“A million freemen may yet inhabit those counties which, while their wealth lay hidden, were disregarded for more fertile parts, but which, when developed, will furnish forth the wealth of an empire.”

–Charles Walker,
The History of Athens County, Ohio 1867

I walked through the double doors of the plasma center at eleven a.m., right behind a man who looked like he’d just spent the night in his car. His hair pitched awkwardly atop his head, and his loose T-shirt hung low beneath the trim of his bomber jacket. I stood behind him in line at the reception desk and looked around the room. I had imagined a rusty, back-alley nightmare of cracked linoleum, flickering fluorescents, stained lab coats, and crumpled dollar bills—the grime beneath the folds of Darwinian capitalism. Instead, I was greeted by starched lab coats, bleached teeth and ponytails, waxed floors, and a computer-automated check-in system—the highly polished face of a multi-billion dollar industry. I waited in line and watched the receptionist give instructions to the man at the counter. Then she waved me forward.

I read waivers and signed forms and stood for my picture. She took my weight on a digital scale, and then led me to a touch-screen computer console where I answered a long questionnaire, mostly concerning my history of sexual contact with drug users and prostitutes. I pushed the “no” button over and over, except after the questions, “Are you male?” and, “Are you feeling healthy and well today?”

After I completed the questionnaire, another young woman in a white coat pricked my finger, measured my iron and protein levels, my blood pressure, and my temperature before sending me to the nurse for a physical, where a woman in blue scrubs checked my balance, asked about tattoos and drug use, and lectured me briefly on getting plenty of protein and fluids. Then she led me to an empty place in a row of brown, vinyl reclining beds situated at the rear of the donation center.

My fellow donors, already prostrate and hooked to donation machines, were distracting themselves with magazines, paperbacks, and other reading material. One donor held a portable DVD player in his lap. Another had his face buried in his phone, and another just lay there with a vacant expression on her face, one arm in her lap and the other at her side, her forearm turned upward to expose a vein. A single crimson tube draped low from her elbow toward the ground and then arced back up into a machine that clicked and beeped at her side.

“Lie down,” said the young woman in the white coat, but with the sweet Appalachian twang of her voice, I could have sworn I heard, “make yourself at home.”

 

Once upon a time, Southeast Ohio had the largest coal deposits in the world. At its peak, the coal industry extracted more than 55 million tons of coal a year from more than one thousand mines around the state. For decades, coal from the region fueled American industry and brought thousands of immigrants to the Appalachian countryside. They settled in small villages that grew up around the mines, and breathed life into a region of the country long overshadowed by more promising territory to the west.

Of course, Melissa and I didn’t know any of this when we moved to Athens, Ohio, a college town built on the western edge of the Appalachian range. We’d both grown up in Oregon, less than two hours from the Pacific Ocean, and we went to college in northern Utah. Droughts and endangered salmon and BLM land and wolf packs were a normal part of our local-news reality. East of the Mississippi might as well have been East of the Nile.

What I did know about Ohio came from memories of my high school history books and those large pull-down maps that hung above classroom chalkboards. I could picture Lake Erie and the great dipping curve of the Ohio River, and I knew that the land in between had been the nation’s first notion of a western frontier, but that’s about it.

As for Appalachia, I knew even less, mere caricature: Hatfields and McCoys, trailer parks and drawled speech, kids named Billy Bob and family trees that didn’t fork. For us, coming to southeast Ohio was nothing more than a means to an end; a brief stop for graduate school on the way to somewhere better. I never once thought about the people who’d come before me, or why they might have chosen to stay.

 

Reclining in my donor bed, I watched Jason, the phlebotomist, move from machine to machine with a grace and offhandedness that surprised me. As he checked meters and unwrapped tubes, he rattled off the details of the donation process. Plasmapheresis, he called it, explaining that he would insert a needle into my arm and the blood would start flowing into the large, almond-colored machine standing beside my bed. He explained that the plasma would be separated from my blood in a centrifuge and that the residual red blood cells would be pumped back into my body. He warned me that I might get a metallic taste in my mouth, that I must keep pumping my hand or the machine would stop working, and finally, that despite blinking lights and warning systems built into the machine, there was a slight chance that air might enter a vein, which could make me terribly sick or maybe even kill me. Then he placed a clipboard in my hand and said, “Just sign here that you heard me explain that.”

