Life and Death in West Virginia

Illustration: Ansellia Kulikku.

And I saw the dead, great and small, standing before the throne, and books were opened.

— Revelation 20:12

I labored with my son Keats in an overcrowded hospital nestled at the base of West Virginia foothills. The room’s window view was green and lush and marred by a concrete, smoke-spewing, open-mouthed coal stack in the not-too-far-off distance. I stared out at the evening sky and hoped I’d beat the latest hours, a baby in my arms before midnight. When I’d arrived at the nurses’ desk in active labor, my hands atop my belly, waiting for another wave of pain as I signed myself in, I said a little prayer—though I’m an atheist—that I was far enough along to be admitted. There were few beds open. As a nurse walked me down the hall to an exam room, we passed a full-bellied woman who fought to stay. They sent her home and gave me her room.

Contractions with Keats were light, nothing more than a twitch in my belly, like the closing of a fist. Not the crushing kind I’d had laboring with my two girls. His labor was like the baby he is now: soft.

I asked for all the drugs anyway.

I pushed my son out in the late morning, into my husband’s hands. Keats was born limp and purple and quiet. I pulled him atop my chest, cord and all, rubbing him into his voice. We both cried out; him from the shock of life; me from the shock of that life colliding with something close to death. My husband passed our son to a mountain midwife and officially into Appalachia. Keats was born face up. The midwife had needed to twist his body to get him out of me; his collarbone broke from that turn. I wouldn’t know this until weeks later. By then we’d left West Virginia to see my husband’s family in California, a departure I hoped would also offer the time I needed to understand all that had happened with our baby and my body.

At Keats’s four-week check-up in California, the doctor felt a hard lump just between his chest and shoulder. “Of course, you know this is broken?” she asked.

I shook my head. But I’d suspected there was something wrong from the day we’d brought him home. Keats could wriggle his legs and curl his toes and punch the air with his left arm. His right arm flapped down at his side, immobile. I’d been assured by his doctors that his arm was fine. Keats was just figuring out how to live in his body, how to make it go.

The doctor placed her hand atop Keats’s clavicle where a bone callus had grown and drawn the fracture together. “Here.”

I was not born in West Virginia. My husband and I moved there three years ago with our then four-year-old daughter Josephine. We moved for my tenure-track job teaching creative nonfiction in an MFA program. I knew almost nothing about the place. If asked, I wouldn’t have been able to find the state on a map. I drove