep, but I rise to check her anyway.•••I first witnessed strip mining’s destructive power nearly 40 years ago while traveling through Eastern Kentucky on Interstate 75. From the ridgeline between Williamsburg, Ky., and Jellico, Tenn., I saw mountains in all directions whose contours had been ripped away to expose gouged rock where lush forest once thrived. Public outcry in the 1960s and ’70s 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 about it in the media, I naively assumed the matter was resolved.But then, while reading Erik Reece’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 leftover rock and debris into the valleys below. What remains resembles a moonscape.Debris from mountaintop removal was originally designated as “waste,” and regulations were developed to guide disposal. However, in May 2002, the Environmental Protection Agency ruled that debris from mountaintop removal can be reclassified as “fill.” Fill, composed of sulfuric acid and other toxins, may be dumped in streams.Estimates say 700 to 1,500 miles of streams have been buried by mountaintop removal. 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,” lamented Eugene Mullins in an op-ed piece in The Courier-Journal. “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, Chelsea, 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 medicine. Four feet of clear plastic tubing fits onto a nodule on the side of the machine and connects to a small plastic canister about 1½ 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. 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 am reborn.•••More than half of American homes depend on electricity generated by coal-fired power plants. 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.“(One hundred) tons of coal are extracted every two seconds in Kentucky, West Virginia, Wyoming, Pennsylvania, and a handful of other states,” writes Reece. “Nearly 70 percent of that coal comes from surface mines.” Big coal is big money. Kentucky ranks third in national production of coal. Eighty percent of the region’s coal leaves the state, however, and out-of-state coal companies take the profits with them.Best-selling Appalachian author Silas House comes from a coal mining family. “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,” he said in an interview with New Southerner magazine, “but I can’t tolerate the industry titans that so blatantly abuse the land and the people who have made them rich.”•••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 11. It wasn’t until the next year 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 pileated woodpecker as it swooped through the forest and came to rest against the trunk of a hollow tree.The next spring, I collected wildflowers in the woods behind my house in Louisville. 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, and others like pink lady’s slipper and dwarf iris. By then, these mountains of redbud and dogwood, southern pine and hemlock, felt like kin.On a recent trip to the Pine Mountain Settlement School in Letcher County, 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.This disappearing forest is home to nearly 80 species of trees, 530 species of flowering plants and 700 breeding pairs of birds.•••Sarah Kate is six now, 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 is a chronic inflammation of the airways. During an asthma attack, the lining of airways becomes obstructed with swelling, tightening of the muscle and increased secretion of mucus. Allergies, viral infections, pollution and other environmental irritants can trigger an asthma attack. 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. She 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 better, but Sarah Kate seldom reaches them. She hovers between 100 and 160. When her peak flows dip below 100, it is 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 percent of her personal best) and a red zone (medical alert, or 50 percent or less of her personal best). I learn to chart Sarah Kate’s peak flows three times a day on graph paper, which helps me predict when she’s heading into an asthma crisis. In the last two weeks, I’ve charted 14 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, a pink tutu and a superman cape. “Can I go down to Alice’s after lunch?”“No.”“Why not? 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 up to 10 times as strong as those that tore open the Murrah Federal Building in Oklahoma City are used to blow the top off the mountain.A Nov. 7, 2005 New York Times editorial 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.”Mountaintop removal proponents such as Bill Caylor, president of the Kentucky Coal Association, argue 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 and lots of men to do. Furthermore, as Reece notes, Appalachia’s poverty rate has changed little, if any, over the past 40 years. It still hovers around 31 percent.Toxic coal slurry is held in hundreds of impoundments throughout Appalachia. In 2000, one of the impoundments broke, sending 300 million gallons of toxic sludge, 15 times larger than the Exxon-Valdez tanker disaster, into the Big Sandy River in Kentucky. The Environmental Protection Agency called it the worst environmental disaster ever east of the Mississippi River. Not that many people heard of it. (Under a federal consent decree announced last month, Massey Energy agreed to pay $20 million in fines for the spill and spend another $10 million to prevent future problems. The public comment period on the consent decree runs through next week before a federal court approves it.)•••Mrs. King, Sarah Kate’s first grade teacher, suffers from asthma. How grateful I am for someone who understands and advocates for my child — who’s not cowed by the nebulizer; who encourages Sarah Kate 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 Kate in the yellow zone. 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 is critically important to distinguish between a normal cough such as one gets with a cold, and asthma. Some nights I can tell. Others, it is trial and error. This afternoon in Dr. Lester’s office, I think to myself that he is wrong. The cough I hear in the middle of the night is not a cold.I give him the benefit of the doubt and administer one dose of Robitussin. Sarah Kate’s cough worsens, so I abandon the cough medicine and increase her breathing treatments. “Sarah, honey, sit up,” I whisper to my sleeping child at 3 a.m. “I’m going to give you a breathing treatment.”She doesn’t resist. She props herself against the pillow and strokes my face, then twirls her hair as she relaxes to the hum of the nebulizer.•••In April 2005, a group of Kentucky writers traveled to Appalachia to witness firsthand 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. One man told of drilling five wells in one year because mining blasts caused each one to go dry. Others talked about well water turned foul because of cracks that let acid rain and toxic chemicals seep through. One woman’s water turned black; she couldn’t bathe her child or run her washing machine. The foundations 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.“The coal companies call it ‘an act of God’ when in truth it’s an act of the devil,” Brenda Mutter Urias, whose family has lived in Pike County since the 1800s, wrote in New Southerner. Mountaintop mining has forced out all but four families in Urias’ community of Island Creek in Phyllis, Ky. But, she concludes, “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.”•••“Blow,” I instruct Sarah Kate, after handing her the peak flow meter. A whisper of air escapes her lips.“Blow again.” 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 OK; skip it.”Sarah Kate’s peak flow, below 50, doesn’t even register.“I’m going to call the doctor,” I tell her, 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 say.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.•••While reading “Lost Mountain,” 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.” My breath stalls in my throat, as I absorb this information. Continuing, I read, “In Kentucky, the number of children treated for asthma has risen almost 50 percent since 2000.” 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.”I set the book aside, boot my computer and Google “coal-burning plants.” From a 1996 Environmental Working Group report, I learn that stationary polluters in Kentucky release some 601,000 tons of sulfur dioxide each year, making Kentucky 11th in the nation for sulfur dioxide emissions. Curious what this means for the part of the state in which I live, I search further. Louisville Gas & Electric 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.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. Southeastern Kentucky, where coal is mined, ranks higher for adult asthma than any other region of the state.•••While I lie in bed nursing a cold, Sarah Kate slips a note under my bedroom door. My heart aches with the poignancy of Sarah’s misplaced guilt. It strikes me 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 crossed a stream, rounded a bend in the trail 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 limestone ledge into the water and paddled across the creek, their whiskered noses jutting above the stream’s dark surface. How long, I wondered, till these otters disappear? Erik Reece 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.”Suddenly, I see Sarah Kate, her sister and myself, ankle deep in Louisville’s 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 attends college in Ohio. This week, she is home on spring break. At 2:30 a.m., she pounds on my bedroom door. “What’s the matter?”“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 she’s OK, 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 ...”Leslie Smith Townsend is a Louisville freelance writer and contributing editor of New Southerner, an online journal. Contact her at firstname.lastname@example.org. Also, Thursday is “I Love Mountains Day” in Frankfort, where the largest rally ever held there against mountaintop removal mining is planned for the Capitol steps at 11:30 a.m.