 

The first white settlers came to southeast Ohio in 1787, led by a Revolutionary War veteran named Rufus Putnam. He had the ear of President Washington and the entire Northwest Territory to choose from, but instead of the fertile Miami River Valley to the west, or some economically strategic location closer to Pittsburgh, or Lake Erie, Rufus and his men chose the tumbling, rolling countryside of southeast Ohio. Other settlers thought Putnam and his company was crazy, but Putnam had a vision for the region and dreams of a bustling metropolis on the banks of the Ohio River, an economy fed by rich farmland and a thriving fur trade. His advertisements described a “delightful region…of a much better quality than any other known to New England,” and for that first exhibition, he signed up 60 men. Still, Ohio was a hard sell for most would-be immigrants. Even after treaties were forced on the natives, even after forts and mills were constructed, even after plans for a university were introduced, only the most desperate and adventurous settlers would take the risk.

 

I had not planned on donating plasma in Ohio, but the impossible math of a graduate student stipend divided by Melissa, me, and our two boys inevitably added up to a visit with a financial aid officer, the small hope of a big loan, and the curious anxiety of mortgaging one’s future for a chance at surviving the present. Add the specter of Christmas on the horizon and you get a perfect formula for fatherly desperation. After just a few months in Athens, I saw a poster for the plasma center hanging on a wall at school. “Save a Life,” it read, and it promised $240 a month. I was sold.

 

During the last decade of the eighteenth century, a slow drip of immigrants arrived in Ohio from the Northeast—families signing on a few at a time for a chance to test the region’s potential. And if that pace had held, Ohio might have remained for many years a sparsely populated forest of fur traders and subsistence farmers. However, shortly after the turn of the century, those farmers and fur trappers began taking notice of the coal. And then the industrial revolution turned that coal into black gold, and by the 1850s large mining interests were laying out a system of railroads to carry immigrants and equipment into the hills, and cartloads of coal back out. Labor came from England, Wales, Scotland, Czechoslovakia, Poland, and elsewhere, and by 1884 there were more than 20,000 miners and their families scattered around the region. A man whose children might have starved in the old country could swing a pick underground in Ohio for a few dollars a week, chipping away at a vein of coal so deep and so thick it would take a legion of men two lifetimes to remove.

 

I have good veins, the kind inexperienced phlebotomists dream of at night. Protruding from my forearms “like garden hoses,” according to one employee, they make easy targets for even the shakiest hand. Thankfully, Jason didn’t need the extra help. “Don’t worry,” he said, as he held up the needle. “I’ve been doing this for years.” He tapped my arm, slid the needle under my skin, and just like that, I was a donor, plugged in and pumping away.

While the machine processed my plasma, I read from my book, kept my fist pumping, and occasionally looked up at the other donors around me. The man with the DVD player was still watching his movie, the man with the cell phone was still texting, and the woman with nothing still stared blankly into space. Our machines hummed along, and every few minutes a finished donor and a pale orange bottle of plasma would leave, and a new donor with an empty bottle would fill the void.

After about an hour, I’d donated my quota and my left-over red blood cells were pumped back into my veins for a final time, followed by a 500 ml chaser of saline that was supposed to boost my blood volume and keep me from fainting. On my way out, a nurse handed me a debit card loaded with twenty dollars and told me I could come back twice a week, for as long as I could stomach it.

 

Mining in Ohio was good work, if you could handle it. Small towns near remote mine entrances all around southeast Ohio were full of immigrants who thought they could. The towns had simple names like Coal Run and Buckhorn, and family names like Murray, Buchtel, and Mudoc, and optimistic names like New Philadelphia, New Lexington, and New Pittsburgh: places where people could start fresh, chase the dream of getting ahead, and, in reality, spend a lot of time just hanging on. Companies built shack housing and paid employees in scrip—play money that was good only at company stores. The hours were long and the system parasitic—the success of the mine sometimes determined less by the amount of coal extracted from the ground and more by the dollar value of scrip that never left company property. Many mining families lived on site, worked on site, shopped on site, and if the town lasted long enough, died on site.

