On a muggy summer day last year, I drove up the winding roads of Coeburn Mountain (sometimes called Wise Mountain, depending on which of those towns you call home). The founder of Remote Area Medical, Stan Brock, known around here as the Appalachia messiah, was coming to town again. I wanted to see what it was like to wait in a RAM line, as my grandfather, my friends and my neighbors have.

It was foreboding. No one should feel like that, especially at a festive fairground, even when it morphs into a field hospital in the holler for the 17th time.

RAM now provides free medical clinics in Wise, the town of Bristol and in Lee, Buchanan and Smyth counties. Lee is hosting its second RAM clinic after losing its only hospital several years ago. An ambulance ride to the nearest emergency rooms in Wise County or Kingsport, Tenn., can take 45 minutes.

Central Appalachia has been my home for all of my 26 years. Over the weekend when Brock returns to Wise, a place where I’ve felt hope and hopelessness simultaneously, surviving is free. I grew up like many poor mountain kids. I had health insurance sporadically. That was bad news for a barefoot country kid who had a knack for finding broken glass or rusty nails. My mother, a nurse, patched those up. Unfortunately, she couldn’t patch up me up in my multiple bouts with Hodgkins lymphoma.

The shadow of poverty has followed me my entire life. My stepfather is a coal-miner. He’s among the the few “fortunate” miners spared by Alpha Natural Resources layoffs before it successfully petitioned a bankruptcy court for $11.9 million for 15 top executives. He’s in danger now of losing his health benefits as Alpha continues to sell and liquidate its mines and other assets. I sometimes take him to a nearby county to drop him off at a deep mine for a “hoot-owl” shift and pick him up the next morning. On the way home I notice the Health Wagon, our mobile free clinic that shuffles health care around the region, set up in a parking lot.

While I still consider myself lucky, I feared my 26th birthday even though I once I questioned if I’d ever see 16. Losing my parents’ insurance eclipsed the fear of cancer coming back.

And all hope evaporated when the Virginia General Assembly again defeated Medicaid expansion, a defeat helped by the votes of every member of the Southwest Virginia delegation. Losing hope isn’t hard when looking at the bleak future facing mountain millennials: inflamed anxiety, depression and exacerbated pining for something better that doesn’t include black lungs and broken backs.

Love of my people and the place I call home is buried deep in me, even deeper than that deep mine into which my stepfather crawls five or six nights a week.

For me, as with too many of the Appalachians I’ve met, hope is all but gone. Hope has faded from the faces of people who pride themselves on their work ethic. It’s missing from the rough hands caked in coal dust.  Their representatives happily exclaim, “Let them eat coal!”

I can’t accept that. I won’t accept that. And I’m not going anywhere.