Now, when I ask my parents how they felt in that moment, they tell me they were terrified. But they say it with a whimsical smile that makes it seem like they weren’t really that afraid—like a pair of teenagers fondly recounting the moment the roller coaster balanced at the top of the hill before plunging, at full speed, toward the bottom. And I suppose that’s what they were in that moment: young people at a precipice, looking over an edge. They didn’t know what this ride had in store for them, but—as young people so often do—they assumed that everything would be fine in the end.
* * *
—
Figuring out how to pay for my birth was the first of many struggles for the young couple. They had little money, and they had trouble finding an obstetrician in the area who would accept their government-issued medical card. “Sorry, we only take private insurance,” each of my mother’s top choices of doctors told her.
In the 1950s and 1960s, Granny had also struggled to get medical care while pregnant. There were no doctors near Cow Creek at that time, and Papaw, her husband, didn’t have a vehicle—or the knowledge to operate a vehicle—to fetch a doctor. Nor did they have a telephone to call for help. Instead Papaw would walk, sometimes miles, sometimes in the middle of the night, once in snow up to his waist, to the nearest midwife. The midwife would come to Cow Creek, and Granny would give birth at home. Midwives like these were called “granny midwives,” and they received little or no formal medical training. They learned from the previous generation how to care for the women in their community.
Granny came down with measles during her second pregnancy. No one had told her that measles could harm her unborn baby, so she hadn’t thought a lot about it when she first fell ill. Even if someone had told her of the risks, it wouldn’t have mattered—there wasn’t a lot Granny could’ve done to avoid this disease, which ran unchecked through mountain communities. The child of that pregnancy, a son named Herbert, died suddenly a few months after his birth. Granny felt guilty for years afterward, wondering if her measles had led to his death. She wondered if there was something she could have done to save him.
There wasn’t. Maternal and infant mortality rates were high in those days. There was little access to formalized medicine. Very few women received prenatal care; even the idea that pregnant women needed a unique type of care hadn’t penetrated many mountain communities. Many granny midwives relied on folklore and invasive practices. The most popular means of pain management was to place an ax under the bed to “cut the pain of labor.”
Despite these dangerous and disparate conditions, women in the mountains cared for one another. In communities where women were perceived as having less power, birth was a time for them to publicly exercise what power they had. One woman described childbirth as the “one occasion when the women took over. No men were allowed….This happy time was known as a ‘granny frolic.’…Every married woman friend and relative was welcome.” It was a time for women to come together to celebrate one another and new life.
They shouldn’t have had to do it, these women. To try to care for one another with such limited resources. To be responsible for filling a role that modern medicine filled in other parts of the country. To mitigate risk in a system of such disparity. But they did do these things, and they did them to the best of their ability. Some people see the statistics on the health outcomes in Appalachia during this time and they are shocked by the disparity with more affluent parts of the United States. I am shocked that, in these communities of such limited resources, the disparities were not even worse than they were.
A woman named Eula Hall lived in Eastern Kentucky, a few counties away from Owsley, birthing and raising children at around the same time as Granny. One of Eula’s children was born premature and deaf; another child died in infancy. She saw families torn apart by lack of healthcare: children left motherless after a woman died in childbirth, parents suffering the loss of a child from routine childhood illnesses such as strep throat or tetanus.
Eula set out to take charge of the situation. As she told me years later, “We was livin’ in hell, so I decided it was time for me to raise hell.” In 1973 she took a $1,400 donation and turned it into a health clinic—sometimes operating out of her own home—that provided care to low-income Eastern Kentuckians.
When the clinic burned down in 1982, Eula went door-to-door raising money to reopen it. In the meantime, she had the phone company attach a telephone to a tree by the river so that she could operate the clinic outdoors. The phone company initially told her that they could not, under any circumstances, put a telephone on a tree. But Eula let them know in no uncertain terms that that answer was unacceptable. “You put telephones outside for the coal mines,” she told them. “You will put a phone outside for me.” The clinic never missed a day of operating.
I met Eula in 2018, when my work with low-income women led us to cross paths. At ninety years old, she was still working every day. The clinic she started was still seeing patients, and Eula operated a food pantry to help struggling families make ends meet. She told me about a man who had come in that morning. He hadn’t eaten in three days, and Eula sent him home with a bag of food. Her original clinic had grown into a network of clinics, providing healthcare to over 200,000 community members—including many new and expectant mothers—a year.
My mother didn’t go to Eula’s clinic when she found out she was pregnant. She didn’t know about it, and even if she had, she couldn’t have made it there. That clinic was several counties away from where she lived, and Wilma didn’t have a driver’s license.
But my twenty-year-old mother had inherited the mountain-woman instinct to fight for her family, and her experience at Berea College had added a modern flavor to this intuition. She knew that she needed quality maternal healthcare; she had learned in her child-development classes just how crucial that care was. She showed up at the doctor’s office ready to find a creative solution.