 

Just across the street from the plasma center was a Wal-Mart. It wasn’t the only shop in town, but sometimes it felt that way. Sure, Athens had a Kroger, a BigLots!, a Lowe’s, and a few other smaller stores, but no matter how we tried to avoid it, we ended up at Wal-Mart at least once a week. Light bulbs, Band-Aids, diapers, milk, cereal, paint, shoelaces—they were all cheaper at Wal-Mart. And its proximity to the plasma center made shopping there that much easier. More than a few times I finished donating only to pull across the street to the Wal-Mart and drop everything I’d just earned on a few groceries. And there, at Wal-Mart, more than anywhere else in town, I ran into employees from the plasma center. On the way to work, or just getting off, they too made the requisite Wal-Mart stop. Sometimes we waved, or exchanged silent nods, but usually we just kept our heads down, closed up in our own little worlds.

 

Coal mining was not for the claustrophobic. It meant working in dark, low tunnels hundreds of feet underground for long hours with nothing but your partner, your light, and the rats to keep you company. It meant tight quarters and an ever-present fear that a fire might break out, a pillar might snap, and a shaft might seal itself off in a crumbling cloud of dust and rubble. On a Friday morning in April 1856, the pillars of a mine shaft near Blue Rock, Ohio, collapsed, trapping four miners beneath several hundred feet of dirt and rock. Fellow miners dug for days, and, near the end of the second week, they heard voices coming from beneath them. By the time the men had been pulled to safety, they’d spent more than fourteen days buried alive, trapped in an underground air pocket with nothing to drink but a bit of murky water collecting in a pool on the floor of the mine shaft. I imagine the entire town heaving a collective sigh of relief when their men emerged from the mine, but what could those men do but dust themselves off and go back to work?

 

 

Once, during my pre-donation screening, while the attendant was checking my protein levels in a microscope, I asked her if she’d ever seen any accidents at the clinic.

“What do you mean, ‘accidents’?” she said.

“You know, something goes wrong with a donor?”

“Sometimes we have people pass out,” she said. “A few times a year.” Apparently, a majority of problems occur while a person is simply reading about donating. They turn white in the face, get shaky, vomit, and sometimes lose consciousness altogether. One woman became so frightened by the sight of an unwrapped needle that she swore, “Oh my God,” and ran out of the center.

Later, while lying in my donor bed, my machine began to beep. It was a familiar sound. “Just an air bubble,” said the phlebotomist. Two or three times during a donation, the plasmapheresis machine detects the presence of air somewhere in the blood line and it shuts down until a phlebotomist comes and pushes a few buttons to purge the system.

“I think I can handle an air bubble,” I said. The phlebotomist gave me a funny look.

“You think you can handle air bubbles?”

“I mean . . . I can handle the beeping,” I said, and she stopped at the foot of my bed.

“Well,” she laughed. “The nurse tells me it takes at least 10 milliliters of air to kill you.” She said this in a voice that was, I think, supposed to sound reassuring.

 

Families in mining towns lived at the mercy of the companies they worked for—the steady flow of coal their only reassurance against poverty, hunger, and cold. If an accident or strike or dried-up mine rendered a town unprofitable, the company could pack up and go, leaving the men and their families to find other ways of making do.

In 1920, a coal processing structure burned to the ground in San Toy, a small mining town northeast of Athens. More than 2,500 people had moved to San Toy since its founding in 1901. The company town boasted a theater, a baseball team, and a hospital, but instead of rebuilding after the fire, the Sunday Creek Mine Company shut down one mine and eventually withdrew from the city completely. Within eight years the town was empty. What equipment could be salvaged was distributed to other nearby mines, and the hundreds of displaced workers had little choice but to pick up and follow the equipment, leaving behind a ghost town, a tiny scar on the hillside stitched together by vacant rail lines fading slowly into the undergrowth.

 

After I’d donated plasma a few times, I showed my scars to Melissa: two red dots on the insides of my elbows.

“Yuck,” she said, and turned away, unwilling to look. This is the response I got from most people who found out what I was doing. Sure, needles and blood make people squeamish, but it was also the stigma of donating itself—an act that lies on the socio-economic spectrum of desperation somewhere between not being able to pay your phone bill and stealing money from a roommate. People understood why I did it, but most couldn’t imagine doing it themselves.

Melissa never liked to hear me talk about it, and she constantly apologized, as if the whole thing was her fault. She worried about my health, that months of donating would cause irrevocable damage to my body, that for the rest of my life I’d wear a solitary track mark on each forearm, my small badge of courage, a pair of misplaced stigmata—a sign to be sure, but of what?

Rattling around in my mind was a foggy awareness that mixing needles, blood, and money was dirty business, but I didn’t know the details. For instance, in 1971, a Time article reported that more than 100,000 people donated plasma regularly in the United States, most of them “Skid Row bums and drug addicts,”—impoverished, desperate men and women who infected the plasma pool first with Hepatitis C and later, in the early 1980s, with HIV. For decades, the unregulated industry allowed cash-strapped junkies to donate several times a week at multiple locations without any screening or testing of collected fluids. The industry then turned that plasma into anti-coagulant medicine for hemophiliacs, and blood volume boosters for trauma victims. According to some estimates, nearly 20,000 hemophiliacs contracted HIV from tainted plasma, not to mention the thousands infected by hepatitis C. The federal government eventually stepped in and set up proper regulations, but by then the plasma industry had secured its reputation as blood pushers, and donors as the industry’s blood whores.

 

Coal miners were rough, dirty, wild, and ignorant. Or so the mythology says. Going down into the mines branded a person and gave permission to those on the surface to simultaneously pity and revile them. Underground five or six days a week, in a saloon or at a card table at night, coated in and coughing up black dust, miners did not live genteel lives. It’s easy to see how the stereotypes got their start. History books from the region overflow with photographs of miners, almost always sitting atop a mining cart, or posing by a piece of equipment, or squatting on their aluminum lunch pails, their faces stained, coal dust darkening the crows’ feet around their eyes and deepening the wrinkles in their foreheads. Theirs was a life of overalls and boots, of headlamps and thick denim, of grime and whistles and black phlegm. Almost universally, they look tired in the high-contrast of old monochrome photographs; and the way they lean elbows on knees, or lift hands to their hips, one gets the impression that these men were busy, that in the backs of their minds they knew there was coal to be loaded and the day wouldn’t be over until the carts were full. I imagine that a miner, stuck with a company tab to pay off and a family to feed, had little time for worrying about public image.

 

Stick is the verb of choice among phlebotomists, as in “I stuck 15 people today,” and “You can choose who sticks you,” and “Who stuck you? They did it all wrong.” The word choice always seemed so unfortunate to me—the one with the needle sticking out of my arm, the one stuck in the bed for an hour, the one feeling like a stuck cow attached to a milk pump. But I don’t think they meant any harm by it. I often told my phlebotomist I could never stick a needle into someone else’s arm. And maybe that’s why they talked about donors like we were pin-cushions; to dehumanize us, if just a little, to steel themselves against the reality of what they were extracting all day, and from whom.

 

By the late twentieth century, more than 3.4 billion tons of coal had been extracted from Ohio soil. At its peak, the coal industry employed 50,000 people in the state, but by the early 1990s, advances in technology had changed coal mining so much that fewer than 5,000 employees could keep the entire industry running. Today mines are safer, cleaner, and more efficient, but they are also emptier. Appalachian boys whose fathers grew up to be miners because their fathers had grown up to be miners have had to come up with new plans for the future.