“I know you don’t take Medicaid,” Wilma told her top-choice doctor, a look of resolve in her eye, “and I don’t have the money to pay you up front. But I do promise that I’ll pay for your services myself. I can’t afford it all right now, but I’ll pay it in installments.”
The doctor, perhaps struck by the determination in this young soon-to-be mother’s eyes, agreed to her proposal. Wilma set up a payment plan, and she and Orlando scrimped and saved. Orlando took a job at a fast-food restaurant and existed on a diet of ramen noodles. They sold some things and did without others. They paid the final balance to the obstetrician shortly before I was born. “We paid you off just in time to take you home,” my mother teases me.
* * *
—
My parents brought me home from the hospital to a rented trailer located near the edge of Berea. It was too cold in the winter and too hot in the summer. It had a window air-conditioner unit, but my parents couldn’t afford to run it.
In the fall of 1986, my father had just graduated from Berea and started graduate school in agricultural economics at the University of Kentucky. He had been accepted into many graduate programs, including one in the Ivy League, but I’m not sure anywhere outside of Kentucky was ever on the table. Wilma couldn’t stand the thought of moving farther away from her family, and the couple needed help with their new baby. They stayed in Berea, within easy driving distance of Owsley County.
As a graduate student, Orlando received a stipend of $583 per month. My mother took a couple of years off from school to stay home with me, and during that time our entire family lived off of that small sum. Paying the bills each month was difficult—babies are not cheap and, since Orlando had graduated and Wilma was no longer a student, the couple didn’t qualify for student housing.
I didn’t realize then how tight money was. My mother had to save up to be able to buy me a pack of old maid cards from Walmart. Sundays, after church, was the only time we would go out to eat. My parents would
buy a Happy Meal at the local McDonald’s. We would all share the small amount of food, my parents splitting the cheeseburger while I ate a few of the french fries and played happily with my new toy.
My mother always says we couldn’t have survived in those days without our Owsley County family. Papaw would offer to buy her gas and give us buckets of vegetables from the garden if we would come down for the day. So three or four days a week my mother loaded me into my car seat to go to Owsley County. As I got older and my mother went back to college, I spent time there by myself.
I know it was hard for my mother to leave me, even for just a few days at a time. Berea was my home base, and even though my parents were busy students, with homework and midterms, I always felt like I mattered to them. They always had time for a round of “go fish” or choreographing a dance routine. But from the time I was old enough to talk, I would ask to go to Owsley County—to be with the farm and the mountains—and my mother knew that I would learn more there than I would in daycare. I learned science from watching the tomatoes grow, engineering from helping repair a fence, art from watching Aunt Ruth quilt in the evenings.
Owsley County was different for me than it was for my mother and her many siblings. Although I had cousins to get into trouble with, they were just that: cousins. Most evenings they would go back to their own houses after we spent the day playing. I was never lonely, but I was sometimes alone.
My mother was one of seven kids. J.L., the oldest son, was a rambunctious first addition to the family clan. Herbert, the second child, died when he was an infant. Vernon, the third, was proud and quick to anger. Ruth, the fourth-born, was a tomboy who preferred fieldwork to housework. Dale, the fifth child, was jolly and quick-witted. Wilma, my mother, was the sixth to come along. Charlie, the last, was and will always be the baby of the family.
The children fought like banshees amongst themselves, but they fiercely defended one another against any outsider. Ruth once beat up a boy a head taller than her who had picked on Charlie at school. Dale threatened Wilma’s boyfriends with various types of shooting if they mistreated her. In the evenings, they played kickball together in the front yard. They were a tight-knit group. Granny sometimes showed me a box with a few of their toys in the attic, and Aunt Ruth constantly told me stories about their escapades. “That right there is where yer mommy pushed Dale into the creek,” she would say as we walked through the holler in the evenings. “It’s a wonder she didn’t kill ’im!”
When I wasn’t at Cow Creek, I spent a lot of my time on the campus of Berea College, especially once my mother went back to school full time when I was four years old. The college had a daycare for children of students and faculty that I sometimes attended. One of her friends picked me up at the end of the day and walked me over to the academic buildings to wait for her. I made friends with the college students I met en route. “Hello! I’m Cassie,” I would say as I waved vigorously. “Have a good class!” My mother says that when we ate at the campus dining hall, more people knew me than her. I would take her hand and drag her up to different tables, saying, “Come meet my new friend!” I was as comfortable at the college as I was in the tobacco fields.
But my mother was not.
In some ways, it’s amazing that Wilma decided to finish college. She had been looking for an excuse to drop out of Berea from the time she’d enrolled. She hadn’t wanted to attend and ended up there thanks only to pressure from Granny and Aunt Ruth. She assumed that she would go to school for a semester, maybe two. With a husband and a child, she certainly had reason to put her education on an indefinite hold. Plus, things continued to be tight financially. So tight that once, my father had to break my piggy bank to afford a water pump for the car. It would’ve been easy for Wilma to have given up and gotten a full-time job.