 

Since the early 1990s, the plasma industry has worked hard to transform the donating process into the reassuringly sterile experience I endured in Ohio. There are now more than 300 certified plasma donation centers in the United States that collect roughly 15 million liters of plasma every year. The process is, for the most part, streamlined, safe, and secure. In fact, it feels as routine as, say, a trip through Jiffy Lube, with someone guiding you through every step of the process, minding the fluids and hoses while you sit and read a magazine. Plasma donation is a fundamental part of the global medical machine, and while it’s safer and more reliable than it has ever been, the donor pool is still made up primarily of the poor and underprivileged.

Here in Athens, that means the hard-knock locals like the small family I noticed one day as I was leaving the center. A couple was standing in front of the computer kiosk reserved for checking debit card balances and scheduling appointments. Their children had apparently been in the “supervised waiting room” watching movies while mom and dad donated, and now they were all preparing to leave. One child stood in front of mom and another sat on the floor chewing on a drawstring that hung from his father’s coat. The father held a third, smaller child in his arms, a little girl that kept trying to take off his hat. I wondered what the money would mean for them—the extra $120 a week.

I knew what it meant for me—a temporary buffer between my family and the end of my monthly teaching stipend, an excuse to get dessert at Applebee’s, an extra gift under the tree, and gas money for a trip to Cleveland. We needed the money, to be sure, but the poverty I felt was a somewhat artificial one. We had a little money in the bank, more student loan options than I knew what to do with, and I was working on a graduate degree. Donating was never an act of true desperation. I came here to Ohio for school, and school would be my ticket out. Those children huddling around their parents at the donation center, if they’re from Appalachia, will probably want to go to college, but, statistically speaking, they’re just as likely to drop out of high school as earn a bachelor’s degree. They are the grandchildren of miners and farmers and craftsmen, the children of Wal-Mart clerks and construction workers, and, while it’s not impossible for them to break out of the poverty they grew up in, the current system doesn’t offer them much hope.

 

In the spring, Melissa and I took our boys to see the old train depot in Murray City, a defunct mining town tucked back into the hills north of Athens. The drive took about twenty minutes on narrow winding roads that cut through green-leaf forests pocked by the occasional trailer or farm home. Murray City itself emerged from the woods first as a series of small houses, and then a new fire station beside a park, and finally as a few larger brick buildings, including a boarded-up high school, a convenience store, a bar, and an Elks lodge. Beyond that were clusters of small houses and, at the end of town, an old train depot recently converted into a small mining museum. Beside the depot sat a large red caboose that helped complete the picture of a little train stop in the middle of the woods. We parked in a gravel lot next to the depot and climbed out of the car. Across the parking lot was a long narrow greenway that I could tell had once been the train line.

The mines around Murray City were once among the highest yielding coal mines in the world, and that success meant great things for the growing town and its more than two thousand citizens. There were schools, churches, banks, retail stores, a newspaper called The Murray City News, a labor union, and four trains a day that steamed through the small depot. One dollar and twenty-five cents could get you to Columbus for the weekend, but why would you want to leave? Wake up on a Saturday morning and you could visit the doctor, take your kids to the park, and pick up some produce at Lunt’s Groceries, all before lunch. Then you could get your haircut at the barber’s shop on Locust street and still have time to see a show at the theater or watch the Murray City Tigers wallop a neighboring town on the grid iron. At night you could buy a friend a drink at one of twenty-three saloons, and on Sunday morning you could catch a sermon from five different pulpits. The coal brought the people and the people built the town and the town became the center of life for hundreds of miners and their families for nearly half a century.

Looking through the museum’s old photographs of parades and marching bands and city councilmen in sharp bowler hats, it was easy to imagine a happy life in Murray. And it was easy to see why some residents would resort to violence to defend that life. The first labor strikes occurred at the Murray mines in 1884. Locals wanted better pay and companies wanted more output, and that tension broiled up every few years for decades. Striking miners set fires, destroyed company property, and even fired shots at foreign scabs brought in to work the mines. But, amid all this, Murray managed to survive. Even after World War II, when strip mining was rapidly replacing underground operations, and Murray’s mines began to close, the city didn’t fold. Not completely. Even when the last picks and shovels were hauled away, a few people stayed put, deciding to commute to whatever job came next, rather than sell their land and look for something new.

Today, about 450 people live in Murray City. There is no bank, no newspaper, and no grocery store—and all but one of the churches has been shuttered. All the children in town are bused to schools in other cities, and those adults who are not elderly or retired must commute to Athens, or Nelsonville, or farther, for work. Other than the depot and the grassed-over rail bed, the only hint of the city’s mining past was inscribed on a plaque in a park built over an old mine entrance.

My boys poked around the museum for a few minutes, asking questions about old photographs and train tickets and a large bucket of coal in the corner, but they grew restless. We went outside and let them climb on the red caboose, snapping photos as they posed against the overcast sky. When we pulled up to the museum that morning, I wondered aloud to Melissa why anyone would live way out in such impossible quiet. But the quiet my boys sat in as I took their photo was not the quiet of a ghost town. The forests around us laid benevolent siege to the little village in the way only an Appalachian forest can, and I felt both secluded and nestled in a strange way. In that moment, the silent, wet world of the woods was enough of a reason for Murray to persist. Before we left, we climbed inside the caboose and sat on the cracked seats and looked out the window at the tracks below—tracks that had been restored just for this little memorial: two beams of oxidized steel coming in from nowhere to hold up the bright old caboose, and then quitting just beyond the car’s front coupler, a heavy steal question mark that seemed to punctuate the town’s only question: “Going so soon?”

 

One day at the plasma center, a young couple walked through the door as I tapped out my questionnaire on the computer. The man wore a pair of vintage Air Jordans and jean shorts with the words mi raza embroidered down one leg. Tattoos wrapped around both his forearms and around both calves, and he spoke loudly on his cell phone in a thick West Virginia drawl. The woman had blond, curly hair, and a strip of her midriff peaked out beneath the hem of her white tank top. They couldn’t have been older than twenty. I watched as the woman stood on the scale and then heard the attendant give her the bad news.

“Hundred and eight,” she said. “You have to weigh at least one-ten.”

The man rolled his eyes, and I heard him explain the situation to the person on the phone—he had been cleared for donation, but the woman would have to wait out front.

A few minutes later I was all plugged in, and the man on the phone sat a few beds over, still talking loudly.

“A house and a double wide,” I heard him say. “We only pay utilities.” He paused for a moment and then raised his voice: “That’s what I’m talking about,” he said. “Appalachian Ohio is the poorest place in the United States, man.” He raised his voice again, and continued: “’Cause there ain’t no jobs!” And he went on for several minutes about his struggle to find work, his hopes for starting a business, his affinity for good pot, and his frustration with the cops who wouldn’t leave him alone. “Its like no one’s free up here!” he yelled. But then his voice softened, and he said, “But it’s beautiful, dude. Come up here in the summertime. It’s beautiful.”

By then I’d been living in Ohio for more than a year, and men like this still surprised me: men for whom Appalachia was home in the deepest, most sentimental way possible, men whose families had lived in the region for generations—who knew what it took to put down roots, and also what it meant to pull them up. I have, more often than I care to admit, been guilty of the easy, patronizing conclusion that men like this are simply victims of circumstance, products of their region’s own troubled history, stuck as much by geography as genealogy. And sure, you might call what I heard in his voice anxiety, maybe even a little desperation, but when he said, “come up here in the summertime. It’s beautiful,” his voice hinted at something else—less fear of what a place might take from him, and more faith in what it might have to offer. It was a voice that trusted in the hidden promises of a sleepy Appalachian hollow, a voice he might have heard first from his father, or his father’s father, a voice that sounded that day like an invitation. And perhaps it was something like that voice that called us out to Ohio in the first place, that got me into that donor bed and selling myself a few hundred liters of plasma at a time, a voice from beyond history that calls men and women to settle strange lands and offer their own pound of flesh for a chance at life; a voice that says “come and stay a while—see what happens,” a voice that has echoed in those hills for a very long time.