But being at Berea changed Wilma. She was in an environment where everyone around her expected to get college degrees. Her peers viewed a degree not as an impossibility, but as an inevitability. She began to identify herself as the type of person who graduated from college. Orlando encouraged her to keep going. Granny, too, pressured her to finish her education.
When she first arrived at Berea, Wilma had been content to earn C’s. After all, she thought, a C is average, and she was perfectly happy to be average in this new and different world. But, once she went back to school, average was no longer good enough for Wilma. She knew she could be remarkable—she wanted to be, for her daughter. She also didn’t like Orlando having a better GPA than her—she knew that she was just as smart as he was. So she began studying with dedication and purpose; she was soon earning A’s on her report cards. She once complained that she got only 104 percent on a test. With the bonus points, she could have gotten 105.
When I was five, my mother graduated from college. I remember getting a new dress for the occasion—the first I’d owned that was that fancy. It had lace trim and a delicate flower print. My mother bought me a child-sized graduation cap and gown and let me walk with her in the processional. “We’re graduating!” I told my family as we walked past them down the aisle.
I didn’t know then how true that statement was. How by graduating with her degree, my mother changed both of our lives. How the value that she had come to place on education would seep into my core and carry me far beyond the hills of Appalachia. How her ability to better herself and her family would set me up for success. The day after the graduation ceremony, the local newspaper ran a picture of the two of us, my mother and me, standing side by side, eyes focused forward, graduating to the next phase of our lives.
One hundred and thirty-two, one hundred and thirty-three, I silently counted as I walked, one hundred and thirty-four…I knew the number of steps to the public library in Berea by heart. We went there almost every day, my mother and I, ostensibly because it was air-conditioned. Our apartment was not, and the electric fans we set up to blow through the house provided little relief.
We walked to the library because we didn’t have a car; even if we’d had a car my mother wouldn’t be comfortable driving. She hadn’t had her license that long, and driving still made her nervous. Perhaps that’s because neither Granny nor Papaw ever had a license. The one time Papaw tried to drive a neighbor’s car he ran it straight into a ditch. When Wilma was first learning to drive, she crashed right into a bridge.
Once we reached the library, I relaxed into the cool air. It was small and poorly lit; fluorescent lights hummed and flickered. The air smelled like damp paper, and everything looked just a little green. Although it was not objectively impressive, the library was, to me, the best place on earth.
We spent the hottest part of the day there, reading and talking. As we left, the librarian, who knew us by name, offered to let me pick a kids’ book from the free book pile. I had no trouble choosing one because I had already combed through the pile several times that week, ranking the books in my head. Books about dogs, cats, and farm animals went to the top of the pile. Books about science fiction and superheroes went to the bottom.
Even before I was in school, I spent my days learning with my mother. We explored the backyard and tried to identify the different types of bugs and plants that lived there. I loved the earthworms, and I made it a point to rescue each one we saw stranded on the sidewalk after it rained. We made our own play dough and experimented with mixing the colors together. Inevitably, the dough turned a shade of dingy brown from my overly exuberant squirts of food coloring. We caught box turtles along the road and built pens for them in the backyard. The turtles dug out, and we would search the neighborhood for signs of the tall flowers we had taped to their backs.
My mother built her life around teaching me. Although she now had a college degree, she wanted nothing more than to be a stay-at-home mom. Once, a college professor shook her paper at her, saying, “You have the rest of your life to be a mother. You only have now to be a college student.”
My mother re
sponded, “I only have right now to be the mother of this four-year-old.”
Wilma didn’t know any other way to be in the world. Most of the women she had seen growing up were stay-at-home moms. She didn’t know what it looked like to do anything else. And she was good at being a mother, always finding creative activities and new adventures. She had majored in child development in college, which had given her a new skill set with which to nurture and teach me. Everything was a life lesson.
As I got older, this emphasis on education shifted into the classroom setting. It didn’t take much for my mother to convince me that schoolwork was important: I had grown up watching her do her own, had spent my earliest days around classrooms and students. In my mind, getting an education was built into the backdrop of life, something you did because it was the only option, like breathing or sleeping.
It may not seem like much: a young girl enthusiastically embracing education, a mother emphasizing its importance. But this scene was the culmination of a story that began long before I was born.
When my mother was a child, Papaw never placed much of an emphasis on his children getting an education. Perhaps that was because he himself never went past elementary school. J.L., the oldest child, never finished middle school. Vernon, the second oldest, dropped out sometime around the third grade. Papaw didn’t object, since he needed the extra hands to help out in the fields. Tobacco was the way—seemingly the only way—to support a family in Owsley County. Education was a luxury, thought Papaw, and a somewhat useless one at that.
The other children dropped out at some point during middle or high school, all for their own reasons. Ruth went sporadically as a child, and finally dropped out after her bout with rheumatic fever, one of the few times Wilma remembers seeing Ruth cry. She made her flash cards to study with in an attempt to cheer her up.
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